Ethical Considerations in End-of-Life Discussions

Abstract

Every person deserves a dignified death. What this entails varies dramatically from patient to patient. Most people, however, never discuss their wishes regarding the care they desire for this very personal, final journey. As technology improves, as well as the ability to successfully treat almost any condition, both patients and clinicians alike have begun to ignore the reality of death. In this paper, the term clinicians will refer to doctors and nurses. In our present culture discussing death has become taboo. Patients may think about the end of their lives but are unsure or uncomfortable broaching the topic with their medical staff and families. Additionally, many clinicians are uneasy with end-of-life (EOL) discussions and, consequently, avoid them entirely. It is, however, the ethical responsibility of health care providers to address their patient’s wishes regarding EOL care. Clinicians need to take the initiative to begin the conversation regarding prognosis and care choices. They need to make the patients feel that they can comfortably discuss this delicate issue without fear of judgment, pressure, or the possibility of abandonment. Ethical dilemmas are common when caring for a dying patient, often a direct result of avoiding or delaying difficult, EOL conversations [1]. By not adequately preparing patients for the dying process, clinicians are in danger of ignoring the ethical principles of autonomy, justice, beneficence and non-maleficence. Nurses and physicians alike share this responsibility, although nurses have historically shied away from this obligation. The American Nurses Association (ANA), the premier nursing organization representing registered nurses throughout the U.S., leaves no doubt that it is nurses’ ethical duty to assure that patients have a dignified death - one that respects their spiritual, emotional, and physical needs, as well as those of their families. This duty is spelled out in the Nursing Code of Ethics. Nurses are called on to identify barriers that prevent early EOL discussions with patients so that they may work to eliminate them and ultimately improve the patient’s ethical rights to a good death. Nurses should challenge themselves to break through these barriers to ensure that patients are able to die in a manner consistent with their beliefs and values.