A situation of ethical dilemma that you have experienced in practice

Sample Solution

Scenario:

I am a registered nurse working in a busy oncology unit. One of my patients, a 72-year-old woman with terminal cancer, is in a significant amount of pain despite medication. She is mentally competent and repeatedly asks me to help her end her life through physician-assisted suicide (PAS). PAS is illegal in our state.

Ethical Dilemma:

I am torn between two ethical principles:

• Patient Autonomy: The patient has the right to make her own decisions about her healthcare, including the right to refuse treatment.
• Preserving Life: Nurses have a professional obligation to do no harm and to preserve life.

Full Answer Section

Additional Considerations:

• Emotional Distress: The patient is clearly suffering physically and emotionally.
• Family Conflict: The patient's adult children disagree on her wishes. Some support her decision, while others want her to fight the disease.

Resolving the Dilemma:

Here's how I might approach this situation:

1. Active Listening: First, I would prioritize creating a safe and supportive space for the patient to express her concerns without judgment. I would actively listen to her story and understand her reasons for wanting to end her life.
2. Exploring Options: I would explain the limitations of PAS in our state but explore all available pain management options with the patient and her doctor. This might involve discussing alternative medications, complementary therapies, or referral to a palliative care specialist.
3. Respecting Autonomy: While I cannot directly assist with PAS, I would respect the patient's right to make her own decisions. This might involve providing her with information about relevant support groups or organizations that advocate for end-of-life rights.
4. Facilitating Communication: I would encourage open communication between the patient and her family members to help them understand and respect each other's wishes. This might involve facilitating a family meeting or involving a social worker to provide support and guidance.
5. Collaboration with the Team: I would collaborate with the patient's doctor, social worker, and other members of the healthcare team to ensure the patient receives comprehensive care that addresses her physical, emotional, and spiritual needs.

Outcome:

The ideal outcome would be for the patient to feel supported and comfortable during her remaining time. She might ultimately choose to continue treatment with improved pain management or may decide to pursue hospice care.

Conclusion:

This scenario highlights the complex ethical dilemmas nurses can face. By prioritizing patient autonomy, providing emotional support, exploring all treatment options, and promoting open communication, nurses can help patients navigate difficult end-of-life decisions.