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End-of-Life Issues: Ethical Issues

3.5 Contact Hours
Target Audience: Nurses, healthcare professionals, and interested individuals
Purpose/Goal: The outcome of this course is for the learner to describe the tools necessary to make ethical decisions when providing care for patients at the end of their lives.
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End-of-life care presents health care professionals with many ethical challenges and dilemmas. Understanding ethical theories and ethical principles can provide a foundation for decision making. This course provides health care professionals with the tools necessary to make ethical decisions when providing care for patients at the end of their lives. Key ethical issues related to end-of-life care, including advance directives, euthanasia, medical futility, do-not-resuscitate (DNR) orders, pain management, terminal hydration, organ donation, and considerations for the neonatal and pediatric patient are examined. In addition, guidelines for dealing with ethical dilemmas are also provided.

Upon completion of the course, you will be able to do the following:

  • Describe the role of ethics in end-of-life care in health care today.
  • Define ethics.
  • Describe the key elements of the ethical theories of utilitarianism, deontology, Ross's ethics, natural law ethics, ethical egoism, and virtue ethics.
  • Describe the key ethical principles of autonomy, beneficence, nonmaleficence, veracity, confidentiality, justice, and fidelity.
  • Outline a method for analyzing ethical dilemmas.
  • State the relationship between culture and ethics.
  • Define brain death.
  • List key items from the Dying Patient's Bill of Rights.
  • Describe two types of advance directives and explain their purpose.
  • Define euthanasia and compare active versus passive euthanasia.
  • Compare involuntary active euthanasia with voluntary active euthanasia.
  • Describe assisted suicide and medical futility.
  • List important considerations relevant to do-not-resuscitate (DNR) orders.
  • Define terminal sedation and describe how and why it is utilized.
  • Define the double effect.
  • Describe considerations for the health care provider relevant to the voluntary refusal of hydration and nutrition.
  • Describe issues related to the removal of mechanical ventilation and organ donation.
  • Identify key issues related to end-of-life care of the neonatal and pediatric patient.

With the availability of increasingly sophisticated health care technology, end-of-life care presents unprecedented ethical challenges for individuals, families, health care professionals, and policy makers. The role of health care professionals and the use of these technologies are changing how death, dying, and end-of-life care are viewed and managed.

Almost all adults have had some experience with the death of a spouse, a parent, a grandparent, or a child. The experience is rarely easy. Most deaths are the result of chronic disease. Compassionate and effective coordination of care is essential because health care and science are not close enough yet to finding cures for the major chronic diseases. This slow progress toward finding a cure means that sick individuals are living longer with their chronic disease. The resulting financial costs are unprecedented (Callahan & Lawler, 2012).

According to Callahan and Lawler (2012), one of the unexpected consequences of the unlimited use of technology in health care is that technological advances have made it harder and harder to determine with any precision when a patient is actually dying. There is almost always something that can be done to give dying people a few more hours, or days, or even weeks before they actually die

Dying patients face many challenges that affect their physical, psychosocial, and spiritual integrity (Tulsky, 2005). The Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatment (SUPPORT) documented that many patients die a prolonged and painful death and that they receive expensive, unwanted, and invasive care during their last days. The emotional suffering of patients can be profound, and so, too, can the suffering of those who provide care for those patients at the end of their lives.

Yet, often, health care providers are ill-prepared to address the suffering experienced by dying patients and their families as they journey from serious illness to death (Tulsky, 2005). The SUPPORT study showed that many physicians behaved as though they were unaware their patients were dying and they rarely discussed prognosis and advance directives with their patients (Coll, Duffy, Micholovich, & Cohen, 2002). Many physicians do not know the extent of options for care at the end of life (Silveira, DiPiero, Gerrity, & Feudtner, 2000). As a result, end-of-life care has remains a high national priority (Steinhauser et al., 2000).

Complete the course post exam (CE Test) with a score of 80% or greater. Complete all fields of the course evaluation form. Certificate of Completion is provided once the course post exam is passed per criteria above.

  • American Board of Managed Care Nursing
  • ANCC - American Nurses Credentialing Center
  • AOTA - American Occupational Therapy Association
  • ASWB - Association of Social Work Boards
  • California Board of Behavioral Sciences
  • California Board of Registered Nursing
  • California Department of Health, Aid, and Technician Certification Section
  • District of Columbia Board of Nursing
  • Florida Board of Nursing
  • Florida Board of Nursing - Certified Nursing Assistants
  • Florida Board of Respiratory Care
  • Florida Council of Dietetics and Nutrition
  • Florida Council of Licensed Midwifery
  • NAADAC - The National Association of Alcohol and Drug Abuse Counselors
  • NCBTMB -National Certification Board for Therapeutic Massage & Bodywork
  • Florida Board of Massage Therapists


Practice Level:


Content Focus:

Domain of OT

Course Expires:

May 30, 2019

  • Cyndie Koopsen, RN, BSN, MBA, HNB-BC, RN-BC, HWNC-BC
  • Caroline Young, MPH
Jurisdictional Requirements:

Continuing education (CE) licensing requirements vary by jurisdiction, are not well defined, and may change. These CE requirements may vary in terms of the number of hours required to the types of courses that must be taken. ALLEGRA Learning Solutions, LLC recommends you contact your licensing board or accrediting organization for the latest continuing education requirements of your state or territory. Compliance with CE requirements is the responsibility of the individual health care provider. Health care providers must understand the CE requirements in their jurisdictions, and be sure they are up-to-date on any rule changes that affect their license. For further information, please see our Accreditation Information.

Accommodations for Disabilities:

Every effort will be made to accommodate your special needs. To request accommodations, please contact us.

Conflicts of Interest and Relevant Financial Relationships:

The authors/planning committee members have no conflicts of interests or relevant financial relationships to declare relevant to this activity.

Commercial Support:

No commercial support has been received for this activity.

Non-endorsement of products:

Accreditation refers to recognition of continuing nursing education only and does not imply ALLEGRA Learning Solutions, LLC approval or endorsement of any commercial product.

Off-label Use of Products:

None of the authors intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.