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Ethical Challenges in Nursing: Honouring Patient Autonomy in End-of-Life Care. Need Assignment Help?
One of the most challenging ethical dilemmas I have encountered in nursing involved respecting a patient's autonomy in end-of-life care while navigating family disagreements. Specifically, a patient with advanced dementia and a do-not-resuscitate (DNR) order was repeatedly subjected to aggressive medical interventions because a family member insisted on full resuscitative efforts, despite the patient's legally documented wishes (Atkinson Smith et al., 2020).
I selected this ethical challenge because patient autonomy is a fundamental principle in nursing and healthcare. In end-of-life situations, conflicts often arise between what patients have decided for themselves and what their families desire. These conflicts can lead to moral distress for nurses and other healthcare providers who must balance ethical responsibilities while supporting both the patient and their loved ones. Ensuring that a patient's wishes are honored is crucial to providing ethical, patient-centered care and preventing unnecessary suffering (Atkinson Smith et al., 2020).
In this particular situation, the patient had an advance directive specifying a DNR status. However, when the patient's condition worsened, a close family member insisted that all possible interventions be performed, including CPR and intubation. Nursing staff, including myself, were placed in a difficult position. Following the DNR order meant respecting the patient's autonomy, but it also meant challenging the family member's emotional and deeply held beliefs about prolonging life. The family member repeatedly pressured staff to override the DNR order, stating, "I don't care what the paperwork says-do whatever it takes to keep them alive."
To address this ethical challenge, the healthcare team-including physicians, nurses, the hospital's ethics committee, and social workers-held multiple meetings with the family to explain the legal and ethical importance of honoring the patient's advance directive. The chaplain and social worker provided grief counseling and emotional support to help the family process the situation. When discussions failed to resolve the conflict, the hospital's legal team stepped in to clarify that the healthcare team was obligated to follow the patient's documented wishes. Eventually, after continued discussions, the family member reluctantly accepted the decision, though they remained distressed.
I believe the approach taken was appropriate. The team prioritized the patient's rights while also demonstrating compassion for the family's grief and distress. By involving multiple disciplines in ethics, legal, social work, and pastoral care we ensured a well-rounded, patient-centered approach to resolving the conflict (Gomez-Vírseda et al., 2020). However, looking back, I believe earlier involvement of the ethics committee and legal team could have helped reduce emotional distress for both staff and the patient's family. Additionally, this situation highlighted the need for better education on advance directives. Families should receive clear explanations about what DNR orders mean before a crisis arises to help prevent future conflicts. Instead of multiple discussions over time, I would have preferred a structured family conference earlier in the process to set clear expectations and address emotional concerns proactively.
This experience reinforced the importance of advocating for patient autonomy while also supporting families in difficult decisions. Ethical challenges in nursing often involve emotional, legal, and ethical complexities, but by following ethical principles and engaging in compassionate communication, we can navigate these challenges while upholding the highest standards of care.