Ethical Legal Dilemma in Advanced Nursing Practice

Ethical Legal Dilemma in Advanced Nursing Practice

Assisted suicide

In most organizations, there are ethical principles that guide members in decision making. In hospital setting, nurses and health professionals have ethical principles that guide them in decision making. The core ethical principles in nursing involve beneficence, maleficence, and respect for autonomy, fairness, truthfulness and justice. (American Nurses Association, 2016) Advanced nursing involves greater level of responsibility, decision making and autonomy. Ethical dilemma occurs when the nurse choice of action is not exactly what the client wants. When the care giver and service consumer don’t agree, this becomes an ethical dilemma which can also be a legal dilemma if the law is against the decision. Assisted suicide or assisted euthanasia is one of the ethical legal dilemmas that nurses commonly face. Assisted suicide is when a patient wishes to die and seeks the nurse assistance in completing this mission. (Cherry & Jacob, 2016) This is an issue that involves life and death hence needs a lot of consultations of the ethical principles and the state of the law. This essay will discuss in detail, a case study in which an advanced nurse is faced with an ethical legal dilemma at the administration level.

The case

Mr. Jones is 89 year old patient who has been in palliative care for the past one and half year. He was diagnosed with skin cancer two years ago and since then, his condition has been deteriorating. The cancer has metastasized to the lungs making perfusion for the patient almost impossible. The patient has been on mechanical ventilator for the past six months. Once in a while, the patient can do without the mechanical ventilator but put him at risk of apneac attacks. Most often, Mr. Jones   goes to cardiac arrest following poor perfusion and resuscitations have been successful so far. Most importantly, this patient experiences a lot of pain following skin breakage especially in the pressure areas. The patient has also been showing signs of depression in the past few months which is quite reasonable based on the challenges he has been facing. The patient spouse died two years ago and only his son and daughter come to visit him at the centre. This case has however become an ethical legal dilemma to the nurse in charge because the patient constantly insists that they want to die and need assistance in doing so. The patient explains that the suffering has become unbearable and death would be a great relief for them. They further explain that they have lived the best days of his life and don’t want to end them in suffering. The patient insists that the nurse should not inform his children on this decision because he wants them to see his death as natural. The nurse becomes in dilemma because codes of conduct don’t allow her to assist in self harm yet the patient insists that death is what will be best for them.

Violation of ethical principle and law

If the nurse agrees to the patients wish, they will break the ethical principle of non-maleficence, and truthfulness. Non maleficence principle states that one should do no harm in the process of care delivery. Assisting a patient in suicide is definitely assistance in self harm. The nurse is also expected to commit the act without letting the children know. The patient seeks assistance through removal of the ventilation and lack of resuscitation.  Euthanasia or assisted euthanasia is illegal in most of the states in America. The patient request hence puts the nurse in a matter that could lead them to lawsuits too.  This issue becomes an ethical dilemma because other ethical principle states that caregivers should respect the patient’s autonomy. This case hence presents one complex ethical legal dilemma.

Decision making

In ethical dilemmas, it’s really challenging to make a solid decision that both parties will be okay with. However, with the administrative role, decision making is quite crucial and inevitable.  The nurse will hence review the patients concern and do what best for both the nurse and the patient. (Frankie, Billson et al, 2016)The advanced nurse practitioner hence reviews the patients concern and evaluates what best for them. In this case, the patient has undergone much pain and views death as their way of pain alleviation. The nurse can hence consider improved methods of pain alleviation. Concentrate most on the best ways to improve the patient quality of life so they can live their dying stage with integrity. The patient is also going through depression episodes hence bringing a counselor would be beneficial as well as improving the family bond of the patient. This would be the best course of action for this case because it reduces chances of lawsuit for the nurse as well as improves quality of life for the dying patient.

Legal concerns

                Most states clearly indicate that euthanasia or assisted euthanasia is illegal and a criminal offence. The law breakers are hence charged with murder. (Parran, Learry, 2016)The court considers it as breech of the ethical principle of non maleficence. Non maleficence mandates that care givers should do no harm to their service consumers. Assisting patients in dying is legally considered as harming them.

Example evidence on the legal concern on assisted suicide is the may 31, 2013 law declaration of Maine.  The states legislature refused to decriminalize assisted euthanasia or even voluntary euthanasia. In addition, California court charged two physicians with murder for assisting patient to die by withdrawing medication and all the support system. The physicians were charged with murder despite clear evidence that the family request for the euthanasia.

Difference between legal and ethical reasoning

Legal reasoning is generally focusing on the set laws and avoiding breaking laws. Laws have charges and clearly defined. Ethical reasoning on the other side focuses on human definition of what right and what wrong. ( Vaughn, 2015) Therefore an action could be legal but unethical. In this case, murder is illegal and that has been employed as part of the consideration in decision making for this case. Ethical reasoning has also been employed in this case study where the nurse chooses truthfulness even though it’s not necessarily illegal to withhold patient’s information if that’s their choice.


To start with, I highly recommend training of the health personnel frequently on ethical and legal issues. This is because ethical dilemmas can be very challenging even for advanced practitioners and some consequences can be avoided with knowledge acquisition.( Dwarswaard & Bovenkamp, 2015) I also recommend the effective use of the problem solving process appropriately. This will help practitioners from being crowded with thoughts. Critical thinking would also be essential in solving dilemmas. ( Morton, Fontaine et al 2017) I therefore recommend equipping health professionals with critical thinking skills through continued training and use of rationales.


    In conclusion, ethical legal dilemmas put the health professional in a very challenging position but this can be overcome through thorough training. Assisted euthanasia is illegal in most states hence the nurse should always familiarize with the laws to ease their decision making process. Ethical principles will also highly help nurses in their activities hence all nurses should be equipped with this knowledge.















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Francke, A. L., Albers, G., Bilsen, J., de Veer, A. J., & Onwuteaka-Philipsen, B. D. (2016). Nursing staff and euthanasia in the Netherlands. A nation-wide survey on attitudes and involvement in decision making and the performance of euthanasia. Patient education and counseling, 99(5), 783-789.

Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a holistic approach (p. 1056). Lippincott Williams & Wilkins.

Parran, L., Elison, K., Leary, E., MacDougall, H., Otterlei, L., Warlick, E., … & Defor, T. E. (2016). Lawyers Partnering with the BMT Team: Impact on Patient Perception of Legal Concerns and Well-Being. Biology of Blood and Marrow Transplantation, 22(3), S108-S109.

Vaughn, L. (2015). Doing ethics: Moral reasoning and contemporary issues. WW Norton & Company.