I recently started a new job doing home hospice and found this topic very interesting. First, I have done a lot of reading and there seems to a consensus that physicians are not educated properly or fully on end of life care. Another problem that I have heard my new colleagues mention is the problem of referring patients to a hospice service when they are actively dying. Although my agency is primarily a home hospice agency, we do provide care for hospital inpatients at times. Several of the intake nurses have mentioned the problem of admitting a patient to hospice only to have them die 6, 8, 12 or even 24 hours later. Our hospice team is interdisciplinary in nature and when we get patients that die shortly after being admitted to the service, it hampers the team's ability to provide effective care and support for the patient and the family.
So my feeling is that there needs to be more education on the concept of hospice and what a hospice agency can do for a patient in their last months of life. I would venture to say that most nurses DO NOT want to see any patient they are caring for die in pain or be uncomfortable in any way during the last hours of life. The reasons for pursuing aggressive care inappropriately are many---physician arrogance, unwillingness to admit they can't help a patient, denial on the part of the patient and/or family...the list goes on and on. With all the technology available in this day and age, it is very hard for the healthcare team (doctors, RN's, etc) to acknowledge that in some cases, a patient's disease cannot be cured.
I think Jill hit the nail on the head with her comment about doing no harm. Patients deserve to die peacefully, without pain or other discomfort. I have learned a tremendous amount about palliative care in a short time and look forward to learning more about this very important specialty of nursing.