In furtherance of their duties, nurses face numerous ethical dilemmas where no right answer becomes clear. Death is inevitable because all human beings are mortal (Karnik & Kanekar, 2016). However, with the advancement in the medical technology, the norms of natural mortality are now changing because they can mediate during death to extend life. Despite that, they do not hold promises to recovery. Such technological progressions have, therefore, permitted the patients and their caretakers to select from the available preference for treatment during end-of-life care. During such situations, choices have turned out to be of great importance in prolonging life through the support of the technology or allowing the natural death to take in charge (Karnik & Kanekar, 2016). The outcome of this is ethical dilemmas. For this paper, we explore the issues surrounding the independent decision making, the advance orders and care rationing for hopeless treatment. In addition to that, it provides recommendations that can remedy the situation.

With the advances in modern medicine and technology, people are now living longer, increasing the number of older adults in the society. Such advancement has brought about several ethical concerns at the end of life care. Many of the patients who die spend much of their time in ICU which is costly (Alliance & WHO, 2014). There final days in their life consists of unnecessary suffering. The alternative to that is the palliative care which focuses on both prolonging their lives as well as ensuring their comfort and dignity. Regardless of the setting, nurses are essential in transiting from aggressive treatment to palliative care (Alliance & WHO, 2014). In all the transitions, they are required to exhibit numerous ethical and humane decisions while at the same time acting in legal ways to avoid personal liabilities. According to the world health organization, palliative care is one directed to patients with diseases that do not respond to curative treatment (Alliance & WHO, 2014). Such treatment affirms and considers dying as a normal process and therefore does not either postpone or hasten death. The role of such care is to relieve the patient from the pin and other distressing pain.

Delivery of end of life care involves a lot of choices which in most occasions become difficult to give because of their ethical nature and for fear of becoming liable. For instance, prescription of life-sustaining medications such as opioids have a lot of adverse effects, yet some patients require them for comfort. Such and other decisions introduce a lot of dilemma to the nurses and other caregivers. For this section, review the available literature on the ethical issues faced by the caregivers.

During an end of life care, the self-directed decisions are complicated and challenge both the patients and families (Bekkema et al. 2014). Patients have the right to identify their preferences for care delivery. Their independent voice should be respected ethically concerning the application of advanced treatments and prognosis. Despite that, the autonomy right may be limited and thus resulting in an ethical concern. Care providers must uphold respect for the independence of the patient and at the same considering the limitation to institute their responsibilities so that they can benefit the patient without causing any harm to them. Sometimes their autonomy is foregone, yet the right gives the right to direct their cure preferences (Bekkema et al. 2014). They have to acquire the end-of-life care steady to their choices of end-of-life care. All this raises the ethical issue of autonomy and care preferences during the end of life.

Physicians have the responsibility to solve issues. One of the functions of the healthcare professional is to provide detailed information on the advanced medical treatment essential in the end-of-life care (Thorns, 2013). I such occasion, the physicians can avail the required information on benefits, limitations, and drawbacks but the patient has the final say on what treatment to get. For instance, the caregivers and physicians may work following the deontological theory to benefit the patient, but the last say rests on the patient. While the choice of treatment is to the patient, the physician can explain the implication of their choices. The autonomous decision of the patient can allow them to either take medication to delay death or forgo the treatment deemed as hopeless to save on costs and emotive stress of the financial supporters (Thorns, 2013). For instance, if the ill person opts to extend life using advanced means which the physician deems as futile, the physician must explain to the patient about all the factual details to prevent the needless application of resources for a useless cure without harming them. Apart from that, the beliefs and values of the patients should be respected. While the physicians must preserve the lives of the patient, they should not indulge in inflicting more harm to them by way of having continuous futile treatments (Thorns, 2013).

Another ethical dilemma arises when there are advance directives from the patients undergoing end of life care (Brinkman-Stoppelenburg et al. 2014). Such instructions occur in the form of instructional or proxy to guide in making their healthcare choices in case of an occurrence of disability or terminal illness. They provide the patients with a separate independence to obtain end-of-life care that is dependable with their preferences. In situations of incapacitation, the family of the patient acts as the proxy or their primary caregivers and thus having the duty to identify the end-of-life care inclination to the patient on their behalf. Their decisions sometimes are attached to their moral interests such as financial interest and this can influence the choices they make as proxies (Brinkman-Stoppelenburg et al. 2014). In other occasions, the advance preferences may be lacking authenticity requiring renewed evaluation and decision making. Such advance and proxy-based preferences create a lot of ethical dilemmas to the care providers because sometimes they may not lead to the protection of the life of the sick.

It is essential that individuals recognize that they are mortal and that it is relevant to get evidence and make strategies for their care. The existence of the fruitless and costly treatment at the end of life makes it costly for the healthcare delivery and further promoting inequitable health care services (Aslakson, 2016). While the patient autonomy, as well as surrogate autonomy, should be respected, there is a need to evaluate it against the expensive treatment during hopeless situations and the increasing cost of healthcare. Therefore, the patients, as well as families, can opt for comfort care and thus introduce elements of ethical concerns (Aslakson, 2016). Apart from that, even though the advancements in medical technology influence the decisions on the treatment preferences, they do not promise any recovery. They can lead to humiliation and finally become burdensome. Rationing of care in hopeless situations have the most significant good to the society but against the patient autonomy and thus becoming of ethical concern (Aslakson, 2016).

Nurses are relevant in the transition of care of the critically ill patient from aggressive to palliative care. It is a process that requires a lot of ethical and humane decisions because of the choices involved. They become difficult to give because of their moral nature and for fear of becoming liable. They have to uphold respect for the autonomy of the patient and at the same considering the limitation to institute their duties so that they can benefit the patient without causing any harm to them.

While the management of ethical issues prevalent at the end-of-life care remains a challenge, healthcare administrators can play a critical role in addressing them. They can adopt policies and procedures guide whenever such dilemmas arise (Karnik & Kanekar, 2016). Patients, as well as their surrogate, can use them to make informed treatment preferences through the use of appropriate information, prognosis and the options that fit the treatment choices. Both the patient and their proxies can make informed choices about end-of-life care to have their favorites documented. In the occurrence of a divergence between the providers of care and the patient or their proxies, there can be steps to follow such as appointing an ethics committee to deal with the issues at either ethical or legal level.

Apart from that, there is a need to have collaboration among the healthcare organizations towards the development and implementation of the guidelines for deciding the end-of-life care (Karnik & Kanekar, 2016). Such policies can be helpful in instances when the patient chooses to either withhold or withdraw from the available treatment options to prevent occurrences of ethical dilemmas. While the treatment preference rests on the patient, there need to have limitations and with proper disclosures to the available treatment options so that both the patient and their families can be aware of making informed judgments.

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