Name
Chamberlain University
NR-581: Foundational Concepts for Advanced Nursing Practice
Prof. Name
Date
Ethical dilemmas in healthcare often emerge from complex scenarios involving conflicting values, insufficient information, or the need to comply with both legal and ethical standards. One of the most challenging areas where these dilemmas occur is end-of-life care. This discussion highlights an ethical dilemma experienced during hospice care, examining the roles and responsibilities of advanced practice nurses (APNs) and proposing strategies to improve patient-centered decision-making. The focus is on balancing respect for patient autonomy with professional and family expectations, ensuring that care remains compassionate, ethical, and legally sound.
Advanced practice nurses play a critical role in patient advocacy by ensuring holistic, patient-centered care. They provide support that considers not only physical health but also emotional, cultural, and spiritual needs. Advocacy in this context means protecting patient autonomy while facilitating clear communication between healthcare providers and families.
APNs also function as educators by delivering comprehensive knowledge about disease progression, treatment options, and ethical decision-making. Through education, they empower both patients and families to make informed decisions, particularly in sensitive end-of-life situations where clarity is essential.
Nursing leadership is vital in managing ethical dilemmas. Research suggests that nurses often feel less capable of influencing the trajectory of care compared to physicians or advanced practice providers (Cederquist et al., 2021). However, APNs can lead interdisciplinary teams by ensuring that patient values are respected and that ethical principles guide decision-making. Their leadership fosters collaboration, clarity, and advocacy for the patient’s best interests.
In professional practice, nurses often encounter ethically challenging situations while caring for terminally ill patients. One such case occurred in a long-term care facility where a hospice patient remained competent and capable of making decisions. The patient developed Kennedy ulcers, indicating imminent death. Despite the patient’s competence, the power of attorney (POA) insisted on initiating sedative medications to keep the patient unconscious during the dying process.
Although the nurse educated the family about the patient’s autonomy and the absence of medical indications for sedation, the provider honored the POA’s request. The nurse complied with the provider’s order, and the patient passed away soon after. This case reflects the tension between respecting patient autonomy and navigating family demands, raising significant ethical concerns.
The following stakeholders were directly involved in this ethical dilemma:
| Stakeholder | Role/Responsibility |
|---|---|
| Long-Term Care Organization | Ensured compliance with care standards and faced potential legal/ethical ramifications. |
| Provider | Balanced medical judgment with patient autonomy and family requests. |
| Registered Nurse | Advocated for patient rights while complying with medical orders. |
| Client | Experienced emotional and physical effects of end-of-life decisions. |
| Power of Attorney (POA) | Made healthcare decisions on behalf of the patient, often influenced by personal beliefs and financial responsibilities. |
| Stakeholder | Impact |
|---|---|
| Long-Term Care Organization | Risked legal liability and reputation if ethical standards were perceived as compromised. |
| Provider | Faced moral conflict between honoring patient autonomy and family demands. |
| Registered Nurse | Encountered moral distress in balancing advocacy for the patient with compliance to medical orders. |
| Client | Experienced anxiety, loss of autonomy, and diminished quality of end-of-life experience. |
| Power of Attorney (POA) | Managed emotional burden of decision-making along with financial and healthcare-related responsibilities. |
This scenario raised several ethical concerns:
Autonomy: The patient’s right to make decisions about their care was overlooked in favor of the POA’s wishes.
Beneficence: The provider and nurse acted with the intent to benefit the patient, but the actual benefit remained questionable.
Non-maleficence: Administering sedatives without clear clinical need may have contributed to harm by limiting the patient’s final moments of awareness.
According to Nnate (2021), healthcare professionals must carefully weigh patient preferences alongside ethical principles, ensuring that moral values guide clinical decisions.
The Code of Ethics for Nurses provides relevant guidance:
| Provision | Description |
|---|---|
| Provision 1 | Nurses practice with compassion and respect for every patient’s dignity. |
| Provision 2 | The nurse’s commitment is primarily to the patient. |
| Provision 3 | Nurses must advocate for and safeguard the rights and safety of patients. |
| Provision 4 | Nurses hold accountability for practice decisions and actions in patient care. |
The American Nurses Association (ANA) recommends that nurses utilize available resources and conflict resolution strategies in end-of-life scenarios (ANA Center for Ethics and Human Rights, 2021). Comprehensive advanced care planning ensures that patient wishes are documented early, reducing conflict among providers and family members. By prioritizing patient-centered approaches, healthcare teams preserve self-determination and dignity (Smith et al., 2020).
Frequent and transparent engagement of stakeholders helps clarify roles and expectations. Consulting organizational policies and professional codes of ethics offers guidance when disagreements occur, ensuring that patient care aligns with best practices.
Implementing standardized documentation for end-of-life decisions ensures clarity and accountability. Recording the rationale behind decisions helps protect both providers and patients while serving as a reference in case of disputes or future care planning.
Advanced practice nurses are essential in managing ethical dilemmas in end-of-life care. Through advocacy, education, and leadership, APNs help ensure that patient dignity, autonomy, and safety are maintained. Ethical practice requires balancing professional responsibilities with patient rights, and advanced care planning can minimize conflicts while promoting compassionate and respectful end-of-life care.
ANA Center for Ethics and Human Rights. (2021). Nurses’ Professional Responsibility to Promote Ethical Practice Environments (By ANA Board of Directors). American Nurses Association. https://www.nursingworld.org/~4ab6e6/globalassets/practiceandpolicy/nursingexcellence/ana-position-statements/nursing-practice/nurses-professional-responsibility-to-promoteethical-practice-environments-2021-final.pdf
Atkinson Smith, M., Torres, L., & Burton, T. C. (2020). Patient rights at the end of life: The ethics of aid-in-dying. Professional Case Management, 25(2), 77–84. https://doi.org/10.1097/NCM.0000000000000392
Cederquist, L., LaBuzetta, J. N., Cachay, E., Friedman, L., Yi, C., Dibsie, L., & Zhang, Y. (2021). Identifying disincentives to ethics consultation requests among physicians, advanced practice providers, and nurses: A quality improvement staff survey at a tertiary academic medical center. BMC Medical Ethics, 22(1). https://doi.org/10.1186/s12910-021-00613-7
Code of Ethics for Nurses. (2017). American Nurses Association. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/
Nnate, D. A. (2021). Treatment withdrawal of the patient on end of life: An analysis of values, ethics, and guidelines in palliative care. Nursing Open, 8(3), 1023–1029. https://doi.org/10.1002/nop2.777
