End-of-Life Care & APRNs: Unraveling Ethical Complexities in Modern Healthcare
Ethical Issues Affecting APRN Practice
In Advanced Practice Registered Nursing (APRN), practitioners are often faced with significant ethical challenges that directly impact patient care, decision-making, and treatment plans. Ethical issues affecting APRN practice are broad and involve a variety of factors such as patient autonomy, end-of-life care, medical technology advances, and more. APRNs must navigate these complexities while adhering to legal and institutional policies, ensuring that patient well-being remains the focus of their care.
End-of-life decisions are particularly complex for APRNs, as they involve life-sustaining treatments (LSTs) and discussions about the quality of life. The goals of care framework (Robinson et al., 2020) emphasizes the importance of purposeful care decisions. APRNs must be prepared to make ethically and legally sound decisions regarding LSTs, ensuring that they align with the patient’s goals and values.
Table: Common Ethical Issues in APRN Practice
| Ethical Issue | Description | Related Legislation / Guidelines |
|---|---|---|
| Life-Sustaining Treatment (LST) | Ethical challenges in deciding whether to continue or withdraw LST. | Bartling v. Superior Court, Brophy v. New England Sinai |
| Patient Autonomy | Ensuring patients’ rights to make their own healthcare decisions. | U.S. Patient Rights, Advance Directive Laws |
| End-of-Life Care | Decisions related to palliative care and discontinuing treatment. | POLST, National POLST Program |
| Advance Directives | Legal documents outlining patients’ wishes for future healthcare decisions. | Living Wills, Healthcare Surrogate Laws |
| Medical Aid in Dying (MAID) | Ethical and legal complexities surrounding assisted suicide. | Oregon Death With Dignity Act, Compassion & Choices |
| Confidentiality and Privacy | Ensuring patient data is kept secure and private. | HIPAA (Health Insurance Portability and Accountability Act) |
| Resource Allocation | Ethical dilemmas related to the fair distribution of medical resources. | National Institute of Health guidelines |
| Informed Consent | Ensuring patients are fully informed before agreeing to treatments. | AMA Code of Medical Ethics |
Reference: National POLST
Ethical Issues in End-of-Life Care
End-of-life care is a critical area where ethical dilemmas arise for APRNs. The decision to continue or withdraw life-sustaining treatments (LSTs) involves balancing the potential benefits of the treatment with the patient’s quality of life and overall prognosis. While advances in medical technology have significantly improved survival rates, they have also created ethical challenges, particularly when these treatments prolong the dying process without improving the patient’s quality of life.
The right to refuse life-sustaining treatment is a bedrock principle in healthcare ethics, and APRNs must understand the ethical and legal framework surrounding this issue. As stated in landmark legal cases, competent patients have the right to refuse LST, and APRNs must ensure their decisions align with both the patient’s wishes and legal guidelines.
The Role of Advance Directives in APRN Practice
Advance directives are essential tools that allow patients to express their wishes regarding future healthcare decisions when they can no longer communicate. These directives come in two forms: the appointment of a surrogate decision-maker and living wills that detail specific treatments the patient does or does not want. APRNs must be well-versed in state laws governing advance directives to ensure they are legally valid and followed.
Advance directives offer APRNs guidance in difficult ethical situations, especially when patients lack decision-making capacity. In such cases, APRNs may rely on a legally appointed surrogate or default decision-maker to make healthcare decisions in line with the patient’s wishes. However, studies show that compliance with advance directives is low, with only about 33% being followed accurately (Yadev et al., 2017). APRNs can play a key role in educating patients and families about the importance of advance care planning.
Medical Aid in Dying (MAID) and APRN Ethical Responsibilities
Medical Aid in Dying (MAID) is another ethical issue that affects APRN practice. MAID, commonly referred to as physician-assisted suicide, is legal in several states, including Oregon, Washington, and California. APRNs practicing in these states may be involved in end-of-life care discussions where patients request assistance in ending their lives.
While MAID is legal in certain jurisdictions, it remains ethically controversial. The practice raises questions about patient autonomy, dignity, and the role of healthcare providers in facilitating death. APRNs must ensure they fully understand their state’s legal framework regarding MAID and remain sensitive to the ethical implications of such requests.
Key Legal Cases Shaping APRN Ethical Practice
Several landmark legal cases have contributed to shaping ethical practices in end-of-life care. In Bartling v. Superior Court (1984), the court affirmed the right of competent patients to refuse life-sustaining treatment. Similarly, Brophy v. New England Sinai Hospital (1986) allowed for the removal of life support from an incompetent patient based on prior expressed wishes. These cases highlight the importance of respecting patient autonomy and underscore the need for APRNs to stay updated on the legal precedents governing their practice.
FAQ: Ethical Issues Affecting APRN Practice
What are the most common ethical issues APRNs face?
The most common ethical issues include patient autonomy, end-of-life care, resource allocation, informed consent, and maintaining confidentiality.
How can APRNs manage ethical dilemmas related to life-sustaining treatments?
APRN can manage these dilemmas by understanding the legal and ethical framework that allows patients the right to refuse treatment and by ensuring that any decisions made align with the patient’s goals of care.
What role do advance directives play in APRN ethical practice?
Advance directives provide a framework for APRNs to follow patients’ wishes regarding end-of-life care when they can no longer communicate, helping to avoid ethical dilemmas.
Is Medical Aid in Dying (MAID) legal for APRNs to participate in?
MAID is legal in certain states, and APRNs in those states may be involved in the process. However, APRNs must ensure they understand both the legal and ethical considerations surrounding MAID.
How do legal cases influence APRN ethical decisions?
Legal cases such as Bartling v. Superior Court and Brophy v. New England Sinai Hospital have set precedents that affirm patients’ rights to refuse treatment, shaping how APRNs approach ethical dilemmas in end-of-life care.