| Course | NURS 6914 Advanced Palliative Concepts and Interdisciplinary Perspectives |
|---|---|
| Week | Week 5 |
| Paper type | Ethics case analysis |
| Length | About 1,030 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | September 2026 |
Free sample paper for NURS 6914 Week 5
"I Have Lived Long Enough": A Four-Principles Analysis of an 89-Year-Old Woman's Decision to Stop Eating and Drinking, With the Dissent Kept In
Student Name
College of Nursing, Walden University
NURS 6914: Advanced Palliative Concepts and Interdisciplinary Perspectives
Instructor Name
Month Day, Year
"I Have Lived Long Enough": A Four-Principles Analysis of an 89-Year-Old Woman's Decision to Stop Eating and Drinking, With the Dissent Kept In
The Case
A retired seamstress of 89 lives in an assisted living apartment with heart failure that limits her to a few steps, macular degeneration that has taken most of her sight and arthritis that has made her hands too stiff to sew. She is not dying in the near term; her physician estimates she may live a year or more. At her care conference she told the team, calmly and more than once, that she has lived long enough, that each day now brings only losses and that she intends to stop eating and drinking. Her daughter supports her. Her nurse practitioner and the facility's hospice-trained nurse believe the team should support her with comfort care. Her primary physician objects, saying he cannot take part in what he regards as helping her end her life.
The disagreement has spread beyond the care conference. Two aides have asked whether they will be expected to withhold her meal trays, and one said she would feel she was letting a resident starve. The facility administrator has asked whether the facility is permitted to support VSED at all. The team therefore needs an analysis that addresses not only her choice but also what it asks of each person who cares for her.
Capacity and Depression
Before any principle can be weighed, the team has to know that the choice is truly hers to make. On repeated assessment she expresses a consistent choice, understands that stopping eating and drinking will lead to her death, usually within one to three weeks, appreciates that this applies to her and reasons about it in terms of her own values: "I have done everything I wanted to do. I can't see my great-grandchildren's faces or thread a needle. I don't want to keep going just to keep going." Capacity is intact.
Depression was taken seriously rather than presumed. A geriatric psychiatrist assessed her and found grief for her losses but no major depressive episode; she enjoys her daughter's visits and listens to audiobooks with pleasure. The team agreed that her decision reflects her values, not an untreated illness.
What Voluntarily Stopping Eating and Drinking Is
Voluntarily stopping eating and drinking (VSED) is a decision by a person with capacity to stop taking food and fluids by mouth with the intention of hastening death. Quill et al. (2018) describe it as an option available to patients who are suffering, that requires no prescription, and that is widely regarded as a capable person's right to refuse intake, although its ethical and legal status is contested by those who see it as a form of suicide. A survey of hospice nurses found that those who had cared for patients choosing this path generally described their deaths as peaceful (Ganzini et al., 2003). VSED differs from medical aid in dying, which involves a prescription and is legal only in some jurisdictions. She has not asked for medical aid in dying, and this analysis does not address it.
The Four Principles
Beauchamp and Childress (2019) set out four principles that clinicians use to test a hard decision, taken here one at a time.
Respect for autonomy. She is a capable adult making a considered decision about her own body and life. Forcing or pressuring her to eat would violate her autonomy. This principle weighs heavily toward respecting her choice.
Beneficence. The team's duty to do good includes relieving suffering. For her, suffering is the daily experience of loss. Supporting her with mouth care, symptom relief and presence during VSED is a way of doing good consistent with her values. The physician argues that beneficence also requires trying to help her find reasons to live; the team agrees this was attempted and should continue to be offered, without pressure.
Nonmaleficence. The duty not to harm is the center of the physician's objection: he sees participating as causing her death. The team's view is that her underlying conditions and her refusal, not the care provided, will cause her death, and that leaving her to go through VSED without comfort care would cause greater harm through thirst, confusion and distress.
Justice. Her choice does not take resources from others, and denying her comfort care because of her age or disability would be unjust.
The Dissenting Physician
The physician's objection is sincere and deserves respect. Professional codes recognize that clinicians may conscientiously object to participating in actions that violate their deeply held moral beliefs, provided they do not abandon the patient. The American Nurses Association's code, for example, supports nurses' moral integrity while requiring that care not be withdrawn in a way that leaves patients without support (American Nurses Association, 2025). The same principle applies to him.
The team's resolution: the physician will transfer her primary care to a colleague willing to support her plan, will tell her directly why he is stepping back and will remain available if she changes her mind. He will not be asked to write comfort orders he objects to. The nurse practitioner will manage her comfort care, and the facility's hospice nurse will provide daily support. This respects his conscience and her autonomy without leaving her without care.
Recommendation
The team should support her decision with comprehensive comfort care: meticulous mouth care to relieve thirst, a plan for delirium if it occurs, emotional and spiritual support for her and her daughter and clear documentation of her capacity and the decision process. She should be reminded that she may change her mind at any point, and food and fluids offered if she asks. Aides will continue to bring her tray at mealtimes unless she asks them not to, so that the decision to decline remains visibly hers each day rather than the staff's. The facility administrator should confirm with counsel that supporting a resident's refusal of food and fluids is consistent with state law and facility policy, and staff who share the physician's objection should be offered reassignment for her care without penalty. The team should also hold a debriefing afterward, since VSED is emotionally demanding for staff, including those who support it.
References
American Nurses Association. (2025). Code of ethics for nurses. https://codeofethics.ana.org/
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
Ganzini, L., Goy, E. R., Miller, L. L., Harvath, T. A., Jackson, A., & Delorit, M. A. (2003). Nurses' experiences with hospice patients who refuse food and fluids to hasten death. New England Journal of Medicine, 349(4), 359-365. https://doi.org/10.1056/NEJMsa035086
Quill, T. E., Ganzini, L., Truog, R. D., & Pope, T. M. (2018). Voluntarily stopping eating and drinking among patients with serious advanced illness: Clinical, ethical, and legal aspects. JAMA Internal Medicine, 178(1), 123-127. https://doi.org/10.1001/jamainternmed.2017.6307
What the NURS 6914 Week 5 instructions ask for
Ethics case analyses in Week 5 typically ask you to apply an ethical framework to a contested end-of-life decision and recommend a course of action. Papers commonly run four to five pages. Settle capacity first, including a careful look at depression, because every later argument depends on it. Define the practice at issue accurately and distinguish it from related practices. Apply each principle of your framework to the facts rather than defining it. Include dissenting views inside your argument and answer them fairly. Address conscientious objection by clinicians without abandoning the patient. Recommend a course of action that also considers staff, facility policy and the law of the setting.
How the NURS 6914 Week 5 example is put together
The case section introduces her, her losses and the team's split, then describes how aides and the administrator have raised their own questions. A capacity section tests the four abilities and reports the psychiatric assessment. A section cites Quill and colleagues to define voluntarily stopping eating and drinking and Ganzini and colleagues on hospice nurses' experiences, and sets aside medical aid in dying. The four principles are applied in turn, citing Beauchamp and Childress. A section on the dissenting physician cites the American Nurses Association code on conscientious objection and describes the transfer of care. A recommendation covers comfort care, daily trays and staff debriefing. Capacity is settled before any principle is weighed.
Reading the NURS 6914 Week 5 rubric
Ethics case analyses are generally assessed on capacity assessment, accuracy about the practice in question, application of principles, treatment of dissent and practicality of the recommendation. Capacity is often a gateway criterion, so it should be settled with evidence before principles are applied. Accuracy matters because practices such as voluntarily stopping eating and drinking and medical aid in dying are often confused. Principle application is scored for engagement with the facts. Treating a dissenting clinician fairly, and resolving the objection without abandoning the patient, earns a distinct share. Recommendations should be workable in the setting. Scholarly sources, APA formatting and balanced tone complete the rubric. Some instructors add credit for addressing the concerns of aides and administrators, not only clinicians.
NURS 6914 Week 5 help from the desk
Ethics analyses lose marks when they assume capacity without assessing it or treat any sadness as depression. Another common loss is confusing voluntarily stopping eating and drinking with assisted death. Some papers dismiss the dissenting clinician as wrong instead of engaging his reasoning. Others recommend supporting the patient without saying how the staff who object will be supported. Assess capacity with evidence, define the practice exactly, apply every principle to the facts, keep dissent inside the argument, respect conscience without abandonment and make the plan work for staff and facility. The desk can draft an analysis for the dilemma your prompt presents. Check your state's law before making legal claims.
Get a NURS 6914 Week 5 example written to your instructions
Forward the Week 5 case and the difficult request at its center, along with the prompt and rubric, and name any ethical framework your course prefers. Capacity is addressed first in the analysis you receive, then the principles applied to the facts, dissent handled fairly and a conditional position, inside 24-48 hours; the first costs nothing.
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NURS 6914 Week 5 questions, answered
What is voluntarily stopping eating and drinking?
A decision by a person with capacity to stop taking food and fluids by mouth with the intention of hastening death, usually in the setting of serious illness or accumulated losses. The example describes its legal and ethical status as contested: many regard it as a lawful refusal, while others consider it a form of suicide. Your analysis gains credit by presenting that disagreement accurately.
How is medical aid in dying handled?
Only as a point of contrast. The analysis notes that it is a different act, legal in some US jurisdictions under specific statutes and not permitted in others, and a subject of ongoing ethical dispute. It takes no position on it. Keeping the two separate matters, because conflating them is a frequent error that graders in this course tend to penalize.
What happens to the physician who objects?
The analysis treats his objection as a legitimate exercise of conscience and describes a transfer of her care to a willing colleague, so that neither her decision nor his integrity is sacrificed. It also notes the team's obligation not to abandon her. Handling dissent this way shows the balance your rubric likely looks for in contested cases.
Where can I find a free NURS 6914 Week 5 sample paper?
The complete ethics analysis, capacity, definition, four principles, the dissent and the recommendation, sits here free of charge. An analysis of the dilemma your course assigns can be requested.
How does the NURS 6914 Week 5 analysis settle the depression question?
A geriatric psychiatrist assessed her and found grief for her losses but no major depressive episode, noting she still enjoys her daughter's visits and audiobooks.