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Ethical Considerations in Palliative Care

Given the complexity of the healthcare system and individual patients who have a serious illness, nurses often are uncertain about the right or most ethically sound action. The nurse who identifies ethical issues or questions will need to use a systematic process to examine the situation and reach a decision about what action to take. Although moral questions can arise about any aspect of nursing practice, including informed consent and duties to colleagues, the issues most frequently encountered in palliative care center around end-of-life decisions. These include withholding and withdrawing treatment (e.g., mechanical ventilation, medically administered nutrition and hydration, cardiopulmonary resuscitation, cardiac assist devices) and concerns about requests for hastened death, nonbeneficial interventions, and palliative sedation. These discussions will be most helpful when they focus on values and goals of care rather than on specific treatments. Although it is increasingly recognized that clinicians have not only the right but the professional duty to refrain from interventions that are harmful, it is essential to be cautious in judging interventions as “futile” or medically inappropriate. Decisions regarding ethical dilemmas and the choices that are necessary require thoughtful discussion and critical communication skills.