Background   The patient's rights to self-determine their own health care is described in Swedish legislation and guidelines. However, due to infancy, unconsciousness, severe brain damage or certain diseases, some patients might be unable to make such decisions. Ethically difficult situations do occur, not infrequently associated with culture. Since the patient is vulnerable, there is a risk that the patient in the treatment and care can not be bothered to maintain right to autonomy and that the nurse violates patient integrity.

Aim                 The aim of this study was to illustrate the nurse's dilemma when the patient refuses vital caring efforts.

Method           A literature review of eight scientific articles with a qualitative approach was performed.

Results           The results revealed the following domains to describe the nurse's dilemma when the patient refuses vital care interventions: patients’ reasons for treatment refusal, the nurse's understanding of the patient's refusal of care and contradictory legislation

Conclusion     More knowledge and discussion of the patient's decision-making competence is needed for both the nursing profession and those who make decisions on legislation.