N108: Transition to the Registered Professional Nurse Role Study Guide The Supreme Court decided in 1997 that the Constitution does not contain a fundamental “right to die.” Although the court did uphold two state laws making assisted suicide a crime, but left open the ability for states that want to legalize assisted suicide. As of 2015, five states had legalized physician assisted suicide: Oregon, Washington, Vermont, California, and Montana. The ANA has recommended that nurses not participate in physician-assisted suicide. Refusal of Nutrition and Hydration If the patient refuses hydration, that refusal is honored. The autonomy of a competent patient is honored. However, the nurse should consider the legal status of the surrogate if the patient is unable to refuse and the surrogate requests withdrawal. The beneficence of continuing feeding should be analyzed and compared to the possible harm of continuing care. The key is whether the patient is legally competent to make decisions. The Patient Self Determination Act was devised to emphasize that each patient’s rights are to be honored and followed by all healthcare providers, regardless of their own values. Moral Distress Moral distress occurs when an individual knows the ethically correct action to take but feels powerless to take that action. Research on moral distress among nurses has identified that the sources of moral distress are many and varied, and that the experience of moral distress leads some nurses to leave their jobs or the profession altogether. Moral distress occurs when a nurse knows the ethically appropriate action to take, but is unable to act upon it. Consequences of moral distress are that nurses avoid patient contact and fail to give good physical care, nurses experience physical and psychological problems, and nurses withdraw from the bedside or leave the profession. Situations that cause moral distress vary among nurses. The following are commonly cited sources of moral distress among nurses, although not every nurse will experience distress when faced with these situations, and some nurses will experience distress from other circumstances. • Continued life support even though it is not in the best interest of the patient • Inadequate communication about end of life care between providers and patients/families • Inappropriate use of healthcare resources • Inadequate staffing or staff who are not adequately trained to provide the required care • Inadequate pain relief provided to patients • False hope given to patients and families 2.2 Rights and Responsibilities in Healthcare The nurse’s role in dealing with rights and responsibilities in healthcare include the following: identifying nurse practice limitations, documenting care, serving as a patient advocate, and maintaining professional competence.