Doctors' and nurses' perceptions of ethical problems in end-of-life decisions

Area of Science:

• Medical Ethics
• Healthcare Professional Collaboration
• Qualitative Research

Background:

• Ethical problems cause tension for healthcare professionals.
• Differing perceptions of ethical issues can lead to conflict.
• Understanding diverse perspectives is crucial for collaboration, especially in end-of-life care.

Purpose of the Study:

• To identify and compare doctors' and nurses' perceptions of ethical problems.
• To explore the sources of ethical tension and moral distress experienced by these professionals.
• To understand how professional roles influence ethical problem-solving.

Main Methods:

• Qualitative study involving interviews with 7 doctors and 14 nurses.
• Participants described frequently encountered ethical problems in acute care medical-surgical and intensive care settings.
• Thematic analysis was used to analyze transcribed interview data.

Main Results:

• Both doctors and nurses identified witnessing patient suffering as a core ethical problem, creating a moral obligation to alleviate it.
• Uncertainty in decision-making, competing values, resource scarcity, and communication issues contributed to moral distress.
• A key difference emerged: doctors make decisions, while nurses implement and live with them, leading to distinct questions and interpretations of moral distress.

Conclusions:

• Differences in doctors' and nurses' ethical problem perceptions are attributed to professional roles, not ethical reasoning or motivation.
• Despite limitations, the study suggests a need for moral discourse between doctors and nurses to foster mutual understanding and support.
• Healthcare administrators should facilitate opportunities for dialogue to reduce moral distress and develop strategies for ethical challenges.