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Death and the right to die

Do some nurses have a more sympathetic view of euthanasia due to the nature of their work? Like vets, has their attitude to death been altered?

Raj Persaud
BSc MSc MB BS MPhil FRCPsych
Consultant Psychiatrist  The Maudsley Hospital London
Gresham Professor for Public Understanding of Psychiatry

Recently a nurse was pictured on the front page of the national press accused of killing elderly patients. The question at the top of many minds is how can this kind of event occur within a caring profession? Whether the nurse will be found guilty or not, the psychological mechanisms involved in this kind of crime are argued to be surprisingly widespread within the profession. But why? Well oddly enough, it has been suggested that part of the answer could come from the high suicide rate among veterinary surgeons.
The suicide rate among vets is an astonishing conundrum because, for example, veterinary science is by far the most competitive course to obtain entry into at university level in the UK, as it is in many parts of the western world. It's far tougher to get into vet school than it is to get into medical school - although that was pretty tough in its day.
One would have thought that since it's so hypercompetitive, those who become vets should be jolly pleased with themselves - after all they have managed to succeed at something others would give their right arm for. And yet very high rates of suicide have recently been reported among veterinary surgeons in the UK, and the figures have raised alarm among the profession and lead to calls for urgent action.
One intriguing theory could be termed an "euthanasia" model, which is based on the idea that a large part of a vet's life is in fact spent putting animals to sleep. The theory is that this leads to a different attitude to death among vets and even a sense in which vets come to see death as a an available solution to problems.
Research has found that over 90% of vets would theoretically consider administering euthanasia to humans while only roughly one-third of doctors would agree to do so.
In order to understand and account for this intriguing "culture of death" theory, it's important to get a handle on a famous theory in social psychology called "cognitive dissonance" theory.
The idea behind "cognitive dissonance" is that we like to think of ourselves as rational, reasonable and consistent beings and therefore if we come to notice that our performance is at variance with consistency we will tend to modify our attitudes to bring consistency back into the frame. This drive for consistency is so powerful that it can have a massive effect, although often an unconscious one, on our attitudes and behaviour.
Cognitive dissonance argues that the longer we wait for something, the more likely we are to believe that the wait was worth it as a way of maintaining our view of ourselves as sensible people who wouldn't wait forever for something trivial. The converse also interestingly obtains, as a general rule, when something is too easily available and no wait is required we tend to mentally reduce its value (doctors and vets may want to consider deploying this finding in their waiting rooms).
Vets experience dissonance when they put animals down so frequently - they have to come to see the administration of death as a particularly powerful form of social good in order to keep their self-image as helpful and moral beings. They will tend to shift their attitudes towards death, seeing it as a positive outcome. This altered attitude to death is going to inevitably translate into lowered inhibitions over considering it as a solution to a problem. This will mean they will possess fewer inhibitions when it comes to considering it for a wide variety of predicaments and even ultimately for themselves.
The ease with which they reliably produce death will also alter their attitude to it as a valuable entity worth preserving.
Is it possible that, in a similar vein, some nurses, particularly those who work in end-of-life or palliative care, come to have lowered inhibitions over administering pain-relieving treatment in the form of euthanasia, and therefore come to harbour a completely contrasting attitude to death compared with the general population?
Our attitudes to death are not something we often discuss among ourselves or within the profession. Maybe this is something we should consider doing more often?

Your comments: (Terms and conditions apply)

"Definitely, having many patients die without dignity due to loss of muscle tone etc. I feel very strongly that there comes a point in everyone's life where death is a kinder alternative" - Name and address supplied

"We spend endless amounts of resources and time on prevention of many chronic diseases, but at the end of the day a lot of these poor patients end up looking at the TV in a rest/nursing home. If only the government put more into care of the elderly, then prevention would be a good thing. Let me put this into context: a 100 year old with a nappy pad on, fed from a beaker, turned 2 hourly. Is this living? Answer no. I think we need to take a look at what we are preventing. Short and happy rather than long and miserable is how I personally would rather live my life." - Nurse for 33 years