ETHICAL ISSUES IN END

OF LIFE CARE: THE

ROLE OF NURSES
 ABSTRACT

One of the primary objectives of end-of-life care is to tend to the needs of

dying patients and alleviate their suffering as much as possible, all while
upholding their individual desires. Nevertheless, nurses encounter numerous
ethical dilemmas in this realm. To provide optimal care for terminally ill
patients, it is essential that nurses possess a deep understanding of ethical
concerns associated with end-of-life care (Melahat et al., 2021).Although the
aim of Nurses in end of life care is to ensure patients peaceful death. Many
nurses experience Various ethical conflicts during end of life care . This Study
aims to identify the Various ethical end of life care issues in which Nurses can
face and ways to manage them.( Lim & Kim 2021)
 TABLE OF CONTENT
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Overview of ethical issues in end of life care : The Role of nurses
3.2 Ethical issues faced by Nurses in end of life care
3.3 Impact of ethical decision making on patient outcome
3.4 Role of Nurses in end of life care
3.5 Communication Strategies employed by Nurses to address ethical issues
3.6 Strategies for managing ethical issues in end of life care
4.0 Implications to Nursing
5.0 Recommendations
6.0 Conclusion
Reference
 INTRODUCTION

Nurses encounter daily ethical issues, especially in end-of-life care,

leading to dilemmas like communication breakdowns and compromised
patient autonomy. Ethical problems include rationing resources, limiting
patient freedom, and deciding who receives care when resources are scarce
(Chris 2016; Sperling, 2020).
Nurses also face the ethical dilemma of balancing care for patients and
themselves and their families (Binkley & Kemp, 2020).
 INTRODUCTION CONT’D
The main goals of care for terminally ill patients include alleviating
suffering, optimizing quality of life until death, and providing comfort in
death. However, achieving these goals can be challenging due to the need for
decisions on treatment options like prolonging life with medical technologies
or allowing natural death. This leads to ethical dilemmas in end-of-life care for
physicians, patients, and their families (Melahat et al 2021).
 OBJECTIVES
1.To identify the ethical Issues faced by Nurses in end of life care
2.To explore the impact of ethical decision making on patient outcomes
3. To identify the Role of Nurses in end of life care
4. To Assess the communication Strategies employed by nurses in
addressing ethical issues
5. To identify Strategies for managing Ethical issues in end of life care
OVERVIEW OF ETHICAL DILEMAS IN
NURSING
An ethical dilemma involves choosing between morally acceptable
options or equally unacceptable actions, where selecting one prevents
choosing the other (Omg et al., 2012).
An ethical dilemma occurs when available choices in a situation do not
lead to an ethical outcome. This is different from ignorance of ethics or
discomfort in making tough decisions. Ethical dilemmas are inevitable
when working with individuals with varying moral foundations or
obligations.( Stan & Brent 2018)
Ethics are vital for Nursing integrity and patients care. Nurse Managers
face daily ethical challenges in this fast paced profession ( Avant
Healthcare 2021).
ETHICAL PRINCIPLES IN NURSING CODE OF ETHICS

According to American Nurses Association 2023 there 4 major Nursing code of

ethics that could guide Nurses when ethical dilemmas Arises
Four Ethical Principles in Nursing
1.Autonomy : It involves providing patients with information to make decisions
based on their beliefs and values, even if they differ from the nurse's preferences.{
ANA 2023}
2.Beneficence: It focuses on prioritizing the patient's best interests over personal
viewpoints. Nurses provide comfort to terminally ill patients and assist with tasks
they cannot do independently to promote good{ ANA 2023}.
3.Justice : It requires impartiality regarding a patient's age, ethnicity, financial
status, religion, or sexual orientation. Fairness is maintained when assigning
clinical duties or prioritizing patient care to ensure equitable allocation of
advantages { ANA 2023}.
4.Non maleficence: It involves avoiding harm by providing safe and high-quality
care {ANA 2023}.
EHICAL ISSUES FACED BY NURSES IN
END OF LIFE CARE
1. Protecting patient privacy and confidentiality: Patient confidentiality and
privacy present significant ethical dilemmas in nursing in end of life care.
Mishandling of patient information can lead to severe legal consequence
{Avant healthcare 2021}.
2. Honesty versus withholding information: Patients have the right to know about
their medical conditions, even if family members wants to withhold
information ANA promotes truth telling in nursing patient relationships.
3. Science versus spirituality: Healthcare needs may clash with religious beliefs
as some religious beliefs medical intervention.
4. Healthcare needs versus resource allocation: Nurse managers face challenges
balancing healthcare needs with limited resources risking patient’s care
5. Autonomy versus beneficence: Patient autonomy to refuse medical treatment
may conflict with Nurses duty to administer care
IMPACT OF ETHICAL DECISION MAKING
ON PATIENT OUTCOME
1.Ethical healthcare decisions improve patient satisfaction.
2.Priotizing ethics enhances treatment adherence and outcomes.
3.Ethical choices build trust and improve communication.
4.Ethics contribute to patient well-being by respecting autonomy and
dignity
5.Ethical decisions positivity impact treatment impact treatment outcomes
and patient well-being
ROLES OF NURSING IN END OF LIFE
CARE
1.Nurses must offer thorough and empathetic end-of-life care, which
involves identifying the proximity of death and communicating this to
relevant parties such as families or healthcare representatives (ANA 2024).
2.End-of-life care is administered by nurses to ease the suffering of
individuals during the dying process and ensure a positive death
experience for patients (Nacak & Erden, 2022).
3.Nurses collaborate with families and healthcare teams to determine and
confirm the most effective treatment and care according to Nacak & Erden
(2022).
4.The Nurse advocates for comfort-oriented care over treatment-oriented
care for patients (Nacak & Erden, 2022).
5.Nurses facilitate collaboration between healthcare professionals and
stakeholders in end-of-life care decisions, sharing patient and family
information to prioritize comfort (Nacak & Erden, 2022).
COMMUNICATION SRATEGIES EMPLOYED BY NURSES
TO ADRESS ETHICAL ISSUES IN END OF LIFE CARE

1.Build rapport with patients to understand their situation (Nessa et

al..,2016).
2.Asking questions helps Nurses address patient concerns and ensures
understanding ( Nessa et al..,2016).
3.Focus on communication skills to support patients transitioning to end of
life care (Nessa et al..,2016).
4. Respond empathically to patient emotions using supportive skills (Nessa
et al..,2016).
5.Conclude conservations by acknowledging overwhelming information
and reassuring continuation.(Nessa et al..,2016)
STRATEGIES FOR ENHANCING EFFECTIVE IN
END OF LIFE CARE
1. Nurses should discuss patients end of life care preferences as these can
vary between individuals (Amar 2016).
2. Collaborate with healthcare professionals to address patients physical
and emotional symptoms in end of life care (susan et al..,2012).
3. Have a backup protocols for situations where patients may be
experiencing harm (Susan et al..,2012).
4. Communicate with patients family members to make decisions in the
best interest of patients care (Susan et al..,2012).
IMPLICATIONS TO NURSING

1. Decision making: Nurses help patients and families make informed

decisions.
2. Advocacy: Nurses advocate for patients rights and comfort.
3. Communication: Nurses need communicate effectively with patients and
families
4. Emotional support: Nurses provide support to patients and families.
5. Ethical dilemmas: Nurses face ethical dilemmas and must uphold
professional standards.
RECCOMENDATION
1.Truth telling and honesty: Being honest with patient and families about
treatment prognosis is crucial for ethical care.
2. Decision making capacity: Assessing patients ability to make decisions
and determining decision makers raises ethical concerns bout autonomy.
3. Resource allocation: Ethically challenging to balance individual needs
and limited healthcare resources in end of life care.
4. Cultural and religious consideration: Crucial to respect diverse beliefs
when making end of life decisions for culturally sensitive care.
5. Family involvement and conflict resolution: Ethical dilemmas arise in
balancing patient wishes, family involvement and resolving conflicts
CONCLUSION

Nurses are essential in end of life care providing holistic support to

patients and families. They advocate for patients for patients wishes ensure
high quality care and help with communication and ethical decisions.
Their care and guidance greatly impact end of life experience
 REFERENCES
 Advent health university 2017 The Importance of Ethics in
Nursinghttps://www.ahu.edu/blog/ethics- nursing#:~:text=The%20code%20of%20ethics
%20can,and%20examining%20their%20own%20 biases
 American Nurses association 2023 Why ethics in Nursing Matters
https://www.nursingworld.org/content-hub/resources/workplace/why-ethics-in-nursing-
matters/
 American Nurses Association 2024 Nurses Roles and Responsibilities in Providing and
Support at the End of life
https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-
statements/id/nurses-roles-and-responsibilities-in-providing-care-and-support-at-the-end-of-
life/#:~:text=Nurses%20are
 Bradley university 2020 What ethical issues can arise in end of life care
https://onlinedegrees.bradley.edu/blog/what-ethical-issues-can-arise-with-end-of-life-care/#
 Crane MK, Witting M, Doucs DJ. Respecting end-of-life treatment preferences. Am Fam
Physician 2019; 72: 1263–1268.
 Cavalieri, TA. "Ethical issues at the end of life" Journal of Osteopathic Medicine, vol. 101,
no. 10, 2021, pp. 616-624. https://doi.org/10.7556/jaoa.2001.101.10.616
 Chris Prische 2016l Ethical dilemmas at the end of life care
 Efstathiou N, Walker W. Intensive care nurses' experiences of providing end-of-life care after
treatment withdrawal: a qualitative study. J ClinNurs. 2014;23(21-22):3188-3196.
REFERENCES CONT’D
 Engel M, Kars MC, Teunissen SCCM, van der Heide A. Effective communication in palliative care
from the perspectives of patients and relatives: A systematic review. Palliative and Supportive Care.
2023;21(5):890-913. doi:10.1017/S1478951523001165
 Lim, A., Kim, S. Nurses’ ethical decision-making during end of life care in South Korea: a cross-
sectional descriptive survey. BMC Med Ethics 22, 94 (2021). https://doi.org/10.1186/s12910-021-
00665-9
 Maureen Nokuthula Sibiya 2018 Effective communication in Nursing Doi: 10.5772/intechopen74995
 Melahat Akedeniz Biilent Yardimci and Ethem Kkavukcu 2021 Ethical consideration at the end of life
care doi : 10.1177/20503121211000918
 Nacak UA, Erden Y. 2022 End-of-Life Care and Nurse's Roles. Eurasian . doi:
10.5152/eurasianjmed.2022.22324. PMID: 36655458
 Nessa Coyle Ruth Manna, Megan Johnson Shen, Smita C. Banerjee, , Stacey Penn, Cassandra
Pehrson, , Carol A. Krueger Erin K. Maloney Talia Zaider and Carma L. Bylund 2016,Discussing
Death, Dying, and End-of-Life Goals of Care: A Communication Skills Training Module for Oncology
Nurses 10.1188/15.CJON.697-702
 Sameera Karnik and Amar Kanekar2 2016 Ethical Issues Surrounding End-of-Life Care: A Narrative
Review doi: 10.3390/healthcare4020024
 Susan E. Hickman, Juliana C. Cartwright, Christine A. Nelson, and Kathleen Knafl, 2011
Compassion and Vigilance: Investigators’ Strategies To Manage Ethical Concerns in Palliative and
End-of-Life Research DOI:10.1089jpm.2011.0515
THANK YOU