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Ethical Issues Experienced by Hospice and Palliative Nurses

Cheon, Jooyoung MSN, RN; Coyle, Nessa PhD, FAAN, ANP; Wiegand, Debra L. PhD, RN, CHPN, FPCN, FAAN; Welsh, Sally MSN, RN, NEA-BC

Journal of Hospice & Palliative Nursing: February 2015 - Volume 17 - Issue 1 - p 7–13
doi: 10.1097/NJH.0000000000000129
Ethics Series

Nurses encounter ethical dilemmas in their clinical practice especially those associated with palliative and end-of-life care. The Hospice and Palliative Nurses Association (HPNA) members were asked to participate in an ethics survey. The survey aimed to identify ethical issues experienced by hospice and palliative nurses, identify resources available to them and barriers if any to their use, and to identify how HPNA can be of support to hospice and palliative nurses. One hundred twenty-nine (n = 129) HPNA members completed the online survey. The information from each of the surveys was carefully reviewed, and responses were collapsed into 6 themes. The ethical dilemmas included inadequate communication, provision of nonbeneficial care, patient autonomy usurped/threatened, issues with symptom management and the use of opioids, issues related to decision making, and issues related to discontinuing life-prolonging therapies. Approximately two-thirds of the nurses used resources in an attempt to resolve the ethical issues, including a formal ethics consultation, involvement of the palliative/hospice team, consulting with other professionals, and use of educational resources. One-third of the nurses said there were institutional or personal barriers that prevented the ethical dilemma from being resolved. Participants suggested ways that HPNA could help them to effectively manage ethical dilemmas.

Jooyoung Cheon, MSN, RN, is doctoral student, School of Nursing, University of Maryland, Baltimore.

Nessa Coyle, PhD, FAAN ANP, is ethics clinical consultant, Memorial Sloan Kettering Cancer Center, New York.

Debra L. Wiegand, PhD, RN, CHPN, FPCN, FAAN, is associate professor, School of Nursing, University of Maryland, Baltimore.

Sally Welsh, MSN, RN, NEA-BC, is chief executive officer, Hospice and Palliative Nurses Association (HPNA), National Board for Certification of Hospice and Palliative Nurses (NBCHPN), Hospice and Palliative Nurses Foundation (HPNF), Pittsburgh, Pennsylvania.

Address correspondence to Jooyoung Cheon, MSN, RN, School of Nursing, University of Maryland, Room 404, 655 West Lombard Street, Baltimore, MD 21201 (

The authors have no conflicts of interest to disclose.

© 2015 by The Hospice and Palliative Nurses Association.