Nurses provide guidance and address issues in end-of-life decision making. It is the nurse's job to explain to families and other health care providers when advance directives might be used. Advance directives serve as a guide for clinicians to respect and honor the patient's autonomous decision when they are in the position of not being able to express their wishes (Roux & Halstead, 2009). Nurses could help ensure that patients' needs are met and protect their rights. The professional nurse acts as a client advocate in health maintenance and clinical care (Standards of Nursing Conduct or Practice, 2003). Advocating for patients could bring implications such as conflicts with the doctor and families regarding the treatment plan decision. Nurses struggle with feelings of helplessness over the family's decision rather than supporting the patient's decision. Nurses also experience moral distress and outrage over failed attempts to become patient advocates. According to provision two of the American Nurses Association's nursing code of ethics, nurses' primary commitment is to the patient, whether an individual, family, group, or community ( American Nurses Association, 2001 ). This code influences the professional decision of nurses because, if a conflict arises, they are the ones who help resolve it. The nurse's loyalty is still to the patient especially when the conflict persists. They inform patients and their families about options leading to the decision-making process. Nurses, however, must ensure patient safety, supervise what is important and support any decisions made by the patient. The scenario in which E is placed on the ventilator has multiple ethical implications. ...... half of the document ...... services should be initiated by the nurse as soon as personal or professional values/interests are challenged. Consideration should be given to using a multidisciplinary approach to help achieve and represent a shared goal in which Mr E's wishes and end-of-life choices are supported. Works Cited by the American Nurses Association. (2001). Code of Ethics for Nurses with Interpretative Statements. Retrieved March 26, 2012, from http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf.Roux, G., & Halstead, J. A. (2009). Issues and trends in nursing: essential knowledge for today and tomorrow. (p. 349). Sudbury, Massachusetts: Jones and Bartlett. Retrieved from http://wgu.coursesmart.com/9781449608347/1?CSTenantKey=wguStandards of Nursing Conduct or Practice. Washington Administrative Codes. WAC 246-840-700 (2003).