Ethical dilemmas and nursing.

Professional responsibilities, tradition, and personal conscience along with legal, philosophical, and religious convictions dictate nursing interventions. Inevitably, these factors embrace life-sustaining therapies; however, in view of complications, prognosis, pain and suffering, and their own views of quality of life, some patients express wishes inconsistent with life-sustaining measures. In other situations, the health care provider as well as the patient may view heroic efforts as more debilitating than resortative. Resolving the conflict while preserving the patient's best interests requires a confrontation with the status of "do-not resuscitate" policies within th e nurse's institution, informed consent, refusal, and competency as the necessary underpinnings for the development of an ethical and legal posture within the profession, with which to approach significant decisions regarding life-sustaining therapies. Literally every hour of every day nurses are immediately and directly involved with resolving ethical dilemmas based upon judgements and interpretations of oral or written orders, patient and family wishes, professional training, and an infinite number of other factors. When clear policies or orders are lacking, the nurse is left with the burden of making a life or death decision. It is imperative that professional nurses assess the administrative, legal, and ethical ramifications of their actions in terms of ethical codes of practice, patients' rights, institutional and personal liability, civil and criminal laws, and private conscience. An understanding of these issues, passive and active euthansia, state and national trends, and uniform legislation can assist in resolutions of the no-code dilemma. Nursing as a profession must strive to develop sound and consistent guidelines and rationale for the scope of practice in ethical dilemmas.