![]() The nurse needs to administer the pain medication but fears that giving it may hasten (or accelerate) death. The patient is very close to death with irregular respirations around 8 breaths per minute. A patient whose death is imminent is in pain and requires pain medication to maintain comfort. An example of this is the all too common clinical situation that occurs in end-of-life care. If the act is for a greater good for the patient and is not meant to deliberately harm them, it is justifiable. Sometimes harm may be caused to a patient in order to prevent them from further harm. Although some of the interventions that patients receive might cause pain or some harm, nonmaleficence refers to the moral justification behind why the harm is caused. Nonmaleficence is the principle of refraining from causing unnecessary harm. While the nurse has grown fond of this patient and would not want him to die, they must respect the patient’s wishes and choices for his own medical care. This patient has decided to stop his cancer treatments and focus on spending time enjoying his family for the time he has left. For example, a nurse has been caring for an elderly gentleman for several months as he has been receiving treatment for cancer. While a nurse might not agree with a patient’s decision, they must support it. As nurses, we must support and advocate for our patients’ rights, including their right to make decisions. Sometimes it can be difficult to see a patient make a decision about their health that the nurse does not personally agree with or that the nurse does not feel is the best decision for that patient’s individual circumstances. This principle is described as an agreement to respect another’s right to self-determine a course of action and to support another’s independent decision making (ANA, 2015). The goal of this chapter is to provide a basic understanding about ethical principles and to explore issues surrounding the issues that can arise during end of life decisions in patients who are nearing the end of life. After several evaluations, the child was determined to be medically brain dead, and therefore continuation of medical treatments was considered to be futile. In this case, the family wanted to continue to keep their young daughter on life support which conflicted with what the health care facility wanted. This was evident in the recent national news story about 13-year old Jahi McMath (Fox News, 2013). ![]() Other times, the insurance or health care system has specific criteria that may come in conflict with the goals and values of the patient or family. Sometimes, there can be conflicts between what the clinicians believe to be best for the patient and what the patient and family want to have done. In the clinical setting, it is not uncommon to witness conflicts between the patient’s wishes and those of their family. Some of these are related to what kinds of medical treatments they would want to have if they were no longer able to make their own decisions. Often as patients near the end of life, many difficult decisions will have to be made. These are the goals the patient wishes for in terms of their illness. These goals are based on the patient’s moral principles and values. By having an understanding about some of the issues that can arise during end of life decisions, the nursing student or novice nurse can be better prepared for what to expect and how best to handle ethical issues.Īs discussed in Chapter 5, patients’ goals of care are what patients place highest value on and would hope to achieve in regard to their illness. As nurses, sometimes our morals and values are in conflict with those that our patients have, and this can cause some distress for the nurse. There are often ethical issues that can arise in the context of end-of-life care, particularly when patients and families make decisions regarding the care they will accept or not accept. \( \newcommand\)Įthics is a branch of philosophy that is focused on understanding the moral principles of people and how they make decisions based on what is considered morally right or wrong (Merriam-Webster, 2014).
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