Ethical

Responsibilities
Maximize values the patient
treasures
Extend supportive care to
significant others
Relieve the cascade of
symptoms and suffering
Support the patients right of
self-determination

Interventions with the

Dying
Communicate honestly and openly
about patients situation and
prognosis
Provide maximal symptom relief
compatible with values
Encourage but do not force decisionmaking
Be there!
Provide support to significant
others

Stages of Dying
Anger
Denial
Bargaining
Depression
Acceptance
Kubler-Ross (1971)

Goals
Symptoms will be managed
Patient and family will progress
through the stages as time and
readiness allow
Patient and family will decide on level
and type of treatment within medical
realities
Patient will review and evaluate life
Unfinished business will be completed
Patient and significant others will say
goodbye

Advance Directives
Living Will
Instructional Directive
Durable Power of Attorney for
Health Care

Nurses Role in
Advance Directives
Advance Directives Exist

Respect the decisions made

Communicate the provisions
Get appropriate orders

No Advance Directives

Communicate possibilities
Encourage decision-making
Facilitate discussion with
physician/family