Geriatric and end-of-life care often involve difficult decisions about autonomy, treatment burden, dignity, and family involvement. Nurses must balance clinical obligations with respect for the older adult’s values.
Autonomy and Consent
Older adults should participate in decisions whenever they have capacity. Nurses should assess understanding, use clear language, involve interpreters when needed, and document informed consent or refusal. When capacity is impaired, follow legal surrogate decision-making processes.
Dignity and Quality of Life
Maintain privacy during personal care, address pain and breathlessness promptly, preserve routines where possible, and avoid unnecessary restrictive interventions. Palliative care should focus on comfort, psychosocial support, and family preparation.
Common Ethical Dilemmas
- Families requesting or refusing life-sustaining treatment.
- Conflicts between patient wishes and family preferences.
- Use of feeding tubes, antibiotics, or hospital transfer near end of life.
- Pain management concerns and fears of hastening death.
- Resource limitations in long-term care settings.
Nursing Role
Nurses advocate for the patient, facilitate family meetings, communicate changes clearly, document care goals, and collaborate with palliative care teams. Ethical geriatric care centers the patient’s voice while supporting families through difficult transitions.