Caregivers, especially adult children of elderly patients, will probably have as much contact with nurses as they will with doctors. This is particularly true during Intensive Care Unit periods and in the last stages of life. The majority of Americans die in hospitals, where nurses serve on the frontline of care.
Nurses are in a difficult position when it comes to the end of life issues. The American Association of Colleges of Nursing notes that “People in our country deny death, believing that medical science can cure any patient. Death often is seen as a failure of the health care system rather than a natural aspect of life. This belief affects all health professionals, including nurses.” One might as well say “including and especially” nurses, who see patients and their families on a daily basis.
In attempting to achieve the impossible expectation that medical science can cure any patient, even of death, doctors will continue to treat a person in the end stages of life unless the patient or family members intervene. Explaining how the end of life ethical issues intersects with medical care often falls to nurses. Jeannette Der Bedrosian recounts in the Johns Hopkins Magazine that such an ethical situation arose in a case for a nurse when family members wanted continued blood transfusions for a loved one, although there was no hope of recovery. The blood supplies were needed for other patients for whom there was a hope of recovery.
Nurses have given family members advice in other end-of-life issues that have an ethical aspect. In one case, a nurse apprised a family member that her loved one’s kidneys were showing signs of failure, in addition to the person being in the end stage of Congestive Heart Failure. Since the elderly patient only had a few days to live, the nurse advised the family member not to subject the dying patient to the invasive and uncomfortable process of dialysis. The nurse believed dialysis was not a compassionate solution for the patient.
Nurses must help people make such serious judgment calls, often without guidelines for doing so. Der Bedrosian reports that the nurse’s ethical handbook was updated in 2015–fourteen years after its publication and at a time when medical science is advancing very rapidly and ushering in hosts of new ethical dilemmas.
The American Association of Colleges of Nursing says that facing ethical dilemmas unguided adds to the already heavy burdens of nurses. It may contribute to nurse burn-out, a common phenomenon. Although ethical issues vary, there are certain stressful situations that most nurses encounter: 1.) nurses suffer stress and conflict about not knowing the right thing to do, or 2.) nurses suffer stress and conflict about knowing all too well what should be done and being restricted from doing it.
Fortuitously, 2015 is the Year of Ethics for Nurses. The special year was inaugurated on January 16, 2015, when the newly revised code of ethics for nurses was issued. As nurses study an updated code of ethics, family members and caregivers can find common cause with their fellow front-line workers in their elderly loved ones’ care. Together they can make the most responsive, responsible and compassionate decisions.
Der Bedrosian, Jeannette. Nursing Is Hard. Unaddressed Ethical Issues Make it Harder. reports in the Johns Hopkins Magazine Summer 2015. Available online at http://hub.jhu.edu/magazine/2015/summer/nursing-ethics-and-burnout.
The American Association of Colleges of Nursing. End-of-Life Nursing Education Consortium. Available online at http://www.aacn.nche.edu/elnec/about/fact-sheet.