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Informed consent and the elderly. An ethical challenge for critical care nursing
Critical Care Nursing Clinics of North America
|September 1, 1990
Summary
Critical care nurses face ethical challenges with elderly patients, particularly regarding informed consent. Navigating advance directives and cognitive impairment requires careful ethical decision-making to uphold patient autonomy.
Area of Science:
- Bioethics
- Nursing Ethics
- Geriatric Care
Background:
- Nursing ethics has historically overlooked ethical dilemmas concerning elderly patients in critical care.
- The doctrine of informed consent, rooted in respect for persons and autonomy, presents significant ethical challenges in critical care nursing.
- Advance directives offer a mechanism for elderly patients to express wishes when unable to provide informed consent, but cognitive impairment complicates this.
Purpose of the Study:
- To explore the ethical challenges critical care nurses face with elderly patients, focusing on informed consent and autonomy.
- To examine the complexities of advance directives and cognitive impairment in decision-making for elderly patients.
- To highlight the moral distress experienced by nurses in these situations and emphasize nursing's role in ethical mediation.
Main Methods:
- Ethical analysis of the doctrine of informed consent in the context of critical care for the elderly.
- Discussion of the limitations and contradictions of medical empowerment for the elderly.
- Exploration of the concept of moral distress in critical care nursing.
Main Results:
- Informed consent is often reduced to a bureaucratic procedure, losing its ideal of preserving patient autonomy.
- Cognitive impairment in elderly patients makes determining their preferences extremely difficult, even with advance directives.
- Medical empowerment initiatives can paradoxically lead elderly patients to opt out of decision-making, causing moral distress for nurses.
Conclusions:
- Critical care nurses are central to navigating complex ethical issues concerning elderly patients' autonomy and decision-making.
- Nurses experience moral distress due to the challenges in upholding informed consent and respecting patient wishes.
- Collaboration with colleagues across professions is vital for nurses to strengthen their role as mediators of meaning in life-and-death situations.