Most of the duties performed by nurses with respect to offering end-of-life care have certain ethical challenges. Compared to other health care professionals, nurses spend most of time with patients at the last moments of their lives. It raises two issues. The first is how prepared the nurses are in the provision of comprehensive care to such group of patients. Second concerns the ethical issues that result from the knowledge that nurses may not be very prepared to handle the ethical challenges related to end-of-life situations. The seriousness of such issues led to the formation of End of Life Nursing Education Consortium. It is a program aimed at training the various stakeholders in palliative care field. The issues that have been raised include palliative sedation, resuscitation, assisted suicide, research, autonomy and euthanasia among others. All the above-mentioned issues are related to decisions that nurses have to make. As a result, they have an effect on the time and the nature of death suffered by the end-of-life patients. Such vital concern makes ethical issues surrounding end-of-life care a source of ethical dilemma among nurses as they try to serve their patients and members of the affected families (Mani, 2012).
A number of approaches can be taken to help nurses solve the ethical dilemmas related to the end-of-life patients. One approach that has been fronted to nurses is the ‘principlist approach’, which seeks to solve the various dilemmas experienced by nurses in handling issues related to the end-of life patients through a number of principles. The principles include: respecting the autonomy of patients, upholding justice, beneficence and remaining non-malfeasance. Irrespective of the criticism that the approach is basically west-oriented in its methodology, it has enabled nurses to prepare to situations where they have to make decisions that raise ethical considerations (Gallagher, 2011).
Beneficience can enable the nurses to ensure that their actions or decisions are done for the good of their patients. In such perspective, they are able to ensure that the benefits received from the kind of treatment that they give during the end-of-life care outweigh the expected risks. The principle of non-maleficience can help the nurses take actions that will not cause any harm to the patient. In this case, it is important to ensure that the nurses do not tell lie to their patients. Respecting patients’ autonomy can also help nurses show respect to their patient’s self-determination’s rights. In such way, the patients are able to consider and choose the kind of treatment that they prefer. On the other hand, fair treatment can ensure that all the patients at such state of health are allowed equal access to the necessary health care resources. Such principle helps nurses not to discriminate anyone, while giving the resources needed to care for end-of-life patients (Gallagher, 2011).
A good example of where such principle can help is a case where an aged patient is diagnosed with a terminal disease like cancer. In such case, the health care providers may reach a conclusion of the necessity to perform an operation. If the patient requested to inform his/her family members of all the progresses in his/her treatment process, then a challenge may arise where the said family member sees that it is better for the patient to be left to die than to live. At this point, it may be difficult for the nurses to decide on whether to act in the best interest of their patient (by doing the will of the family members) or ensure that they honor their duty of preserving life.
Another dilemma related to end-of-life care is disclosure and communication. Nurses are expected to be honest, while explaining to their patients their health condition. It means that whenever a patient declines any information, his/her opinion should be respected. It has been a common phenomenon for nurses and doctors to agree with the patient’s family members to deny them their right to information. Consequently, it is against the Mental Capacity Act of the year 2005, which gives adults the right to mak decisions relating to the kind of care they want to receive. Such right must be respected unless there is a medical proof that the patients are not able to make decisions on their own. It has to be done even if it requires the help or support of the nurses to make their decisions and communicate to their relatives or doctors. The approach ensures that the patients’ autonomy is respected (Gallagher, 2011).
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The third issue revolves around resuscitation, which involves correction of physiological disorders that occur during the end-of-life care process, like the case of hospice. It is an ethical concern especially with regards to the time when the questions regarding resuscitation should be raised. Professionally, such discussions should involve the health care provides, family members of the patients and the patients themselves. It means that it should be done early when the patients are still able to understand their status, make and communicate their decisions. However, it is evident that most of the time nurses are tempted to wait until the patient is at the point of death to carry out such discussions. Where a patient is admitted in a hospital, the discussions should be performed during the first session held between the three parties and the outcome should be documented to ensure that the decision of the patient will be taken into consideration. It means that the nurses are normally find themselves in a situation where they have to choose whether to make decisions regarding resuscitation on the end-of-life patients or not without their consent. It may be difficult, especially in cases where there is a difference in opinion between the nurse and the family members (Mani, 2012)
Another very controversial ethical issue has been surrounding the decision on when to stop giving food and fluids to critically ill patients. The issue is associated with giving the patient life and comfort and is, therefore, affected by people’s values, as well as their beliefs. Though the issue does not raise any dilemma when the patients are still able to make and communicate their decisions with regards to eating, a time comes when the safety of the patient may demand that the nurses withhold food from them against the wish of their family members. At this point, the family will blame the nurse for any fatal outcome relating to her decision and the failure of the nurse to care for their patients. However, nurses must not be influenced by such criticisms. They should only strive to make the family members understand the reasons behind every decision they are taking.
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Another issue is that of research being carried out during end-of-life care with an aim of identifying how the dying patients can be cared for. However, there has been opposing arguments about current issue. People supporting research have maintained that it gives patients a voice and an opportunity of contributing to the improvement of care that will be given to the patients who will come after them. However, due to their value and beliefs, certain families may consider such issue as unnecessary burden for the already sick person. In such scenarios, nurses are encouraged to refer to the consent of their patients and be patient while expressing the patients’ will to his or her family members.
Finally, there is another ethical dilemma with regards to assisted suicide. It involves intentional efforts of a patient to die unnatural death. It can be caused by a nurses’ failure to give vital treatment to their patients. Assisted suicide is a case where a patient requests a nurse to assist him/her die. It results from the feeling of being a burden, depression or distress. In such situation, nurses should be able to listen to the fears of their patients. In this case, they should develop a multi-disciplinary approach to such situations, since it requires the practitioner not to make the decision single-handedly. It should be done in the same way when a nurse is faced with euthanasia (Boudreu, 2011).
In conclusion, the ethical dilemmas involved in the provision of end-of-life care are numerous. However, through knowing and following the nursing practice guidelines and statutes, nurses should be able to address them as they arise.