Ethical Issues Experienced by Hospice and Palliative Nurses

Abstract

Nurses encounter ethical dilemmas in their clinical practice especially those associated with palliative and end-of-life care. The Hospice and Palliative Nurses Association (HPNA) members were asked to participate in an ethics survey. The survey aimed to identify ethical issues experienced by hospice and palliative nurses, identify resources available to them and barriers if any to their use, and to identify how HPNA can be of support to hospice and palliative nurses. One hundred twenty-nine (n = 129) HPNA members completed the online survey. The information from each of the surveys was carefully reviewed, and responses were collapsed into 6 themes. The ethical dilemmas included inadequate communication, provision of nonbeneficial care, patient autonomy usurped/threatened, issues with symptom management and the use of opioids, issues related to decision making, and issues related to discontinuing life-prolonging therapies. Approximately two-thirds of the nurses used resources in an attempt to resolve the ethical issues, including a formal ethics consultation, involvement of the palliative/hospice team, consulting with other professionals, and use of educational resources. One-third of the nurses said there were institutional or personal barriers that prevented the ethical dilemma from being resolved. Participants suggested ways that HPNA could help them to effectively manage ethical dilemmas.

Real-world ethics in palliative care: A systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice

“…It also covered whether it may be appropriate to withhold information from patients, either because of clinician beliefs regarding harms, or the wish of the families. 13,15,38,39,42,[43][44][45][46][47] High confidence. This finding is contributed to by most of the studies included in the review.…”

“…Administration of antibiotics 15 Appropriate use of antibiotics, particularly in end of life care. Advance directives 13,40,45 Challenges implementing advance directives, particular when family requests may contrast with the directive. Bloods transfusions 15,44 Appropriateness of blood transfusions.…”

“…This related to decision-making regarding broader aspects of clinical care, as compared to the more focused medical sub-theme that focuses on individual clinical interventions. Broader topics included dilemmas concerning overall therapeutic aims and strategies, particularly around clinical decision-making moving from disease modifying to symptom management only, withdrawing and withholding, treatment proportionality and assessment of futility, and patient's preferred place of care and death 13,15,[37][38][39][40][41][42][43][44][45][46][47]. High confidence.…”

Drug‐seeking: A literature review (and an exemplar of stigmatization in nursing)

“…One research article (Speroni, Fitch, Dawson, Dugan, & Atherton, 2014) and one conference abstract (Pompeii, Schoenfisch, Lipscomb, Dement, & Upadhyaya, 2014) identified drug-seeking behavior as responsible for an increase in workplace violence in hospitals, with no definition or description of the term provided. A research article indicated that concern about drug-seeking behavior was a primary factor contributing to hospice and palliative care nurses' inability to resolve an ethical dilemma, with no elaboration (Cheon, Coyle, Wiegand, & Welsh, 2015), and a description of a medication on demand device used by postoperative cesarean patients indicated that a history of drug-seeking was a contraindication (Hreniuk, Sheaffer, Sukeena, & Tribioli, 2014). An abstract describing an educational simulation of a drug-seeking patient in an ED setting described the scenario as beginning with 'a soft-spoken patient whose request for intravenous morphine was not met and then is transformed into a loud, manipulative, and demanding patient' (Bauer, 2019, 274).…”

An Interdisciplinary Framework for Palliative and Hospice Education and Practice

“…Patient autonomy is consistent with what some would label an essential element of bioethical principles in Western hemisphere cultures but not across all cultural variations (Kara, 2007). Autonomy is a value that encompasses the freedom to make individual choices and decide on a course of action for those who are capable (Beauchamp & Childress, 2013;Cheon et al, 2015). The amount of autonomy is wholly governed by the patient and family acknowledging their cultural/religious preferences.…”