End of Life Issues



End-of-life issues are ethical issues that recur in nursing practice. These include health care practitioners revealing the truth, ensuring confidentiality, and withdrawing treatment. All patients have the right to complete and accurate information about their health. This means that physicians and nurses must tell patients the truth about their health issues. They can show respect for this right by explaining to patients the status of their health problems, the benefits and dangers of treatment, alternative forms of treatment, and the possible consequences if the treatment is not administered (Matzo, 2005).

Confidentiality must be maintained to protect the patient’s information from public disclosure. Nurses are not supposed to disclose health information to unauthorized people without written authorization from the patient. About treatment withdrawal, a patient’s life can be prolonged at all costs by technology, beyond justifying its benefit. Life and death decisions may sometimes continue to circumvent patients, thus, violating ethical principles. This paper discusses the right to die law and advance directives.

Right to Die

Advance Directives

The right to die legislation has been enacted in most states to recognize the patient’s right to select death by refusing extraordinary medication when recovery hope is slim. This law was enacted to help professionals in health care, risk managers, management, and legal counsels in making decisions about forgoing or continuing with terminal medical treatment by explaining the law that governs this decision-making process (Meisel, 2001).

Another purpose for its enactment was to delineate the boundaries between legal and illegal practices to avoid fears. Whenever a competent person expresses specific wishes, the providers of health care must attempt to follow them. Written evidence of the patient’s wishes provides the best indication of what treatment the patient would accept if she or he were able to communicate. This information may be provided through advance directives (Matzo, 2005).

Advance directives are written statements that identify the wishes of a competent person concerning terminal care. They are mechanisms by which people can exercise control over their bodies allowing individuals to direct the kind of medical care they prefer in the event they cannot make decisions at the time a medical decision is required to be made. Advance directives provide guidelines to others about the kind of medical care an individual would like to get in advance. They also provide direction, particularly to professionals in health care, concerning how to continue with decision-making about terminal treatment in the face of diminished capacity.

Lack of decision-making capacity brings about uncertainty in a clinical setting. For instance, as to how health care decisions are to be made, who has the authority to make them, and what the treatment decisions should be (Matzo, 2005). They contribute immensely to the willingness of professionals to continue with a clinical approach to decision-making rather than ask for judicial intervention when patients cannot make decisions.

Advance directives also offer health care workers immunity from civil and criminal liability when certain stated conditions are met. Litigations about right-to-die cases end up in court due to fear of liability and provisions of statutory immunity to professionals offer an impetus for making decisions by protecting professionals of health care in the clinical setting (Matzo, 2005). The advance directives information may be provided through living wills and durable power of attorney.

As an instructive form of an advance directive document, a living will specify the wishes of a patient about the medical care, if he or she becomes terminally sick, incompetent, or unable to communicate (Matzo, 2005). Generally, living wills are used to declare wishes to refuse, limit or withhold terminal treatment under certain circumstances should the patient become incapacitated and unable to communicate (Meisel, 2001). Patients must share advance directives with providers of health care to ensure that they are implemented. The Durable Power of the Attorney to health care providers allows patients to designate a proxy to make health care decisions on their behalf should they lose decision-making capacity (Cooney et al., 2004).

The designated individual can offer or withhold permission for medications on behalf of the patient at the end of life situations or when the patient is temporarily unconscious. The living will and durable power of attorney are measures that are best composed before a medical crisis develops to help care providers to fulfill the patient’s wishes. The measures also assist in avoiding legal expenses, or unwarranted decisions made by the court or ethics committees. Therefore, nurses should update all patients about their right to self-determination, encourage them to compose advance directives, and support their decisions (Baer, 1997).


Nursing practice has a tradition of respect for patients and emphasizes the patient’s participation in health care decisions. Therefore, the practice could take a leadership role in identifying the views of individuals in health care in a systematic manner. Through nursing, patients could be empowered to identify health options within their dimension of values and support them in defending their rights as partakers of health care (Baer, 1997). Nursing as a professional practice could be expanded to include educating and discussing with patients and their families about their rights and responsibilities regarding advance directives (Meisel, 2001).

Through the Patient Self Determination Act enacted in 1991, the delivery systems of health care are required to recognize patients’ preferences (Emmanuel, 1993). However, a lot needs to be done to encourage patients to dialogue and enhance understanding between proxies and health care providers. This educative and facilitative role can be ably assumed through nursing practice. Continuing education and development ensures that nurses are informed about living wills and health care proxies (Emmanuel, 1999).


Baer, C. (1997). Elders Views on the Right to Die. New York: Taylor and Francis.

Cooney, L., Kennedy, G., Hawkins, K., Hurme, S., & Balch, J. (2004). Eho Can Stay at Home? Assessing the Capacity to Choose to Live in the Community. Archives of Internal Medicine, 164, 357-360.

Emmanuel, E., & Weinberg, D. (1993). How well is the patients Self Determination Act Working. American Journal of Medicine, 95, 619-627.

Emmanuel, L., Von Gunten, C., & Ferris, E. (1999). Education for Physicians in End of Life Care. The EPEC Project. Web.

Matzo, M., & Sherman, D. (2005). Palliative Care Nursing. New York: Springer Publishing Company.

Meisel, A., & Cerminara, K. (2001). The Right to Die. New York: Aspen Law and Business.

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