Nursing: End-of-Life Care as an Ethical Issue

Introduction

Nursing is one of the fundamental components of the medical profession. This arises from the fact that it contributes towards improvement in the patients’ wellbeing and that of their families. However, nurses are faced with numerous ethical dilemma cases that make the profession very challenging. Some of the ethical issues that nurses encounter daily are related to pro-choice versus pro-life, end-of-life care, quality of life, and quantity of life.

Quantity addresses the number of people who will be directly affected by the decision made by the nurse. Additionally, it also refers to the number of years that a person lives. On the other hand, quality refers to how well a patient lives. The two elements can be a source of an ethical dilemma for nurses. For example, nurses may be required to support patients when making decisions on treatment that might prolong their life but whose implications on the quality of life are dire.

In an effort to create an environment conducive for working, various nursing associations such as the American Nurses Association (ANA) have formulated comprehensive codes of ethics. The codes guide nurses in the course of executing their duties by ensuring that they adhere to the set principles. Additionally, governments have formulated various legal guidelines aimed at making the nursing profession more effective.

Despite the codes of ethics and the legal guidelines, nurses may feel challenged when dealing with some cases. One of the most challenging ethical dilemma cases relates to caring for dying patients. This paper discusses end-of-life care as one of the ethical issues encountered in the nursing profession. The paper outlines the various legal and ethical principles that have been formulated in an effort to provide quality end-of-life care.

End-of-life care as an ethical issue

According to Hebert, Moore & Rooney (2011), end-of-life care is composed of a number of aspects such as symptom and pain management. Moreover, Herbert, Moore, and Rooney (2011) assert that nurses providing end-of-life care are charged with the responsibility of “assisting patients and their families through the death and the dying process and ethical decision making” (p.325). This emanates from the fact that they spend a lot of time with the patients and their families which leads to the development of trusting relationships between the two parties (Adams, Bailey, Anderson & Docherty, 2011).

Nurses caring for patients in critical care settings such as Intensive Care Units (ICU) grapple with difficult ethical issues (Santiago & Abdool, 2011). For example, the nurse may be required to administer painful procedures and treatments whose outcome is futile. On the other hand, the nurse may view adhering to the laid down procedure in caring for the patient as an ethical duty that he or she should employ in an effort to cure the patient. The patient’s family may decide to prolong the life of their loved one. These conflicting perspectives affect nursing in their caregiving process.

The approach of end-of-life care by nurses while still upholding legal and professional ethics

According to Adams et al (2011), death is an inevitable phenomenon. However, caregivers should not hasten death but should ensure that patients die comfortably by treating any unpleasant symptom. There are a number of legal and ethical principles that have been formulated in an effort to assist nurses to deal with end-of-life situations. Some of these ethical and legal principles are discussed here-in.

Best interest

Nurses should ensure that all their actions are aimed at improving their patients’ wellbeing. However, some end-of-life situations may hinder the patient’s decision-making capability. In the UK, patients who do not have the mental capacity to make decisions are protected under the Mental Capacity Act (Adams et al 2011). In the course of executing their duties, nurses are under an obligation to adhere to the Act.

With regard to ethics, nurses facing such situations should be guided by the principle of beneficence. Herbert, Moore, and Rooney (2011) define beneficence as the practice of treating patients in the right manner. The principle of beneficence requires nurses to focus their actions on improving their patients’ wellbeing. Consequently, they should desist from taking actions that might harm the patient. In order to achieve this, nurses should weigh the costs and benefits associated with a particular treatment. Additionally, ethics require nurses to be well informed with regard to modern medical knowledge. If they cannot manage the situation faced, they should consult a qualified end-of-life care specialist.

Informed consent

Nurses need to ensure that they provide patients with adequate information regarding the treatment to be administered if it is possible. This will provide patients with an opportunity to make an informed decision. It is unethical for a nurse to administer a particular treatment to a patient without his or her consent. Administering treatment to patients without their consent is against the ethical principle of autonomy. Adams et al (2011), defines autonomy as the moral element of respecting the dignity and uniqueness of other individuals. Adams et al (2011), further assert that respect for other people is one of the primary aspects of ethics. Nurses are under an obligation to respect the decision made by the patient irrespective of their opinion.

In the course of executing their duties, nurses should value patients and acknowledge their dignity. As a result, they should not treat patients as instruments. The law recognizes that patients have certain legal rights that should be respected. For example, patients have the right to terminate, resist or accept treatment without any form of penalty or duress. Moreover, patients have a right to complete, accurate and comprehensible information regarding their treatment. a

Duty of care

Nurses should perform their duties in such a manner that they do not harm their patients through action or omission. Common law requires nurses to provide care to patients in a manner that is equivalent to the skills gained in the specialty. Nurses can be liable for negligence if they fail to execute their duties effectively leading to the patient being harmed. For example, a patient can sue the nurse if he or she fails to administer drugs on time. Therefore, nurses need to realize that they have a duty of care which they should execute diligently.

Justice

Adams et al (2011) assert that justice encompasses various aspects in health care provision. First, nurses are under an obligation to ensure that they provide effective health care services. Consequently, they should not over-treat or under-treat patients but should administer care equally. In end-of-life situations, nurses should do their best in order to maintain the patient’s quality of life. The element of justice also requires nurses to consider the legitimate needs of the patient’s family so as to safeguard them from being over-burdened by the situation. Additionally, nurses should ensure that scarce resources necessary to provide care are accessed equitably.

Conclusion

From the above analysis, it is evident that nurses face numerous ethical challenges in the course of executing their duties. Some of the ethical issues faced are related to pro-choice versus pro-life, end-of-life care, quality of life, and quantity of life. In an effort to create an environment conducive to working and to improve the quality of care given to patients, a number of ethical codes have been formulated. Moreover, the legal environment also supports the nursing profession in an effort to ensure that the ethical issues faced are adequately addressed. This is evidenced by the various ethical and legal principles that nurses should follow.

When dealing with end-of-life situations, nurses are required to act in the best interest of their patients. Consequently, they should make decisions that contribute towards improvement in the wellbeing of their patients. To achieve this, nurses should adhere to the concept of beneficence. Moreover, nurses should provide patients with adequate information to enable them to make informed decisions. Under common law, patients have a right to information.

Nurses are charged with the responsibility of providing adequate care to their patients. As a result, they are liable for any harm that the patient may suffer as a result of omission or action. The paper also cites justice as the other legal and ethical principle that nurses should adhere to. In summary, nurses should adhere to the aforementioned ethical and legal issues when executing their duties.

Reference List

Adams, J., Bailey, D., Anderson, R., & Docherty, S. (2011). Nursing roles and strategies in end of life decision making in acute care: a systematic review of literature. Nursing Research and Practice, 2011 (2), 1-15.

Herbert, K., Moore, H., & Rooney, J. (2011). The nurse advocate in end of life care. Ochsner Journal, 11(4), 325-329.

Santiago, C., & Abdool, S. (2011). Conversations about challenging end of life cases; ethics debriefing in the medical surgical intensive care unit. National Institute of Health, 22 (4), 26-49.

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