Nurses have traditionally encouraged people to live, regardless of the meaning or consequences of continued life for the client. Despair profound enough to lead to a suicide attempt is viewed as an illness that must be cured. Nurses, as well as physicians, subscribe to the maxim primum non nocere (first, do no harm), although it may not be as clearly articulated in the canons of the nursing profession as it is in those of medicine. Nurses, for the most part, operate under the belief that suicide is always both mentally unhealthy and morally wrong; thus all efforts are made to prevent suicide. The idea that life is good and worthwhile and must be preserved at all costs applies to a wide variety of clients, including those who engage in behaviors that will probably lead to serious illness or death (e.g., overeating, smaoking, and suicide).

In 1972 the California Supreme Court helped set the standard for informed consent in the landmark case of Cobbs v. Grant. That case involved a middleaged gentleman who was operated on for an intractable peptic duodenal ulcer. He suffered complications which included loss of his spleen, a subsequent gastric ulcer, and a 50% gastrectomy. None of these well-recognized potential risks of ulcer surgery had been disclosed to him. The court determined that physicians must disclose the following information to patients, in lay terms, before performing procedures on them:

1. a description of the procedure and its success rates;

2. risks of death or serious bodily harm;

3. alternatives, and the dangers inherent in each; and

4. major problems of recuperation.

It is easier to identify an ethical dilemma than to solve it; this is the nature of the beast. In the process of deciding what to do, nurses are often pulled by conflicting demands from employers, patients, physicians, and other nurses: the feeling is that no resolution can be found which will satisfy everyone. A most difficult situation arises when the nurse feels an obligation to act in the best interests of patient care, but knows that to do so may be detrimental to her employer. When this happens, the nurse may fear that action to protect the patient will result in her being fired or some other form of retaliation by the employer. This fear is not entirely unfounded — employers do sometimes fire nurses who speak out against institutional policies. But a recent federal court case demonstrates that a hospital cannot summarily fire a nurse who acts responsibly in seeking to bring about institutional change.