Ethics of End-of-Life Decisions

This assignment delves into the complex ethical landscape surrounding end-of-life decisions. It examines topics such as resuscitation ethics, patient autonomy, surrogate decision-making, and the role of advance directives in shaping end-of-life care. The provided research papers offer insights into various perspectives and challenges faced in this sensitive area of medical practice.

Running head: NURSING END OF LIFE DECISIONS
End of life decisions
Name of the Student
Name of the University
Author Note

NURSING END OF LIFE DECISIONS 1
All patients are entitled with the rights of receiving quality care, which allows them to
live healthy until they die. This quality patient care is generally provided by physicians and
nurses. Often people who approach the end of their lives, along with their family members face
decisions and tasks, which include an array of simple and complex choices (Erbguth & Erbguth,
2016). This essay will therefore elaborate on the role of nurses in taking such decisions, the legal
isseus and legislations that are associated with such instances.
Effect of regulatory control- The principal function of regulatory framework is ensuring
compliance with various standards to protect patients from health risks. A regulatory
environment ensures a higher quality of healthcare service that meets provides patient
satisfaction (Evans et al., 2013). These assist patients, family members and policy makers to hold
the organizations that are accountable for measuring the effectiveness and reliability of the care
given to dying patients (McMahan et al., 2013). Furthermore, these end-of-life regulatory bodies
promote systematic research related to the organizational, clinical and financial avenues for end-
of-life care.
Effect of legislations- Several policies are formulated with the aim of organizing a
national response to meet the problems associated with end-of-life care. Important legal
principles are formulated by the state courts that help healthcare workers to arrive at a consensus
(Sprung et al., 2014). There are several EOL laws such as, the End of Life Option Act, ABX2-15
(AB-15), California and the Proposition 106, the End of Life Options Act, Colorado that create
provisions for patients who lack decision making capacity to authorize surrogate decision
makers. Similarly, the End of Life Law and Policy, Canada allow terminally ill patients to make
medical decisions. Furthermore, the courts draw a differentiation between intentional patient
death and death that occurs due to withdrawal of life-sustaining treatments. Legal consensus

NURSING END OF LIFE DECISIONS 2
states that withhold or withdrawal of such treatment is justifiable, if not asked for by the patient.
The legislations are often utilized to formulate advance directives, which are considered legally
valid across the United States (Periyakoil et al., 2014). These are legal documents that allow a
person to specify what treatment measures should be taken at end of their life if they fail to make
decisions due to incapacity or illness (Raijmakers et al., 2012). Moreover, the polices contain
financing options such as, Medicare and Medicaid, which cover the associated costs that the
beneficiaries are eligible to obtain till their death (Teno et al., 2013). The EOL policies also
provide hospice care where the emotional, social, psychological and spiritual needs of the people
are identified and cared for until the end of their life. These hospice cares therefore involve
physiotherapy, occupational therapy, rehabilitation, bereavement and respite care to the patients.
Role of nurses- The nursing staff has several responsibilities related to end-of-life care of
patients. These responsibilities range from recognition of the changes in patient health condition
to offering them support and compassion and understanding the preferences of the patient. The
primary role of nurses is concerned with providing compassionate care to dying people and their
family members. It is essential to make these decisions after consulting healthcare professionals
because they will be able to provide information on the risks and benefits of the proposed
treatment. They identify futile disputes and help in providing superior quality EOL care. Their
role involves effective collaboration with the healthcare team members to ensure that availability
of optimal symptom management and support for the patient (Albers et al., 2014). The brunt of
grief is often borne by nurses as the patients reach their end-of-life (Piers et al., 2012). Nurses are
responsible for identifying options that are no longer beneficial. However, they face several
ethical issues that are associated with the complex process of decision making and patient
autonomy rights, the application of advance directives and the high expenditure related to end of

NURSING END OF LIFE DECISIONS 3
life care (Bossaert et al., 2015). Ethical issues involve consideration of resource allocation in
cases of futile treatments. Hence, families and patients ethically consider comfort care options.
Thus, healthcare rationing is essential in EOL care. Thus, ethical dilemmas are related to the
consideration of the patient’s perspectives and preferences while judging the situation and
providing an appropriate treatment prognosis (Heiser, 2014). The effective strategies that can be
adopted to improve EOL care are starting conversations with the loved family members in order
to know how they want to be cared for, treating the individuals with respect and dignity, keeping
them in close company of friends and family and care planning in advance.
Thus, it can be concluded that end-of-life choices encompass a wide range of domains
such as, practical, legal, spiritual, psychosocial, or medical choices. Nurses play an essential role
in making decisions related to end-of-life care. Such decisions are most commonly supported by
some living wills or advance directives. These legal decisions give the patients the authority to
decide whether they want to receive treatment at an institutional setting or at home.

NURSING END OF LIFE DECISIONS 4
References
Albers, G., Francke, A. L., de Veer, A. J., Bilsen, J., & Onwuteaka-Philipsen, B. D. (2014).
Attitudes of nursing staff towards involvement in medical end-of-life decisions: a
national survey study. Patient education and counseling, 94(1), 4-9.
Bossaert, L. L., Perkins, G. D., Askitopoulou, H., Raffay, V. I., Greif, R., Haywood, K. L., ... &
Georgiou, M. (2015). European Resuscitation Council Guidelines for Resuscitation 2015:
Section 11. The ethics of resuscitation and end-of-life decisions. Resuscitation, 95, 302-
311.
Erbguth, F. J., & Erbguth, L. (2016). End-of-life Decisions. Deutsche medizinische
Wochenschrift (1946), 141(20), 1484-1496.
Evans, N., Pasman, H. R., Alonso, T. V., Van den Block, L., Miccinesi, G., Van Casteren, V., ...
& Onwuteaka-Philipsen, B. (2013). End-of-life decisions: a cross-national study of
treatment preference discussions and surrogate decision-maker appointments. PLoS
One, 8(3), e57965.
Heiser, G. (2014). End of Life Ethical Dilemma. Best Integrated Writing, 1(1), 8.
McMahan, R. D., Knight, S. J., Fried, T. R., & Sudore, R. L. (2013). Advance care planning
beyond advance directives: perspectives from patients and surrogates. Journal of pain
and symptom management, 46(3), 355-365.
Periyakoil, V. S., Neri, E., Fong, A., & Kraemer, H. (2014). Do unto others: doctors' personal
end-of-life resuscitation preferences and their attitudes toward advance directives. PLoS
One, 9(5), e98246.

NURSING END OF LIFE DECISIONS 5
Piers, R. D., Van den Eynde, M., Steeman, E., Vlerick, P., Benoit, D. D., & Van Den Noortgate,
N. J. (2012). End-of-life care of the geriatric patient and nurses’ moral distress. Journal
of the American Medical Directors Association, 13(1), 80-e7.
Raijmakers, N. J., Van Zuylen, L., Costantini, M., Caraceni, A., Clark, J. B., De Simone, G., ...
& van der Heide, A. (2012). Issues and needs in end-of-life decision making: an
international modified Delphi study. Palliative medicine, 26(7), 947-953.
Sprung, C. L., Truog, R. D., Curtis, J. R., Joynt, G. M., Baras, M., Michalsen, A., ... & Bulpa, P.
(2014). Seeking worldwide professional consensus on the principles of end-of-life care
for the critically ill. The Consensus for Worldwide End-of-Life Practice for Patients in
Intensive Care Units (WELPICUS) study. American journal of respiratory and critical
care medicine, 190(8), 855-866.
Teno, J. M., Gozalo, P. L., Bynum, J. P., Leland, N. E., Miller, S. C., Morden, N. E., ... & Mor,
V. (2013). Change in end-of-life care for Medicare beneficiaries: site of death, place of
care, and health care transitions in 2000, 2005, and 2009. Jama, 309(5), 470-477.