Quandary at the crossroads: paternalism versus advocacy surrounding end-of-treatment decisions.

The moral and ethical basis for promoting the patient as ultimate decision-maker regarding his or her treatment plan is advanced. The practice implications of differing educational and historical backgrounds of physicians and nurses is addressed. Paternalism and maternalism are examined. These traditional roles are contrasted with the emerging provider role as patient advocate. Recommendations are suggested for improved physician/ nurse/patient interaction in the resolution of ethical dilemmas in a highly complex health care arena.