Patient Ethical Dilemmas

The reality of a patient’s upcoming death is typically very difficult for both the patient and their family. Discussions regarding choices about the most appropriate health care at the end of a person’s life often address whether specific treatments are ultimately likely to benefit the patient. During these discussions, it is important to note quality of life for the patient. Often, nurses fill the role of providing guidance for patients and families confronting difficult decisions and adapting to painful realities. It is not uncommon for a patient’s death to follow the withdrawal of potentially life-prolonging therapies (i.e., ventilator support, dialysis, vasopressors or inotropes, chemotherapy, antibiotics, etc.). There is no ethical, moral,

Though these options may be difficult information for the family to absorb, nurses are obligated to provide care that includes the promotion of comfort, relief of pain and other symptoms, and support for patients, families, and others close to the patient. While nurses should make every effort to provide aggressive symptom management at the end of life, it is “never ethically permissible for a nurse to act by omission or commission, including, but not limited to, medication administration, with the intention of ending a patient’s life.” [2] Decision-making for the end of a patient’s life normally should occur over years rather than just in the minutes or days before a patient’s death. Nurses can be a resource and support for patients and families at the end of a patient’s life and in the decision-making process that precedes it. Nurses are often ideally positioned to contribute to conversations about end-of-life care and decisions, including maintaining a focus on patients’ preferences, and to establish mechanisms to respect the patient’s

Nurses assist patients as necessary with these decisions. Nurses should promote advance care planning conversations and must be knowledgeable about the benefits and limits of various advance directive documents. The nurse should provide interventions to relieve pain and other symptoms in the dying process consistent with palliative care standards and may not act with the sole intent of ending a patient’s life (p.