Ethical Dilemma in End-of-Life Nursing Care Decisions
This paper examines an ethical dilemma encountered by an emergency department nurse caring for a 93-year-old patient with advanced Alzheimer's disease. The patient's family, holding power of attorney, requested feeding tube placement despite the patient's terminal prognosis and lack of an advance directive. Using Catalano's (2009) ethical decision-making algorithm, the paper analyzes the nurse's process of data collection, dilemma identification, and outcome consideration. Three potential resolutions are evaluated — feeding tube placement, hospice care, and return to the extended care facility — along with the positive and negative consequences of each. The analysis concludes that hospice care best serves the patient's dignity and quality of life, while acknowledging the emotional complexity facing the family.
- Introduction: Case background and ethical dilemma overview
- Analysis of the Dilemma: Applying Catalano's three-step decision algorithm
- Resolution of the Dilemma: Three possible solutions evaluated for the patient
- Positive and Negative Consequences of the Decision: Pros and cons of each proposed resolution
- References: Cited sources in APA format
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What makes this paper effective
- The paper grounds its analysis in a named, structured framework — Catalano's (2009) ethical decision-making algorithm — giving the argument a clear methodological backbone rather than relying on opinion alone.
- It presents three distinct resolution options and evaluates each on its merits, demonstrating balanced, multi-perspective reasoning rather than arguing for a predetermined conclusion.
- The paper integrates clinical detail (stage three decubitus ulcer, non-verbal status, failure to thrive) with ethical reasoning, showing how factual evidence informs moral judgment.
Key academic technique demonstrated
The paper demonstrates applied ethical reasoning through a structured algorithm. Rather than treating the dilemma in the abstract, it systematically works through data collection, dilemma framing, and outcome evaluation — mirroring the step-by-step logic expected in clinical nursing ethics. This technique shows how a formal decision-making model can organize complex, emotionally charged situations into actionable professional judgments.
Structure breakdown
The paper opens with a case narrative establishing the clinical and ethical context, followed by a section-by-section walk through Catalano's three-step algorithm. A dedicated resolution section proposes and weighs three solutions, and a consequences section explicitly maps pros and cons for each. This four-part structure — context, analysis, resolution, consequences — is a reliable template for applied ethics case studies in health professions writing.
Introduction
This paper narrates an ethical dilemma faced by a nurse working in a local emergency department. The dilemma is analyzed using Catalano's (2009) ethical decision-making algorithm for nurses. Various potential solutions are discussed along with an examination of both the positive and negative consequences of each decision.
The ethical dilemma was related to a 93-year-old patient who was transferred from an extended care facility (ECF). The patient had been diagnosed with Alzheimer's disease. She was unable to eat or drink, which was insufficient to sustain her health. The patient did not respond to voice or touch and was non-verbal. Her physician at the extended care facility had diagnosed her with failure to thrive. Her granddaughter held power of attorney (POA). The patient did not have an advance directive. The patient's family had strongly requested that she be sent to the emergency department to have a feeding tube placed, having been told that "the patient might get better if a feeding tube was placed." The nurse was therefore faced with the ethical dilemma of balancing the family's wishes against the patient's right to a dignified death (Heiser, 2014).
Analysis of the Dilemma
According to Catalano's (2009) ethical decision-making algorithm, the decision-making process begins with assessment. The first step involves the collection, analysis, and interpretation of data, including determining which party will be most affected by the decision. The second step is to clearly state the dilemma — in this case, whether the nurse should fulfill the family's wishes or uphold the patient's right to a dignified death. The third step involves gathering sufficient facts, including potential threats to the patient's life, and using that information to identify possible outcomes (Deshpande, 2009).
In relation to the first step, the nurse assessed the family's wishes. The power of attorney stated that she wanted a feeding tube placed and reported being told at the extended care facility that the patient would improve with nutritional support. Based on her assessment, the nurse found that the family did not understand that Alzheimer's disease is a progressive, irreversible form of dementia (Porth, 2010). The family was unaware that providing nutrition would have no effect on the patient's quality of life or on the progression of the disease. The nurse also considered the patient's physical condition: she was incapable of communication or decision-making and had a stage three decubitus ulcer on her coccyx. Placing a feeding tube would do nothing to improve her quality of life.
The second step confirmed the dilemma: whether to honor the family's desires or to advocate for the patient's right to a dignified death. Moving to the third step, the nurse identified three possible courses of action: having a surgeon place the feeding tube; offering hospice care to the patient and family; or medically clearing the patient and returning her to the ECF. The nurse was required to weigh all gathered information to inform her next steps, with further decisions depending on the potential solutions and their outcomes.
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