Today, more than ever before, it is becoming increasingly clear that the nature and limits of end-of-life (EOL) decisions present the nursing profession with immense ethical, legal, and moral dilemmas (Tamayo-Velazquez, Simon-Lorda, & Cruz-Piqueres, 2012), and that the so-called right to die with dignity for the terminally ill may be inherently difficult to achieve in the face of these dilemmas (Georges & Grypdoncki, 2002). As demonstrated in the presented case scenario, patients may willingly and consciously decide to end their suffering through death if they know that they will end up becoming a burden to family members and society due to the terminal nature of their illness. Although such a decision may sound simple to make if the patient’s right to autonomy is taken into consideration (Costello, 2014), it is often intertwined with profound ethical, legal, and moral dilemmas for nursing professionals.
The first dilemma for a nursing professional in such a situation revolves around the conflicting interests between granting patient autonomy and respecting the legal obligations governing various jurisdictions. This dilemma is both ethical and legal as patient’s autonomy is embedded in the ethics of respecting the capacity of a rational individual to make an informed, uncoerced decision (Costello, 2014), while the various legal obligations requiring the nurse to protect and preserve life are grounded in law (Georges & Grypdoncki, 2002). In the case scenario, the patient seems like she is making a conscious decision on how to end her life due to the terminal illness and also because she does not want to become a burden to her family. Although such a wish is firmly grounded in the ethical principle of autonomy, the nurse may be unable to make a decision due to the legal constraints requiring her to protect and preserve life.
Another moral dilemma may present in terms of the conflicting interests between the patient’s right to autonomy and the nursing professional’s beliefs and attitudes regarding what she holds to be right and wrong. In such a dilemma, the nurse must decide between respecting the patient’s decision to end her life due to deteriorating quality of life and respecting her own beliefs which may be against such a decision. It is demonstrated in the literature that “the moral behavior of nurses has often been described as grounded in their commitment to, and receptivity for, the experience of patients, and directed towards alleviating suffering” (Georges & Grypdoncki, 2002, p. 159). However, in the presented case, it is probable that the nurse may encounter difficulties in deciding whether to agree with the patient’s plan as a means to alleviate the suffering or disagree with her based on personal beliefs and attitudes on the issue.
Lastly, it is evident that the nursing professional may face difficulties in deciding whether to respect the ethical principle of beneficence or follow the standards that inform the nursing practice. In such a scenario, it may be difficult for the nurse to decide between showing compassion to the patient on the one hand and telling the patient that her decision is not supported by law or nursing practice on the other (Costello, 2014). It should be noted that, although providing truthful information to the patient is one of the tenets of autonomy (Tamayo-Velazquez et al., 2002), the nurse may be prevailed upon by compassion and other factors (e.g., the moral imperative of nurses in alleviating patient suffering) to desist from categorically stating to the patient that the plan to end her own life is wrong (Georges & Grypdoncki, 2002).
Costello, J. (2014). Does patient autonomy extend to ending life? International Journal of Palliative Nursing, 20(2), 55-55.
Georges, J.J., & Grypdoncki, M. (2002). Moral problems experienced by nurses when caring for terminally ill people: A literature review. Nursing Ethics, 9(2), 155-178.
Tamayo-Velazquez, M.I., Simon-Lorda, P., & Cruz-Piqueres, M. (2012). Euthanasia and physician-assisted suicide: Knowledge, attitudes, and experiences of nurses in Andalusia (Spain). Nursing Ethics, 19(5), 677-691.