What to Do When the End Is Near: Ethical Issues in Home Health Care Nursing

Authors

  • Rosalind Ekman Ladd Ph.D.,

    1. Rosalind Ekman Ladd is Chair and Professor of Philosophy, Wheaton College, Norton, Massachusetts and Professor of Philosophy, Brown Medical School, Providence, Rhode Island. Lynn Pasquerella is Chair and Professor of Philosophy, University of Rhode Island, Kingston, Rhode Island. Sheri Smith is a Professor of Philosophy, Rhode Island College, Providence, Rhode Island.
    Search for more papers by this author
  • Lynn Pasquerella Ph.D.,

    1. Rosalind Ekman Ladd is Chair and Professor of Philosophy, Wheaton College, Norton, Massachusetts and Professor of Philosophy, Brown Medical School, Providence, Rhode Island. Lynn Pasquerella is Chair and Professor of Philosophy, University of Rhode Island, Kingston, Rhode Island. Sheri Smith is a Professor of Philosophy, Rhode Island College, Providence, Rhode Island.
    Search for more papers by this author
  • Sheri Smith Ph.D.

    1. Rosalind Ekman Ladd is Chair and Professor of Philosophy, Wheaton College, Norton, Massachusetts and Professor of Philosophy, Brown Medical School, Providence, Rhode Island. Lynn Pasquerella is Chair and Professor of Philosophy, University of Rhode Island, Kingston, Rhode Island. Sheri Smith is a Professor of Philosophy, Rhode Island College, Providence, Rhode Island.
    Search for more papers by this author

Address correspondence to Lynn Pasquerella, Chair, Department of Philosophy, 183 Chafee Building, University of Rhode Island, Kingston, RI 02881. E-mail: paski@snet.net

Abstract

As managed care shortens the length of hospital stays, home settings for the practice of nursing will become increasingly important. In spite of community health nursing's long tradition of family-centered care delivered in the home, many discussions of the nurse/patient relationship in the medical ethics literature assume the hospital setting for the practice of nursing and seem to neglect the impact of family and significant others for the nurse/patient relationship. Through a case-based analysis, this article highlights the special ethical and legal issues encountered in caring for patients who are dying at home.

This analysis demonstrates that traditional frameworks for the nurse/patient relationship are inadequate for capturing the richness of the relationship the home health care nurse has with both patient and family. By developing a new framework for the nurse/patient/family relationship that (a) recognizes the patient's decision-making authority and autonomy, (b) allows the exercise of the nurse's moral rights, and (c) recognizes the patient's relationships to significant others, the authors attempt to resolve some challenging legal and ethical questions concerning who should be allowed to decide what to do when the end is near. The discussion details the implications of this framework for nursing assessment in the home care setting.

Ancillary