Ethical decision making on starting terminal care in different health-care units

Set in the context of a major research project on terminal care for cancer patients, this paper examines the process in which the ethical decision is taken to proceed to the stage of terminal care. The sample consisted of 191 nurses from three different health-care units in Finland: a health centre, a central hospital and a radiotherapy clinic. The data were collected in August and September 1989 by means of a postal questionnaire, and they were analysed by cross-tabulation and chi-squared tests. According to the nurses in all three units, there is often no definite and explicit decision to commence terminal care with elderly cancer patients. It was felt that patients and relatives have only very little say in the decision-making process. The nurses themselves would also have wanted to be more closely involved. Most of them said that the decision is usually taken by the doctor alone, especially in the central hospital. The nurses at the radiotherapy clinic said that almost all of their patients are informed of the decision to start terminal care. At the health centre and central hospital, only less than half of the patients are informed.