Doctors’ and nurses’ perceptions of ethical problems in end‐of‐life decisions

Abstract

It was concluded that observed differences between doctors and nurses were a function of the professional role played by each rather than differences in ethical reasoning or moral motivation. Although this was a small qualitative study on one institution, and may not be generalizable, results suggest that doctors and nurses need to engage in moral discourse to understand and support the ethical burden carried by the other. Administrators should provide opportunities for discourse to help staff reduce moral distress and generate creative strategies for dealing with this.

Predictors of Moral Distress in a US Sample of Critical Care Nurses

“…10 Additionally, the results of this study support interventions to promote collaboration between critical care nurses and physicians, as well as educational and emotional support for critical care nurses who provide end-of-life care. 2,25,29 Research is needed to better understand how organizational factors, practice environment, and nurse characteristics converge to potentiate moral distress frequency and intensity. …”

“…At the forefront of care delivery in the intensive care unit are registered nurses, who often experience moral distress associated with care that is inconsistent with the patient's or family's preferences. 1,2 Conceptually, moral distress consists of a moral dilemma that elicits psychological, cognitive, and behavioral modifications within individuals and alters their performance over time. 1,3 Commitment to fostering healthy practice environments and optimizing the quality of patient care decreases moral distress.…”

Role of Clinical Ethicists in Making Decisions About Levels of Care in the Intensive Care Unit

“…Physicians experience the burdens associated with having to make these decisions, and nurses feel the burden of having to carry out care decisions made by someone else. 17 Given the shared burdens that members of the interdisciplinary team face, as well as the reported difficulties in end-oflife care decision making in the ICU, ensuring effective communication is a key feature of high-quality patient care. 7 The following discussion is intended to demonstrate how clinical ethicists can be supportive of such strategies for effective communication and decision making.…”

How Situational Diagnosis Helps Disentangle Ethical and Psychological Features of Complex Cases

“…For example, when a nurse perceives that a patient with advanced disease was not given an opportunity to discuss a desire to forego aggressive treatment, she might experience moral distress if she refrains from speaking up [12]. This situation raises the issue of whether it would be unethical for a physician to proceed with aggressive treatment in such a case.…”