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The multifaceted challenges surrounding dignity in death and dying are examined in this
report manuscript, which also examines the ethical issues, cultural viewpoints,
psychological issues, and interventions related to these important topics. It emphasizes
that people can die with dignity because of their character qualities and virtues, which
are gained during their life, regardless of the circumstances surrounding their
departure. Beyond peaceful or natural deaths, the idea of dying with dignity includes a
customized and subjective perception of a person's aspirations, independence, and
particular life circumstances.
In order to enhance knowledge and
comprehension of dignity in the face of
death, this report wants to investigate
the moral, legal, and emotional issues
surrounding these activities. It also
aims to encourage fruitful dialogues
about them.
 General Objectives
At the end of this report, the reporters of this group will be able to expand the
perspectives of student nurses regarding sensitive topics, with the intention of
enhancing their comprehension of the underlying causes behind such incidents occurring
within a healthcare environment.

Specific Objectives

Define and analyze ethical issues of dignity in death and dying: suicide, end-of-life issues (advance directives, DNR,
care plans), euthanasia, dysthanasia, orthonasia, termination of life-sustaining treatment, food/fluid withdrawal.

Identify the key principles and Discuss the different nursing Explain as to how a person can
considerations involved in each of roles and responsibilities of the make ethical decisions in such
these ethical issues different issues stated. situations
Evaluate personal views on the different issues in the beginning of the report and
compare how they view things after the report.
defined as the intentional act of killing oneself
Associated with psychiatric disorders, substance
abuse, mental disorders, psychological states,
cultural and social circumstances, and genetics
(Nock et al., 2009)
Globally, an estimated 700,000 people take
their own lives annually. Of these global
suicides, 77% occur in low- and middle-income
countries (Soreff & Xiong, 2022).
a broad term that encompasses a variety
of contemplations, desires, and
preoccupations with death and suicide.
Has two types:
Active suicidal ideation
Passive suicidal ideation
Active suicidal ideation refers to the presence of present,
distinct suicidal thoughts. It is present when there is a conscious
desire to inflict self-harming behaviors, and the client has any
desire for death to occur as a consequence.
Passive suicidal ideation refers to a general desire to die without
a plan to inflict lethal self-harm to commit suicide. This includes
indifference to one's own accidental demise if steps are not
taken to preserve life
1. Establishing a Therapeutic Relationship
2. Performing a Comprehensive Assessment
3. Implementing Safety Measures
4. Cooperatively developing a Safety Plan
5. Offering Education and Assistance
6. Emotional support and building self-esteem
7. Promoting positive coping mechanisms
8. Managing hopelessness
Advance care planning is the process by which a mentally capable person
documents their healthcare wishes if they were to lose the ability to
decide for themselves. This is increasingly done today with what is
called an advance directive (Cantor, 1993; President’s Commission,
1983). In essence, an advance directive is a documented expression of
the patient’s wishes.

An advance directive has two parts:

living will (or substantive directive)
healthcare power of attorney (or proxy directive).

1. living will (or substantive directive)

records the patient’s substantive wishes about
medical treatment. Usually, but not always, it is
designed to apply when the
patient is terminally ill or in a
permanent vegetative state

 2. Healthcare power of attorney

(or proxy directive)
An advance directive naming a proxy
is particularly crucial for those who
do not want their legal next of kin
to be their agent. Because legally the
spouse is the next of kin, feuding
spouses may want some other relative or friend to function
as decision-maker
 END-OF-LIFE
CARE PLAN

End of life care includes Palliative care. If you have an illness that
can’t be cured, based on the understanding that death is inevitable.
Palliative care makes you as comfortable as possible, by managing your
pain and other distressing symptoms. It also involves psychological,
social, and spiritual support for you and your family or career.

 END-OF-LIFE
CARE PLAN

When does end-of-life care begin?

Have an advanced incurable illness, such as cancer, dementia,
or motor neuron disease, are generally frail and have co-
existing conditions that mean they are expected to die
within 12
months.
Have existing conditions if they are at risk of dying from a
sudden crisis in their condition
Have a life-threatening event, such as an accident or stroke
 EUTHANASIA ASSISTED SUICIDE
Assisted suicide, also known as The word ‘euthanasia’ comes
physician-assisted suicide or from the Greek word ‘eu’
medical aid in dying, is a meaning good or well and
procedure where a person who ‘thanatos’ meaning death;
is terminally ill and hence, euthanasia means good
experiencing excruciating pain
death. The term explains that it
or other irreversible physical
is an intentional termination of
conditions asks for help from a
life by another at the explicit
medical practitioner to
terminate their life. request of the person who wishes
to die.
 The word ‘euthanasia’ comes from the Greek word ‘eu’ meaning good or
well and ‘thanatos’ meaning death; hence, euthanasia means good death.
EUTHANASIA The term explains that it is an intentional termination of life by another at
the explicit request of the person who wishes to die.

Voluntary: When euthanasia is conducted with consent. Voluntary euthanasia is currently legal in
Belgium, Luxemburg, The Netherlands, Switzerland, and the States of Oregon and Washington in the
U.S

Non-voluntary: euthanasia is when euthanasia is conducted on a person who is unable to consent due
to their current health condition. In this scenario, the decision is made by another appropriate person,
on behalf of the patient, based on their quality of life and suffering.

Involuntary: When euthanasia is performed on a person who would be able to provide informed
consent, but does not, either because they do not want to die, or because they were not asked. This
is called murder, as it’s often against the patient’s will.
 "Dysthanasia" is a term used to describe a
situation where a patient is subjected to excessive
or prolonged medical interventions in an attempt to
prolong their life, despite there being little or no
chance of a meaningful recovery or improvement in
their condition. It is often referred to as "bad death"
or "futile care." In dysthanasia, medical
interventions are continued or even intensified
without considering the patient's overall well-being,
quality of life, or their expressed wishes. This may
result in unnecessary suffering, discomfort, and a
diminished quality of life for the patient.

 A normal or natural manner of death and dying. Sometimes

used to denote the deliberate stopping of artificial or heroic
means of maintaining life Orthonasia" is a term that is not widely
recognized or used within medical or bioethical literature. It is
possible that you may be referring to "orthothanasia" or "a good
death," which is an approach that focuses on providing
compassionate care and ensuring a comfortable and dignified
death for terminally ill patients.
Orthothanasia emphasizes the importance of appropriate pain
management, symptom relief, and psychological and emotional
support for individuals nearing the end of life. The goal is to
allow the natural process of dying to take place without
unnecessary medical interventions that may prolong suffering
or provide little benefit.
 Termination of Life-Sustaining Treatment is the process of
terminating medical treatments or interventions meant to
extend a person's life when there is no chance of recovery and
the treatment is just prolonging the process of death. Clinically,
"termination of life support" is important. It is beneficial for
end-of-life patients whose wishes have been communicated to
refrain from any harsh procedures in the event that their
clinical condition worsens. It prevents care that is pointless,
may include invasive measures, and may have a negative
influence on the patient's quality of life without providing a
material improvement in survival. The comfort of seeing a pain-
free and peaceful death of a loved one also goes to the
bereaved family.
 Withdrawing or withholding food and liquids,
commonly referred to as "voluntary stopping of
eating and drinking" (VSED), refers to the
conscious choice to stop giving nourishment
and hydration to a person who is physically
able to eat and drink but has chosen to refuse
it. This choice is frequently made by people
who are terminally sick, going through severe
agony, and want to pass away sooner.
 SUICIDE
1. Risk assessment and establishing therapeutic relationship

2. Perform screening for suicidal ideations.

3. Assess for early signs of distress or anxiety and investigate possible
causes.
4. Monitor for suicidal or homicidal ideation.
5. Assess suicidal intent on a scale of 0 to 10 or by asking directly if the
client is thinking of killing themself, or has plans, means, and so on.
6. Maintain straightforward communication and assist the client to learn
assertive rather than manipulative or aggressive behavior.
7. Help the client choose activities to redirect their emotions.
8. Acknowledge the reality of suicide or homicide as an option. Discuss the
consequences of actions if the client were to follow through on their
intent.
9. Remain calm and state limits on behavior in a firm manner.
 POSSIBLE QUESTIONS TO ASK A CLIENT
“Have you ever considered harming yourself?”

Suicide ideation is the manner of thinking about killing oneself. The patient’s risk for suicide progresses
as these thoughts become more frequent.

“Have you ever attempted suicide?”

The patient’s status of suicide risk is distinguished if there is a history of earlier suicide attempts.

“Do you currently consider like killing yourself?”

This allows the person to discuss feelings and issues openly.

“What are your plans with regard to killing yourself?”

Citing a plan and the ability to carry it out greatly increases the risk for suicide. The more harmful the
plan, the more serious the risk for suicide.

“Do you trust yourself to maintain control over your insights, emotions, and motives?”
Patients with suicidal thoughts may sense their authority of suicidal thoughts slipping away, or they may
feel themselves surrendering to a desire to end their life.
 END OF LIFE CARE
A. Promoting Effective Coping Abilities

1. Promoting Effective Coping Abilities

2. Assess the level of anxiety present in the family and/or SO.
3. Determine the level of impairment of perceptual, cognitive, and/or
physical abilities.
4. Note the patient’s emotional and behavioral responses resulting from
increasing weakness and dependency
5. Determine current knowledge and/or perception of the situation.
6. Assess the current actions of SO and how they are received by the
patient.
7. Establish rapport and acknowledge the difficulty of the situation for the
family.
8. Discuss underlying reasons for patient behaviors with family.
 END OF LIFE CARE
A. Promoting Effective Coping Abilities

9. Assist family and patient to understand “who owns the problem” and
who is responsible for resolution. Avoid placing blame or guilt.
10. Involve SO in information giving, problem-solving, and care of patients
as feasible. Instruct in medication administration techniques, and needed
treatments, and ascertain adeptness with the required equipment.
 END OF LIFE CARE
B. Decreasing Tolerance to Activity

behaviors.

1. Assess sleep patterns and note changes in thought processes and

2. Document cardiopulmonary response to activity (weakness, fatigue,

dyspnea, arrhythmias, and diaphoresis).
3. Monitor breath sounds. Note feelings of panic or air hunger.
4. Recommend scheduling activities for periods when the patient has the
most energy. Adjust activities as necessary, reducing intensity level
and/or discontinuing activities as indicated.
5. Encourage the patient to do whatever is possible: self-care, sitting in a
chair, and visiting with family or friends.
 END OF LIFE CARE
B. Decreasing Tolerance to Activity

6. Instruct patient, family, and/or caregiver in energy conservation

techniques. Stress the necessity of allowing for frequent rest periods
following activities.
7. Demonstrate the proper performance of ADLs, ambulation, or position
changes. Identify safety issues: use of assistive devices, the temperature of
bath water, keeping travel ways clear of furniture.
8. Encourage nutritional intake and use of supplements as appropriate.
 END OF LIFE CARE
C. Providing Emotional Support and Assisting in Grieving

1. Assess the patient and/or SO for the stage of grief currently being
experienced. Explain the process as appropriate.
2. Monitor for signs of debilitating depression, statements of hopelessness,
and desire to “end it now.” Ask the patient direct questions about the
state of mind.
3. Investigate evidence of conflict; expressions of anger; and statements of
despair, guilt, hopelessness, and inability to grieve.
4. Determine the way that the patient and/or SO understand and respond to
death. Determine cultural expectations, learned behaviors, experience
with death (close family members and/or friends), beliefs about life after
death, and faith in Higher Power (God).
 END OF LIFE CARE
C. Providing Emotional Support and Assisting in Grieving

5. Encourage verbalization of thoughts and/or concerns and accept

expressions of sadness, anger, and rejection. Acknowledge the normality of
these feelings.
6. Facilitate the development of a trusting relationship with the patient and/or
family.
7. Be aware of mood swings, hostility, and other acting-out behavior. Set
limits on inappropriate behavior, and redirect negative thinking.
8. Reinforce teaching regarding disease processes and treatments and
provide information as requested or appropriate about dying. Be honest; do
not give false hope while providing emotional support.
9. Review past life experiences, role changes, sexuality concerns, and
coping skills. Promote an environment conducive to talking about things that
interest the patient.
 END OF LIFE CARE
D. Managing Pain

1. Perform a comprehensive pain evaluation, including location,

characteristics, onset, duration, frequency, quality, severity (e.g., 0–10
scale), and precipitating or aggravating factors. Note cultural issues
impacting reporting and expression of pain. Determine the patient’s
acceptable level of pain.
2. Assess the patient’s perception of pain, along with behavioral and
psychological responses. Determine the patient’s attitude toward and/or
use of pain medications and locus of control (internal and/or external).
3. Assess the degree of personal adjustment to diagnosis, such as anger,
irritability, withdrawal, and acceptance.
4. Identify specific signs and symptoms and changes in pain requiring
notification of healthcare provider and medical intervention.
 END OF LIFE CARE
D. Managing Pain

5. Verify current and past analgesic and narcotic drug use (including alcohol).
6. Monitor for/discuss the possibility of changes in mental status, agitation,
confusion, and restlessness.
7. Monitor for/discuss the possibility of changes in mental status, agitation,
confusion, and restlessness.
8. Discuss with SO(s) ways in which they can assist patients and reduce
precipitating factors.
9. Involve caregivers in identifying effective comfort measures for patients: use
of non-acidic fluids, oral swabs, lip salve, skin and/or perineal care, and enema.
Instruct in the use of oxygen and/or suction equipment as appropriate.
10. Demonstrate and encourage the use of relaxation techniques, guided
imagery, and meditation.