Context for Practice: Nurses uphold their professional obligation to provide clients across the full spectrum of care, including end of life, with compassionate and ethical care in accordance with legislation and professional practice standards and guidelines. Nurses reflect on their moral values and beliefs and anticipate when those may be in conflict with a person’s needs, preferences, wishes or decisions (e.g., medical assistance in dying [MAID], abortion care, harm reduction). Nurses communicate any such conflict at the earliest opportunity with employers or clients (if in independent practice/self-employed) and safeguard the best interest of clients until alternative arrangements can be made. Nurses in formal and informal leadership roles advocate for appropriate policies and develop ethical guidance to help nurses meet ethical standards.
| Ethical Responsibilities: Nurses demonstrate compassion and ethical conduct by |
| 1.3.1 |
working to relieve pain and suffering, including appropriate and effective symptom management, to allow people to live and die with dignity; |
| 1.3.2 |
listening to clients’ experiences and stories to gain clarity about their goals and wishes and, when at the end of their life, encouraging them to be clear about what they need; |
| 1.3.3 |
communicating and documenting clients’ wishes regarding end-of-life care to ensure their wishes and decisions are clear and known to other members of the health-care team and caregivers; |
| 1.3.4 |
applying trauma-informed approaches when assisting people in meeting their goals of care; |
| 1.3.5 |
being responsive to the lived/living experience of people they interact with throughout the lifespan and across the continuum of care, including supporting the family/loved ones during and following a person’s death and caring for the person’s body after death; |
| 1.3.6 |
respecting the decisions of all people, including choice of lifestyle or treatment that may not be perceived as conducive to health or well-being while continuing to provide care in a non-judgmental manner; |
| 1.3.7 |
developing awareness of their own moral beliefs and values based on evidence-informed moral concerns and ensuring those do not take precedence over a person’s rights and autonomy in the provision of ethical care; |
| 1.3.8 |
developing ethical sensitivity in nursing practice to assist in the identification of ethical challenges and guide ethical decision-making, resulting in effective and ethical care, services and/or supports; |
| 1.3.9 |
discussing any potential or actual conflict of conscience (e.g., personal opposition to certain procedures and/or practices) with their supervisors, expert resources (e.g., nurse educator, bioethicist) or clients (if in independent practice/self-employed) at the earliest opportunity (e.g., upon employment/at the onset of the nurse-client relationship, as soon as possible) in advance of their direct involvement and arranging for the most appropriate person to attend to the client’s needs or desires; |
| 1.3.10 |
anticipating nursing actions that might conflict with their moral beliefs and values and providing compassionate and ethical care until alternative care arrangements are in place to meet the person’s needs or desires; |
| 1.3.11 |
understanding applicable federal/provincial/territorial legislation (e.g., MAID, harm reduction and/or supervised consumption services, abortion and/or reproductive rights, gender-affirming care), position statements or frameworks (e.g., Medical Assistance in Dying: Implementing the Framework [2024], provincial/territorial gender-affirming health-care frameworks), and regulatory standards and practice guidelines to assist in addressing expectations that conflict with their conscience; and |
| 1.3.12 |
consulting applicable provincial/territorial codes, regulatory standards and practice guidelines related to the duty to provide care and/or to discontinuing or declining to provide care, as applicable in given situations. |
In addition, nurses in formal and informal leadership (e.g., administration, clinical care, education, policy and research) roles support nurses’ ethical practice by
| 1.3.13 |
advocating for excellence in palliative and end-of-life care and for client-centred options that are available at home or in long-term care, acute care and hospice care; |
| 1.3.14 |
providing guidance when they discuss a conflict of conscience and facilitating appropriate care transitions accordingly; and |
| 1.3.15 |
advocating for and working with others to create policies and processes that provide guidance for ethical decision-making to support all nurses facing conflicting ethical situations that may contribute to moral distress. |