Narratives of aggressive care

Abstract

A better understanding of how social roles influence how time, knowledge, and responsibility are related to the provision of aggressive care is needed.

What is ‘moral distress’? A narrative synthesis of the literature

“…According to Jameton, 16 the nurses he encountered were describing as ‘dilemmas’ instances where they had made a moral judgement but were unable to act upon it, and this is what caused their MD. Similarly, Peter et al 27 found that although uncertainty pervaded nurses’ narratives of aggressive care, they only experienced what they called MD, in situations where they ‘knew’ the right thing but were constrained. The subsequent narrative surrounding MD focused on the complexities of negotiating their moral judgements in the presence of constraints.…”

“…The subsequent narrative surrounding MD focused on the complexities of negotiating their moral judgements in the presence of constraints. 27 To make sense of this definition, we must be clear about what it is to have made a moral judgement and to be constrained. There is little ambiguity about how to understand ‘constraint’ – it is a barrier to acting as one would want.…”

“…This conception of MD is also supported by Peter el al. 27 who provide quotes from nurses who have experienced both forms of epistemic injustice. It is not clear, however, to what extent epistemic injustice could be considered a necessary condition of MD or whether it is simply another example of a way in which one’s moral agency can be constrained.…”

The advocacy role of nurses in cardiopulmonary resuscitation

“…48 There is an unequal distribution of power, in which nurses’ knowledge is demeaned. 33,49 Similarly, Peter et al 50 highlighted the existence of the ‘privilege’ of biomedical knowledge that prevails even in those situations in which treatment is futile, generating ethical conflicts in nurses. As reflected by the analysis of the professional discourses, the role of the nurse in making decisions is limited to that of a mediator between the physician and the patient/family.…”

“…The results of this study have also demonstrated that medical practice remains anchored in paternalism in Spain, sustained by the biomedical model, described by most participants as a pressing need to save lives consistent with the study developed by Peter and colleagues. 50 Thus, on occasions, the current medical practice could cross the fine line that separates promoting the well-being of patients from therapeutic obstinacy. Under the yoke of ethical responsibilities, and above all legal pressure that society and health professionals themselves place upon their shoulders within a hierarchical system such as the hospital, power and knowledge are assumed as being primarily medical.…”