Available nursing scholarship demonstrates that it is not uncommon for patients with terminal illnesses to express a desire to hasten their death (Hospice and Palliative Nurses Association, 2011), and that such expressions present nurses with a multiplicity of ethical, legal, and moral dilemmas in large part due to the sensitivity of the issues involved as well as the intimacy that characterizes the nurse-patient relationship (Sneesby, 2009). The case in question presents such a scenario, whereby a terminally ill patient is making a conscious plan of how she will end her own life to avoid becoming a burden to her family. This paper discusses the ethical, legal, and moral dilemmas that a nursing professional is likely to face in such a situation.
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Based on the fact that ethical decision making is nested on the universal ethical principles of autonomy, beneficence, non-maleficence and justice, it is possible that a nurse in such a situation may encounter difficulties in deciding between respecting the rights of the patient as a self-governing individual making a conscious decision to end her life and following the legal obligation binding healthcare professionals that they should act to prevent terminally ill patients from taking their own lives. The principle of autonomy provides the patient with the right “to have wishes and decisions respected, to be listened to, and to be able to make informed choices, free from manipulative or coercive pressures” (Sneesby, 2009, p. 456). However, such rights may be conflicting with the legal obligation of the nurse to protect and preserve life, leading to an ethical and legal dilemma.
The nurse may also experience difficulties in deciding whether to demonstrate beneficence to the patient or follow the laws and regulations that govern the practice. The ethical principle of beneficence allows the nurse to show compassion and take positive action to assist the patient in the end-of-life; however, this action conflicts with an important guideline by the American Nurses Association, which states that “the nurse is prohibited from participating in assisted suicide and should provide interventions to relieve pain and suffering of the dying patient, even if they may hasten death” (Hospice and Palliative Nurses Association, 2011, p. 1). The nurse may become more intertwined with the dilemma upon the realization that disregarding such a rule may have profound legal consequences irrespective of the fact that she may have been motivated to assist the patient due to factors such as compassion, respect for patient autonomy, and quality of life considerations.
Additionally, it may be construed that the patient’s decision to end her life due to the terminal illness is an act of non-maleficence in terms of attempting to avoid harming or hurting immediate family members by becoming a burden to them. Although the nurse may consider this as a good action on the part of the patient based on her values and beliefs, she may nevertheless be faced with another dilemma emanating from the fact that aiding and abetting suicide or attempted suicide is considered as an act of inciting or counseling suicide in many jurisdictions in the United States irrespective of the fact that the patient may have consented (Javashvili, n.d; Sneesby, 2009).
Lastly, arising from the above moral and legal dilemma, the nurse may be faced with yet another challenge of deciding whether to respect the autonomy of the patient or report to relevant authorities about the intention of the patient to end her own life (Javashvili, n.d.). The nurse is obliged by the ethical principle of autonomy to respect the patient’s right to self-determine that she wants to end her own life due to the terminal illness. However, she is also expected by various legal obligations to preserve life and also report attempted suicide cases to relevant authorities for action to be taken, hence the dilemma.
Hospice and Palliative Nurses Association. (2011). Role of nurse when hastened death is requested. Web.
Javashvili, G. (n.d.). Ethical and legal issues of palliative care and care at the end of life: Explanations and recommendations to healthcare personnel. Web.
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Sneesby, L. (2009). The human face behind an ethical dilemma: Reflecting on attempted suicide and outcomes of a case study. International Journal of Palliative Nursing, 15(9), 456-462.