Nurses' Experience of Ethical Dilemmas in Decision-making for Withdrawing life-sustaining Treatments in the Intensive Care Unit: Case Report
With the enforcement of the “Act on decisions on life-sustaining treatment for patients at the end of life” in February 2018, discussion on advanced care planning (ACP) has increased. However, as decisions on life-sustaining treatments are still made in the intensive care unit, deaths related to the suspension of life-sustaining treatment account for a large proportion of deaths in the intensive care unit. The nurses encounter challenges in supporting the patient's dignified death; they experience an ethical dilemma in the ambiguity due to a lack of guidance on legal responsibilities regarding decisions on life-sustaining treatment. In order for the nurses to perform as a supporter providing care to the patients and as a advocate during the process of decision-making on life-sustaining treatment, there should be a systemic change to ensure the nurses' participation. In addition, an open and continuous discussion should be proposed to cultivate nurses’ ethical sensitivity and moral courage. This paper reports two ethical examples related to the decisions on life-sustaining treatment occurred in intensive care units of a tertiary hospital.