Ethical Issues in Long-Term Care End-of-Life Decisions
This paper examines the ethical issues arising in a long-term care setting through the case of Mrs. Beaudoin, a patient with advanced cancer, heart failure, moderate dementia, and severe brain injury. Because Mrs. Beaudoin lacks the capacity to make her own healthcare decisions and has no formal power of attorney, the paper addresses who serves as the appropriate substitute decision-maker, how disagreements among potential surrogates should be resolved, and whether a patient's expressed wish to prolong life must be honored regardless of suffering. Drawing on core bioethical principles — autonomy, beneficence, non-maleficence, justice, and the best-interest standard — the paper argues that end-of-life decisions must prioritize the patient's welfare over the fulfillment of stated desires when doing so would cause undue harm.
- Introduction: The Ethical Dilemma: Overview of Mrs. Beaudoin's medical and ethical situation
- Core Ethical Principles in End-of-Life Care: Beneficence, non-maleficence, autonomy, and justice applied
- Identifying the Appropriate Substitute Decision-Maker: Why eldest daughter is the appropriate surrogate
- Resolving Disagreements Among Multiple Decision-Makers: How to handle surrogate conflict in long-term care
- Must Everything Be Done to Prolong Life?: Patient wishes versus harm-causing interventions
- Conclusion: Bioethical principles guide end-of-life administration
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What makes this paper effective
- The paper grounds abstract ethical principles — beneficence, non-maleficence, autonomy, and justice — directly in the facts of a specific patient case, making theoretical concepts concrete and applied.
- It follows a structured Q&A format that moves logically from identifying the ethical dilemma, to naming the surrogate, to resolving surrogate conflict, to addressing the hardest question: whether a patient's stated wish to live must always be honored.
- Citations are well distributed across the argument, drawing on peer-reviewed nursing ethics, biomedical ethics, and institutional guidance to support each claim.
Key academic technique demonstrated
The paper demonstrates applied ethical reasoning: it does not simply list principles but uses them as analytical tools to evaluate specific decisions. For example, the non-maleficence principle is invoked not abstractly but to argue against prolonging Mrs. Beaudoin's life through interventions that would cause suffering without meaningful benefit — showing how bioethical frameworks resolve real clinical conflicts.
Structure breakdown
The paper opens with a narrative overview of the ethical situation, then systematically addresses three case-specific questions: who the substitute decision-maker is, what happens when surrogates disagree, and whether the patient's desire to live to 100 obligates maximum intervention. Each section integrates principle-level analysis with case-level application before the references close the paper.
Introduction: The Ethical Dilemma
Mrs. Beaudoin faces a serious ethical dilemma given that she does not have a formal power of attorney and her husband, who also resides in the same facility, has moderate dementia and is very frail. The central ethical issue is that Mrs. Beaudoin's health is failing steadily. She is known to have cancer throughout her body, a failing heart, moderate dementia, and Type II diabetes. Following a cardiac arrest and a brief stay in the intensive care unit, she suffered a severe brain injury caused by insufficient oxygen. Because she cannot make healthcare decisions on her own, and her husband's condition is equally compromised, the critical ethical question becomes: who will make healthcare and end-of-life decisions on her behalf?
Mrs. Beaudoin's brain injury and inability to consume enough calories to sustain her body weight mean her health continues to decline. A further ethical dilemma arises because the presumptive substitute decision-maker — her eldest daughter — disagrees with the assessment of the care team. She objects to a treatment plan focused solely on comfort care and the exclusion of CPR. Mrs. Beaudoin does not appear to be leading a meaningful life, and there is a real concern that the team's efforts to keep her alive are causing her suffering. The ethical issues at stake broadly include the patient's capacity to make decisions, the right to refuse treatment, the withdrawal and withholding of life-sustaining treatment, hydration and nutrition, assisted suicide, and no-code decisions (McCabe & Coyle, 2014).
It is the responsibility of the acting long-term care (LTC) administrator to maintain an approach consistent with ethical decision-making and to implement decisions that are morally sound (Thorns, 2010). The administrator must possess sufficient facts, knowledge, and experience regarding Mrs. Beaudoin's condition and the expected prognosis. Moreover, the administrator must be willing to collaborate and communicate effectively with colleagues in order to arrive at decisions that serve the patient's best interests (Thorns, 2010).
In order to deliver medically and ethically appropriate healthcare decisions for patients without surrogates and for patients who lack decision-making capacity, several factors must be considered. Any decision made without knowledge of what the patient would specifically have wished for must be made in that patient's best interest (Santa Clara University Markkula Center for Applied Ethics, 2019). Appropriate care decisions are defined by the provision of beneficial ethical interventions and the avoidance of interventions that offer no benefit or that would impose a burden on the patient. Interventions that contravene generally accepted healthcare standards or that are medically ineffective must be avoided (Santa Clara University, 2019).
References
Hamilton Health Sciences (2015). Making decisions for others: Your role as a substitute decision maker. Retrieved 21 March, 2019 from
Holt, J. (2017). Ethical issues at the end of life. In Key concepts and issues in nursing ethics (pp. 129–143). Springer International Publishing. https://doi.org/10.1007/978-3-319-49250-6_10
Macauley, R. C. (2018). Ethics in palliative care: A complete guide. Oxford University Press.
McCabe, M. S., & Coyle, N. (2014). Ethical and legal issues in palliative care. Seminars in Oncology Nursing, 30(4), 287–295. https://doi.org/10.1016/j.soncn.2014.08.011
Santa Clara University (2019). Healthcare decisions for incapacitated patients without surrogates. Markkula Center for Applied Ethics. Retrieved 21 March, 2019 from https://www.scu.edu/ethics/focus-areas/bioethics/resources/healthcare-decisions-for-incapacitated-patients/
Schroder-Back, P., Duncan, P., Sherlaw, W., Brall, C., & Czabanowska, K. (2014). Teaching seven principles for public health ethics: Towards a curriculum for a short course on ethics in public health programs. BMC Medical Ethics. BioMed Central Ltd. https://doi.org/10.1186/1472-6939-15-73
Shulman, R. (2016). Consent for treatment and conflicts between substitute decision makers: Options for resolution. Retrieved 21 March, 2019 from https://www.allaboutestates.ca/conflicts-substitute-decision-makers/
Thorns, A. (2010). Ethical and legal issues in end-of-life care. Clinical Medicine, Journal of the Royal College of Physicians of London. Royal College of Physicians. https://doi.org/10.7861/clinmedicine.10-3-282
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