What Are Three Common Ethical Issues That Arise at the End of Life?

Some common ethical issues present at the end of life include compromised patient autonomy, shared decision-making, and the principle of double effect. Ethical dilemmas often arise in end-of-life scenarios where medical best practices conflict with patient or family preferences. Understanding the likelihood of these ethical issues and the principles at their foundation can help you anticipate and navigate them in the future should the need arise. 

Respect for autonomy is characterized as the ability to respect the patient’s right to determine the next steps in their care and support their decision-making capability. When patient autonomy is compromised, issues can manifest in a variety of different ways. When patients have specific preferences regarding their treatment, the care team must respect the patient’s autonomy and deliver the most appropriate care without compromising that autonomy. However, ethical issues may emerge when the patient’s wishes and preferences are not acknowledged and supported by their partner, family or surrogate. Without proper documentation, such as advance directives, patient autonomy can be compromised and can have negative implications on the patient’s care. 

Decision-making is integral to end-of-life care settings, but can quickly become an ethical issue when shared decision-making is used to make decisions on the patient’s behalf that are not aligned with their preferences and values. Being mindful of who is designated as a surrogate decision-maker can be crucial, especially in instances where the patient is incapacitated and unable to make decisions on their own. Ethical issues are likely to occur when faced with decisions regarding artificial nutrition and hydration, mechanical ventilation, terminal sedation, withholding or withdrawing treatments, and resuscitation. 

Additionally, although actions may be taken to ease or relieve the patient’s symptoms, sometimes these can intersect with ethical concerns as well. For example, medication may be administered to manage a patient’s pain levels, but may hasten the patient’s death due to the potential to decrease respiration. This is known as a double effect; the intended effect is to decrease the patient’s pain, whereas the unintended effect results in decreasing their respiratory rate. Although the care team aims to provide appropriate pain management for the patient and minimize as much harm as possible, the patient’s family may perceive that the undesired effect of the medication causes harm. In many instances, the care team will need to discuss the moral and ethical intent of such treatments with the patient’s family or loved ones so that they understand the implications of these decisions.  

Sources 

“Ethical concerns in end of life care.” Milne Library. https://milnepublishing.geneseo.edu/nursingcare/chapter/ethical-concerns-in-end-of-life-care/ 

“Ethical considerations at the end of life care.” SAGE Open Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC7958189/ 

“Ethics and palliative care: a case of patient’s autonomy”. Journal of Medical Ethics and History of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC10151720/