1. Hader, Richard RN, CNA, CHE, CPHQ, PhD, Editor-in-Chief

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Nurses ask thousands of patients admitted to hospitals each day, "Do you have an advanced directive?" The highly publicized and controversial case of Terri Schiavo illustrates this inquiry's importance. The unprecedented involvement of the executive, legislative, and judicial branches of government-in addition to religious and special interest groups-will enduringly impact the manner in which nurses and other healthcare providers deliver care to patients who can no longer make decisions for themselves. The Schiavo case brought a typically private and difficult treatment care decision into the media limelight, and consequently, into the homes of millions. This ethical dilemma sparked heated emotions deeply rooted in political and religious beliefs, which were further ignited by contrary medical prognosis.

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As nurse leaders, we must take center stage in educating the public about the importance of advanced directives and end-of-life care options, while simultaneously presenting evidence-based facts wrapped in a shroud of care and compassion to family members making these difficult decisions. We need to provide effective forums to educate nurses regarding ethical issues. Critically examining actual or theoretical cases will better prepare nurses to participate and coordinate care in complex clinical situations. Facilitating a discussion regarding the Schiavo case would be an excellent way to engage staff members about how they and the institution would respond, given a similar situation. Make available to staff members published reports, editorials, opposing arguments, and institutional policies and procedures, as effective resources will assist them in debating this ethical dilemma.


Staff nurses should become actively involved in hospital-based bioethics committees, to share their views and learn from others' experiences. Unit-based staff meetings or shift "huddles" are an excellent opportunity for nurse leaders to facilitate dialogue regarding ethically challenging issues. Clergy, a medical ethicist, legal counsel, and other clinical disciplines should be available for staff nurses to consult when ethical issues complicate care delivery.


The unpredictable event that sparked Ms. Schiavo's health outcome is a solemn reminder that a life-threatening episode could occur at any time. Regardless of an adult's age or current health status, nurses also need to document and facilitate advance directive discussions, even when it appears unnecessary. Maintain a cache of educational materials for staff to present to patients and their family members to guide the discussion and significance of considering treatment options.


Nurses who are knowledgeable and skilled regarding end-of-life treatment options should lead aggressive campaigns to educate the public on the importance of completing an advanced directive. Nursing is considered one of the most trusted and respected professions. We're highly educated in medical knowledge, yet oriented to offer intimate and personal care. Given these abilities, we're in the unique position to lend guidance and support to patients and their families.


We must act as role models by ensuring that we, too, have documented our desires regarding care options. Consider facilitating a local drive in your home institution to ensure that nurses have completed their own advanced directives. A lesson learned from the Schiavo experience is that we should be prepared to ensure that our own wishes are carried out.