A hospice nurse has been working closely with a client who, on ...

[joblessjake]

A hospice nurse has been working closely with a client who, on several occasions, has asked about guidance and support in ending her life. The nurse, in making an ethical and moral decision, should recognize that:
 
  1. Passive euthanasia is an easy decision to arrive at.
  2. Legal issues are not the same as moral or ethical ones.
  3. Active euthanasia is supported in the Code for Nurses.
  4. Assisted suicide is illegal in all states.

Question 2

An client with terminal cancer is dying. For the past several days, the client has refused food and fluids, and pushes the caregiver's hands away when attempts are made to feed the client or offer any kind of fluid.
 
  The family is considering placing a gastrostomy tube because they feel the client is starving to death. The nurse should:
  1. Honor the family's wishes and have them sign a consent form.
  2. Talk to the physician so he or she can move forward with the family's wishes.
  3. Honor the client's refusal and help the family come to terms with the situation.
  4. Take the case to the hospital's ethics committee.

[sokh]

Answer to Question 1

Correct Answer: 2
Rationale 1: Passive euthanasia involves the withdrawal of extraordinary means of life support and is never an easy decision.
Rationale 2: Determining whether an action is legal is only one aspect of deciding whether it is ethical. Legality and morality are not one and the same. The nurse must know and follow the legal statutes of the profession and boundaries within the state before making any decision.
Rationale 3: Active euthanasia and assisted suicide are in violation of the Code for Nurses, according to the position statement by the ANA (1995).
Rationale 4: Some states and countries have laws permitting assisted suicide for clients who are severely ill, are near death, and wish to commit suicide.

Answer to Question 2

Correct Answer: 3
Rationale 1: Clients, not their families, should make decisions about their own health care and treatment.
Rationale 2: The physician may or may not be involved, but not to disregard the client's refusal.
Rationale 3: A nurse is morally obligated to withhold food and fluids if it is determined to be more harmful to administer them than to withhold them. The nurse must also honor competent patients' refusal of food and fluids. This position is supported by the ANA's Code of Ethics for Nurses, through the nurse's role as a client advocate and through the moral principle of autonomy. Clients, not their families, should make decisions about their own health care and treatment. In this case, the client has made a decision and it should be honored.
Rationale 4: An ethics committee is usually considered when there is a ethical dilemma and more input is needed to make a decision. In this case, the client has made a decision.