I have been a nurse 38 years in many different settings. I have seen this dilemma many times. After many years working with physicians and hospital administrators and chaplains other nurses, and the community at a large country trauma center we developed an ethics committee and encouraged a residency training team in palliative medical care be funded at our medical center. This has worked very well to discuss patient, family, doctor, nurse social worker and community concurs about care appropriate to give our patients.
An ethics committee recommendation is made and documented in the patient's chart with the notation that these recommendations are ethical not legal recommendations. The patient's attending physician makes decisions about care for the patient with patient and family input after the ethics committee's analysis which includes the family.
The ethic committee's work in the hospital made a path for the hiring of a palliative care physician for consults to support the patient's physician problem solve with the patient/family appropriate interventions. This systematic approach including all of the disciplines of care in the hospital was profoundly satisfying as we all saw that the patient got the best outcomes from this approach per the patient's/family report.