By Clareen Wiencek, PhD, CNP, ACHPN


In the past two decades, we have seen progress in our comfort with discussing end-of-life care since the 1998 IOM report, “Approaching Death: Improving Care at the End-of-Life”, revealed that we do not die well in the United States. Though there has been progress, the majority of Americans still do not engage in advanced care planning. Sadly, death is not an option in our culture and many face the end of their life ill-prepared.


Consider this case: A 65-year-old man was admitted to the hospital with severe shortness of breath. He had undergone surgery, radiation and chemotherapy after being diagnosed with Stage IV lung cancer five months ago. He never initiated nor did his physician initiate any discussion about what was important to his quality of life, how his disease had impacted his function or joy, or his hopes for how to spend his final hours with his wife of 45 years. He died within 12 hours of admission before receiving a first dose of morphine.  His wife expressed relief that his suffering was over.


The ethical principle of beneficence calls us to a higher standard of care than this patient, and others, receive. As consumers of health care, we must demand honest discussions about prognosis and treatment options when faced with advanced illness and as providers of healthcare; we must routinely initiate advanced care planning discussions. We deny a person’s autonomy when we do not disclose essential facts. We are not taking away hope but giving choice and the chance to prepare.


Most persons I have met prefer to die at home among loved ones not in hospitals among strangers. If we, as providers, do not ask we will not know and therefore will be providing less than ethical and compassionate care.


Clareen Wiencek, PhD, CNP, ACHPN is a nurse manager/clinician in the Thomas Palliative Care Unit at Massey Cancer Center, Virginia Commonwealth University Health System, Richmond

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Clareen Wiencek
Nursing Ethics

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