Managing pain at the end of life is one of the most critical issues facing nurses. End-of-life care involves adherence to professional rules, such as the ANA codes of conduct. These rules cannot be alienated from certain ethical principles regarding end-of-life care. Ethics concerning end-of-life care tend to be influenced by spiritual beliefs. This is likely to affect the provision of pain relief at the end of life.
Nurses are the primary caregivers for terminally ill patients at the end of life. During this period, management of pain is not only perceived as a professional practice but is also an ethical issue. This implies that pain relief at the end of life is likely to be influenced by ethical norms. The ethics of pain relief at the end of life are intertwined with professional ethics. As such, while ethics are central to professional ethics in nursing, they also enable nurses to adhere to established moral norms with regards to providing pain relief at the end of life (Center for Ethics and Human Rights Advisory Board, 2010: American Nurses Association, 2010).
Moral norms surrounding end-of-life issues form the rationale on which nurses provide pain relief at the end of life. One of the major ethical principles governing end-of-life care involves a patient’s right to self-determination. Nurses ought to inform patients of the available pain relief methods and leave decision-making to the patient. In doing so, the patient’s interests supersede any other interests. Regardless of this, nurses are obliged to provide the best pain relief method that serves the patient’s best interests. This implies that the preferred pain relief method ought not to cause harm or aggravate pain to the patient. This is referred to as the principle of nonmaleficence. Additionally, following the principle of justice, nurse’s ought to provide pain relief without discrimination. All patients have a right to equal treatment regardless of ailment, class, gender, race or age. The end of life is a critical moment in a patient’s life. There are sensitive issues such as the patient’s chances of survival, involved at the end of life. The principle of fidelity means that nurses are obliged to provide truthful, honest, accurate, and timely information to the patient regarding this, and other sensitive issues. Truthfulness with regards to diagnosis, prognosis, and the patient’s chances of survival is paramount (Niemira and Townsend, 2009).
There are a number of issues associated with pain relief at the end of life, and which are closely connected with the above-mentioned principles. These include withdrawal of pain relief methods, the futility of pain relief methods and most significant, issues of spirituality. Spirituality affirms central beliefs with regard to life. For instance, the Ten Commandments are likely to influence ethical decision-making at the end of life. According to the American Nurses Association (2010), “nurses act as moral agents” and therefore should not contravene established moral norms. Killing is forbidden through the Seventh Commandment. Physically assisted suicide, euthanasia, is considered an effective method of relieving pain for terminally ill patients nearing the end of life. Since nurses have traditionally shied away from administering euthanasia, the Seventh Commandment can be said to influence ethical decision-making at the end of life.
Spirituality forms the core of the human belief system, which in turn influences decision-making regarding major life issues. There are several methods of relieving pain at the end of life, including euthanasia. Regardless of the prevailing professional code of conduct, preferring euthanasia as the most appropriate method of pain relief is likely to be influenced by underlying spiritual beliefs such as the Ten Commandments.
American Nurses Association (2010). Codes of ethics for nurse with interpretive statements. Web.
Center for Ethics and Human Rights Advisory Board. 2010. Registered nurses’ roles and responsibilities in providing expert care and counseling at the end of life. Web.
Niemira, D. and Townsend, T. (2009). Ethics conflicts in rural communities: end-of-life decision-making. Web.