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One of the core ethical dilemmas that could arise when caring for patients at the end of life is whether or not to withdraw treatment that prolongs life but does not lead to full recovery (Campbell, 2017; Lo, 2013). The ethical principles applicable in this case are beneficence, nonmaleficence, and autonomy. On the one hand, it is unclear if continuing treatment would comply with laws of beneficence and nonmaleficence, particularly if the patient’s quality of life and mental health suffers as a result. On the other hand, supporting patient autonomy is challenging when a patient wants to die sooner to end their suffering. Physician-assisted suicide is legal in some states or countries, but it may still be challenging for care providers to agree and support patients’ autonomous decision to die (O’Gara, 2015). In addition, it is often unclear whether the patient’s wish to die is truly independent and autonomous. Patients might experience intense emotions, pressure from family members, or pain, which affect their judgment.
When faced with an ethical dilemma, it is crucial for nurses to assess the situation and take appropriate action. In some cases, nurses might find that ethical decision contradicts their personal values and beliefs (Higginbotham, 2002). The U.S. legislation enables nurses to use conscience protections and rights to refuse to perform procedures that are in opposition to their religious or moral beliefs (U.S. Department of Health and Human Services, 2018). However, if a nurse continues to provide care, they should ensure that the care fits in with the principles of bioethics. In the example identified above, the role of the ethical nurse would be to provide information to the patient about various treatment options and their possible effect in terms of life prolongation. Then, the nurse should allow the patient to make an independent decision about whether or not to continue treatment at all. They should assess and minimize any possible influences and offer to postpone a decision if the patient is in distress. Once the patient has made a decision, the nurse should communicate it to other care providers and follow the selected plan of care. The described role of the ethical nurse would allow supporting the moral principle of patient autonomy, which is crucial at the end of life care decisions.
References
Campbell, A. V. (2013). Bioethics: The basics. Abingdon, UK: Routledge.
Higginbotham, E. (2002). When your beliefs run counter to care. RN, 65(11), 69-72.
Lo, B. (2013). Resolving ethical dilemmas: A guide for clinicians (5th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
O’Gara, E. (2015). Physically healthy 24-year-old granted right to die in Belgium.Newsweek. Web.
U.S. Department of Health and Human Services. (2018). Conscience protections for health care providers.Web.
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