In response to this, some medical schools have started teaching students how to break bad news to patients.11 The Ethics in Medicine Web site at the University of Washington School of Medicine contains a six-step protocol titled "Breaking Bad News." Its topic headings are How to Get Started, How to Find Out How Much the Patient Knows, Finding Out How Much the Patient Wants to Know, Sharing the Information, Responding to Patients" Feelings, and Planning Follow-Through.11 .
Respect for patient autonomy is an important principle, but caregivers also have autonomy. When the Oregon physician-assisted suicide statute became law, nurses opposed to suicide on moral grounds were concerned about their ability to exercise their professional autonomy without abandoning their patient. In response, the Oregon Nurses Association drew up a policy clarifying the nurses" rights and responsibilities under the law. The association's White Paper on Assisted Suicide provides guidelines for ethically withdrawing from a case without abandoning the patient for nurses who do not want to be involved, as well as guidelines for nurses willing to care for the patient who is committing physician-assisted suicide.12 .
Although the principle of respect for autonomy is of major importance, other principles such as nonmaleficence, beneficence, and justice have as much or more weight, depending on the situation.1 The principle of nonmaleficence means the obligation to refrain from harm.1 If the nurse cannot bring about good for the patient, the nurse is bound by duty to at least avoid harm.5 Nonmaleficence affirms the need for the nurse to be competent in caring for patients and expresses nursing's commitment to the protection of patients. .
The standard of due care specifies the principle of nonmaleficence. Negligence is the departure from the standard of due care toward patients and includes intentionally imposing unreasonable risks as well as unintentionally imposing risks through carelessness.