Who is Responsible for Discussing End-of-Life Treatment Options?

Who is responsible for discussing end-of-life treatment options with the patient…….the physician? The nurse? In most instances it is the physician’s responsibility to initiate discussion and determine a plan of treatment. But what if the patient is not given information on all the options? What if the nurse does not think the patient and family have been given adequate information or disagrees with the physician?

According to the ANA Code of Ethics, “The nurse's primary commitment is to the patient, whether an individual, family, group, or community.” How does this come onto play with regard to end-of-life care? What happens when the desires of the patient are in conflict with the desires of the physician? Or what if the physician’s plan of care seems more aggressive or unrealistic to the nurse in light of the patient’s condition or prognosis?

One of the primary roles of the nurse is that of patient advocate. Nurses need to be prepared to advocate for the patient when conflicts arise between the patient's wishes and the wishes of the physician and/or family members. Although it is the physician who prescribes the plan of treatment, the nurse must be ready to assist the patient in exploring options for end-of-life care. No matter what setting you practice in—hospital, long-term care facility, clinic, or home—it is of utmost importance to address the patient’s comfort needs as the patient sees them. This is particularly true in providing quality end-of-life care, allowing the patient to prepare for and face death on his or her own terms.