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1. A nurse is caring for a patient who has terminal cancer and is in severe
pain. The patient has a do-not-resuscitate (DNR) order and has expressed
a wish to die peacefully. The nurse administers a high dose of morphine to
the patient, knowing that it will hasten the patient's death. This is an
example of:
a) Euthanasia
b) Assisted suicide
c) Palliative sedation
d) Double effect*
Rationale: The principle of double effect states that an action that has both
a good and a bad effect is morally permissible if the good effect is
intended and the bad effect is foreseen but not intended, as long as the
good effect outweighs the bad effect. In this case, the nurse intends to
relieve the patient's pain and does not intend to cause the patient's death,
even though it is foreseeable. The good effect of pain relief outweighs the
bad effect of hastening death, especially since the patient has a DNR order
and a wish to die peacefully.
2. A nurse is caring for a patient who has been diagnosed with HIV and
has not disclosed his status to his partner. The nurse believes that the
patient has a moral duty to inform his partner and prevent further
transmission of the infection. The nurse also respects the patient's
autonomy and confidentiality. The nurse faces a dilemma between:
a) Beneficence and nonmaleficence
b) Beneficence and justice
c) Beneficence and fidelity
d) Beneficence and autonomy*
Rationale: Beneficence is the principle of doing good and promoting the
well-being of others. Autonomy is the principle of respecting the selfdetermination and choices of others. The nurse faces a conflict between
doing good for the patient's partner by informing him of the risk of HIV
infection, and respecting the patient's autonomy by honoring his decision
not to disclose his status. The nurse also has to consider the potential
consequences of breaching the patient's confidentiality, such as losing his
trust, damaging the therapeutic relationship, and violating professional
codes of ethics.
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