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.