Dilemma overlap: conceptual frameworks and intersections

¶ … Overlap

An ethical dilemma that virtually any Advanced Nurse Practitioner can face when he or she is involved in palliative care is encountering a situation in which their patient's ability to get well has been so reduced that the patient's death is a surety. In these situations, the nurse has an ethical dilemma. The crux of that dilemma is whether or not the nurse should continue to administer care -- knowing that to do so is virtually useless -- or to enable the patient to have as much autonomy in his or her life and death by electing to die without additional treatment.

In a case such as this, which can span a range of causes from terminal diseases to sudden, near-fatal accidents, there are essentially two solutions. The first is for the nurse to continue to administer care because doing so is his or her job. Despite the odds, despite the prevalence and imminence of death, the nurse is still employed for the purpose of doing the best to aid the patient. The true ethical part of this situation pertains to the second option, which hinges on the fact that in certain circumstances, the best thing to aid the patient may be to let him or her die. Before this option is considered, the nurse must consult with other health care officials and physicians, as well as family members and the laws governing the state the nurse is practicing in to involve a "multi-disciplinary team" (Brown and Vaughan, 2008, p. 580). Ideally, a uniform decision can be reached either one way or another, which removes a lot of the burden of the ethical dilemma.

Oftentimes, it may be more economically feasible to simply enable a patient to die because lengthy, expensive medical treatment will be eschewed. This method may also be advantageous to a patient who is spared further pain and suffering. Those who might oppose this stance include representatives from the law as well as friends and family, both of which may have their own objectives for doing so.

Advanced Nurse Practitioners can choose to pursue roles as either a Nurse Practitioner or a Clinical Nurse Specialist. Both of these positions require an individual to learn the basic skills and responsibilities of an Advanced Nurse Practitioner. However, there are both similarities and differences in the work that nurse practitioners and nurse specialists perform. As such, there is a fair amount overlap in the duties these professionals can perform.

The principle duty of a nurse practitioner is to provide primary care to patients. Practitioners can specialize in a number of different areas of service, including women's health, family health, geriatrics, and others. Nurse specialists, however, do not provide primary care and specialize according to type of care, population, disease etc. These two different professionals may actually work in the same area of specialization, with practitioners providing primary care for patients in them whereas the work of specialists is substantially more specialized.