Nursing Essay

Subject: Nursing

Topic: End of life elective: Ethical issues in the provision of end of life care


Ethics in medical practices continue to be the issue of great concern for health practitioners around the globe. In providing end of life care, nurses and health care provider deal with single patient or his family and main objective is to make patient comfortable. With the advent of accelerated medical advancement, health care professionals undergo numerous ethical conflicts in providing palliative care. Medical professionals still face enormous confusion for legal and ethical permissible act to deal with end of life care (Department of Health care, 2011). This research study scrutinizes array of ethical issues in the provision of end of care from diverse business literature. The focus of the study is to elaborate the process of adoption of ‘opt-out’ system of organ donation in Australia. Medical reports have shown that organ donation in Australia has low rate and is on 17th rank in the world (International Registry of Organ Donation & Transplantation, 2009). In Australia, USA and Finland, government implemented an 'opt in' system and made consent legal guideline in which people have right to show willingness and communicate to medical authorities to donate organs after death. In this study, output system of organ donation is elaborated from ethical viewpoint and logical arguments are provided to support this practice. .

Numerous ethical issues in the provision of end of life care:

In today’s technical era, medical knowledge is advanced and provides numerous alternatives for healthcare practices to improve the health status of populace. When medical practitioners deal with critical patients, there are array of ethical issues arise to take decision about treatment techniques. These moral issues for the end of life emerge because doctors have to decide what kind of care has to be given for patients who are terminally ill. . Ethical principles of non-maleficence associated with organ donation that disallows medical doctors from intentionally hurting their clients. This ethical rule permits medical authority to perform medical practices with the consent of patient, or harms that are essential for improving the quality of life.

Role of Nurses in providing end of life care:

In providing end of life care, there is significant role of nurses. Medical scholars consider that basic ethical standard in nursing are independence, beneficence, non malfeasance, fairness, discretion, reality, loyalty, responsibility of the environment and work as an being specialized nurse (NZNO, 2010). It is the main task of nurse to follow legislative guidelines and maintain moral standards of nursing when dealing with end of life care patients. Numerous research studies have shown that expert nursing care is needed in the last stage of life of person because nurses spent most of the time with patients. Nurses enable the patients to grow in the dying experiences. In this period, terminally ill patients experience that he is in the process of healing, transformative under the guidance of professional nurses (Kim, 2011). Nurses can influence patients and family and develop policies for end of life care. For example Medicare benefit, arranging community resources for family or fund raising (Wilkins, 2007). For stress management of dying patients, nurses focuses on professional knowledge, experience the trauma of patient’s illness, accept the reality of death, identify the pain and distress with sensitivity and relate sympathetically with the dying person in acceptance of impending death (Matzo, 2010).

The principle of double effect and its application to issues in end of life:

In maintaining medical ethics, the Principle of Double Effect is considered to handle the patients who are in dying stage but many physicians are not knowledgeable about this concept and develop negative attitude when treating critical patients. The principle of double effect espouses the decision where intention was positive but outcome was not satisfactory. According to this concept, medical practitioners take decision in a manner that the positive effect of the decision made will overshadow any potential negative effects it causes. The negative outcome may be foreseen but it is not intentional (Pettifer, 2012). Generally, principle of doubt effect is the terminology used to support the practice of terminal sedation (Keegan, 2011)

Ethical issues in decision making to withhold or withdraw medical treatment:

There are multiple challenges in decision making process in end of life care such as whether to continue feeding tubes, nitration or life sustaining machine. When all efforts fail then patient’s family rely on legal system developed for such situations (Keegan, 2011). It was established that doctors have fully realized the importance of patient’s consent in medical decision. Medical ethics such as the principle of autonomy, or patient’s right to decide about his life is considered as significant in contemporary American biomedical ethics (Pettifer, 2012). Bulk of medical literature revealed that cancer patients are given chance to show their willingness about type of care they need at this stage and doctors provide full support and respect their wishes (Mack, 2010). But main issue is that some patients are critical who cannot exercise autonomy and decide to sustain or withdraw treatment. There is a general consensus that practitioners may withdraw or withhold life support system in patients who are at the end of their life and this is not considered intentional killing of patients (Miller, 2009). There are some religious values that impact on decision-making in health status by patients and their families in terms of chronic conditions to withdraw life support system and artificial nutrition. It has been observed in Australia that medical practitioners confer differences between dissimilar religious traditions on the concern of removal of treatment. According to catholic viewpoint, intentional killing of patient is wrong doing and not considered ethical medical practices no matter it can lead to positive outcome (Australian Catholic Bishops’ Conference, 2005). An Anglicanism concept of religious standpoint includes range of concepts in withdrawing the life support system in vegetative stage of person. Some religious group supports this view to withdraw treatment while others are against this perspective and state that life must be extended. A conventional Jewish perception denoted that a patient whose is at dying stage is fully authorized to donate its organ to save other living being (Steinberg, 2003). In another religion of Islam, it is described that human life is gift of God and physicians have no authority to withhold treatment ( Abdolkarim, 2000). It can be established that spiritual values have significant influence on medical practices for end of life care and taking critical decision in this regard improve the quality of life.

Adopt an ‘opt-out’ system of organ donation in Australia:

Medical field is so advanced that people at dying stage can also donate their organs to support people who can survive with organ transplantation. It gives life to huge number of people in the world through adopting competent medical practices and maintain ethical and legal standard to make healthy society. Plethora of medical studies indicated that organ transplantation has major drawbacks of non availability of organs. This leads to potentially unnecessary death and morbidity in populace. Though in many countries, medical techniques are modernized and numerous sources are available to arrange organs for needy people, but range of ethical and legal issues are associated with it. According to statistical reports, number of people dies per day in controlled situations in hospital and their organ can be used to give life of other critical patients. But due to family disagreement or ignorance, such organs are cremated and do not use for medical purposes to save the life of people. The one significant process to meet out the demand of organ transplantation is opt-out approval systems for organ donation which is considered in many countries to enhance the quality of life people. Reports indicated that such transformation in legal framework will definitely augment the donation rate in the US or UK ( Rithalia, 2009). The same contemplation is also advocated to changes in the source of organs. The concept of organ donation is emerged in the development of brain-death condition in the end of 1960 (Veatch, 2010). In organ transplantation, array of moral issues are considered to establish the suitability of a planned organ transplant procedure. It has been shown in health literature that the strategies for organ transplantation may be advantageous for many patients.

Among range of medical practices in organ donation, the current "opt-in" system of organ donation is an effectual method to save people and preserve moral standard in medical field. In this procedure, person is given a choice to register their enthusiasm to be a donor after death but this practice is matter of heated debate among health professionals and policy makers. It is apparent that there is scarcity of organ donors and resulting waiting lists for transplant operations in many countries. Therefore many experts advocated that unselfish approach to donate organs must be promoted to fulfill the requirement of organ donation and support critical people who can survive with transplantation (Price, 2012). An output system retain ethical standard and it is altruistic act to donate organs to needy people. Australia has struggled a lot in the practice of organ donation. When reviewing the conditions of Australia, it is demonstrated that in the country, organ donation rate is increased by 15 percentages between 2009 and 2012. But still Australia is lagging behind in these practices and it will take time to match with other countries (Jean, 2013). Presently, Australia adopted an opt-in organ and tissue donation system but still it is not reaching to that height to fulfill the demand of organ donation. Reports revealed that Australians in teens have shown interest to donate organs and donation rate was more than four million in the year of 2012 (Australian Government, Department of Human Services. 2012). Many nations which have already utilized this practice, noticeable increase in donation rate have been observed. There is a need to generate awareness and effective leadership by health organization to supports local recovery arrangements (NSW Government, 2011). It has been observed that deep wakefulness in Australia’ about the organ donation has augmented (DonateLife. 2012).

Taking the example of Chronic kidney disease which is long-term and usually permanent loss of kidney function and transplantations the best treatment (AIHW 2009). In Australia, this problem is highlighted because numbers of donors are less. In many cases, family members donate kidneys to patients (ANZDATA 2009). An output system of donation will best serve this purpose. There must be legal guideline that no return for donation and latent donor is still alive but no guarantee of cure (Zeiler et al 2008). In Australia, other significant moral issue for organ donation is least number of Aboriginal patients on the transplant waiting list (ANZDATA 2009).


To sum up, this study systematically appraised the range of ethical issues faced by medical practitioners to provide end of care. The paper mainly accentuated the moral concern about organ donation and adopting output system to meet the demand of recipient for enhancing quality of life in Australia. Reviewing the bulk of medical literature, it is concluded that there are significant ethical problems and legal hindrance for health care providers to tackle end of care. It is need of the hour to assign suitable resources to health care providers and policy makers and design effectual medical; practices to enhance quality of care in fatal stages of life. The findings of this research study assist to provide ethical strategies for good decision-making in end-of-life care. Numerous religious beliefs such as catholic, Jewish interrupt in providing end life care. All these beliefs have some merits and demerits. Statistical reports signified that Australia comes under the category of lowest rate of organ donation (Prakoso et al 2010). The output system of organ donation is beneficial for populace as it permit the person to willingly donate their organs though numerous ethical issues are involved. In contemporary situation, Australia has a ‘opt in’ system for organ donation where person can make own decision for donating organs. This practice has many advantages over traditional practices for organ donations. Medical reports revealed that there is a severe shortfall in organs for transplant in Australia. It can be overcome by creating medical awareness program.

Abdolkarim S. Reason. (2000). freedom and democracy in Islam. Oxford: Oxford University Press.

AIHW (2009). An overview of chronic kidney disease in Australia, Australian Institute of Health and Welfare, Canberra, Available from:

ANZDATA (2009). ANZDATA Registry Report (2009), Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Available from:

Australian Catholic Bishops’ Conference. (2004). Briefing note on the obligation to provide nutrition and hydration Sep 3. Available at: (accessed Oct 2005).

Australian Government, Department of Human Services.( 2012), AODR Statistics, Canberra, ACT. (available from: accessed 07/2012

Department of Health care, (2011). How people die remains in the memory of those who live on.’

>DonateLife. (2012), Facts and Statistics, Canberra ACT. available from: accessed 07/2012)International Registry of Organ Donation & Transplantation, (2009).

Jean, Peter. (2013). Learning lessons on organ donation. Kim S.( 2011). Development and initial psychometric evaluation of nurses' ethical decision making around end-of-life care scale in Korea. J Hosp Palliat Nurs.;13(2):97–105.
Keegan Lynn, Carole Ann Drick. (2011). End of Life: Nursing Solutions for Death with Dignity. Publisher: Springer Publishing Company.
Mack JW, Weeks JC, Wright AA, et al.(2010). End-of-life discussions, goal attainment, and distress at the end of life: predictors and outcomes of receipt of care consistent with preferences. J Clin Oncol 28:1203.
Meilaender G.(2005). Bioethics: a primer for Christians. 2nd ed. Grand Rapids, Mich: Eerdmans, 65-74.
Mateos-Rodriguez, A., Pardillos-Ferrer, L. et al (2010). 'Kidney transplant function using organs from non-heart-beating donors maintained by mechanical chest compressions', Resuscitation, 81 (7), 904-907.
Miller F.G., R.D. Truog & D.W. Brock.(2009). Moral Fictions and Medical Ethics. Bioethics published online 7 Jul 2009.
New Zealand Nurses Organisation, (2010). Code of ethics. Wellington, New Zealand: New Zealand Nurses Organisation. NSW Government, Department of Health. (2011), Increasing Organ Donation in NSW, Sydney NSW. (available from: increasing_organ_donation.pdf accessed 07/2012)
Pettifer Annie. (2012). Joanna de Souza End-of-Life Nursing Care. Publisher:SAGE.
Prakoso, E., Verran, D. et al (2010). 'Increasing liver transplantation waiting list mortality: a report from the Australian National Liver Transplantation Unit, Sydney', Intern Med J, 40 (9), 619-625.
Price DPT.(2012). Legal framework governing deceased organ donation in the UK. Br J Anaesth;108(Suppl. 1):i68-i72.
Rithalia A, et al. (2009). Impact of Presumed Consent for Organ Donation on Donation Rates: A Systematic Review BMJ. 2009
Sixty-Third World Health Assembly, May (2010), Resolution WHA63.22. Available from accessed October 16 2011
Steinberg A, Rosner F.(2003). Encyclopedia of Jewish medical ethics. Jerusalem: Feldheim.
Veatch RM. (2010). Transplanting heart after death measured by cardiac criteria. The challenhe to the dead donor rule. Journal of medicine and philosophy. (35) June
Zeiler, K., Furberg, E. et al (2008). 'The ethics of non-heart-beating donation: how new technology can change the ethical landscape', J Med Ethics, 34 (7), 526-529.