What Ethical Issues Can Arise with End-of-life Care?

As a nurse, you are constantly put in different situations and will face challenges that will evoke an emotional response and remind you how critical your role is in this complex, ever-changing industry. Specifically, hospice nurses who provide end-of-life care are responsible for helping patients transition to the last stage of existence, all while acting as a resource for patients, caregivers and other family members during this difficult time. While end-of-life decisions are made in all age groups, the number of adults aged 65 and older is projected to double by 2060. This makes it important for nurses to prepare for end-of-life care needs as necessary and understand potential issues that develop.

There is no doubt that you'll face ethical dilemmas during your journey as a nurse; death, and the way it sometime progresses, may be questioned from an ethical perspective. Understanding how to navigate such situations when issues arise is a critical component to end-of-life care.

In this article, we'll discuss the importance of understanding the ethics of end-of-life care. We'll also talk about how the online Doctor of Nursing Practice program can teach you about ethics and help you feel prepared in end-of-life situations with patients and their families.

The importance of understanding ethical issues

Nurses helping patients during the last days or hours of their lives may well face an ethically difficult situation. Physicians and nurses alike have a responsibility to provide patients with detailed information about treatment and the potential outcomes. Medical professionals can work based on deontological theory, as described in "Ethical Issues Surrounding End-of-Life Care: A Narrative Review," which highlights the relationship between duty and morality of the actions taken by human beings.

As a nurse, you have various resources at your disposal in the event that you are unsure how to handle an issue. Performing an ethics consultation, taking advice from hospice team members and other medical experts, and using educational materials can help you navigate an ethical dilemma. Many institutions also have an ethics committee that can help you address such situations. Understanding the most common problems you are likely to encounter can also assist during the decision-making process.

Common end-of-life ethical problems

Offering top-quality care while keeping patients' wants and needs in mind should always be a nurse’s top priority. This can sometimes seem blurred, however, if you're dealing with an ethical problem, especially at the end of someone's life. Here are some of the most common issues you may face during end-of-life care:

1. Broken communication

Whether a patient can no longer speak for him or herself or family members have a hard time describing what their loved one wants, nurses may face the breakdown of communication during the decision-making process. End-of-life conversations are always difficult, but they need to happen. Asking patients early about their wishes and providing them with accurate information and resources ensures a clear line of communication. Gaining perspective from a registered nurse allows prospective nurses to understand the value of strong communication. Jeanne Erickson, Ph.D., RN, told the Oncology Nursing Society that nurses should advocate for regular family meetings so everyone can understand the patient's condition and the best steps to take as the disease progresses.

2. Compromised patient autonomy

The Patient Self-Determination Act (PSDA) aims to increase the ability of health care providers and patients to communicate. It gives patients the right to voice their choices for end-of-life treatment, but this stage of life may come with limitations. As a nurse, it's vital for you to respect patient autonomy while keeping in mind the best treatment route without compromising the patient's decision. Nurses should encourage patients and their significant others to discuss end-of-life care and to use advance directives so patients’ wishes can be maintained if patients lose their ability to make decisions about their care.

3. Poor symptom management

Symptom treatment is a major factor in nurses caring for patients at the end of their lives, as it brings up the question of whether the benefits of using medication outweigh potential risk and side effects."The relief of symptoms must be balanced with the possible side effects of medications," Erickson told the ONS. "Fortunately, we now have so many good treatments for symptoms. The key is knowing that there is always a need for balance and to keep focused on what is in the best interest of the patient's quality of life."

4. Shared decision-making

Known as one of the most important factors of end-of-life care, decision-making becomes an ethical issue when more than one party is involved. When significant others attempt to go against the patient's wishes, nurses face the issue of trusting the intent of the significant others or respecting the patient’s wishes. Advance directives, such as a living will, medical power of attorney, Physician Orders for Life-Sustaining Treatment and DNR orders should be considered in advance to present during the decision-making process.

Significant others and patients should prepare for situations that may have seemed otherwise out of their control. This makes shared decisions easier if a patient becomes unresponsive about making an important decision on his or her own.

"An important role of the nurse is to help patients complete advance care plans to guide their end of life care by listening and offering necessary information," said Erickson.

How Bradley University can prepare you for end-of-life care

Earning your Doctor of Nursing Practice degree can help you understand how to better collaborate with members of your health care plan for end of life care with your patients and their significant others.

One course in particular where ethical decision making is addressed in the online DNP program is NUR 730 Ethics in Advanced Practice Nursing. Here, you will analyze ethical dilemmas that may come up from the beginning of your career in advanced professional practice and administrative roles. You will learn how to navigate the intersection of such issues with patient values, as well as the legal obligations involved. You will explore the history and literature of ethical dilemmas in comparison to how they are now addressed. Experience in NUR 730 will provide you with the opportunity to explore ways to participate in ethical decision making.

Are you ready to expand your knowledge of how to cope with the ethical dilemmas that arise in end-of-life care? For more information, check out the online Doctor of Nursing Practice program today, or contact one of our admissions staff members.

Recommended Readings

The Aging Population: End-of-Life Planning and Advanced Directives

Acute vs. Chronic: FNP Caring Strategies for Both Illness Types

Bradley University Online DNP Program

Sources

ONS - Ethical Dilemmas at The End of Life

NCBI - Ethical and Legal Issues in End-of-life Care

Nursingcenter.com - Ethical Issues Experienced by Hospice and Palliative Nurses

Cancer.org - Types of Advance Directives