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

Aims. To identify and compare doctors' and nurses' perceptions of ethical p roblems. Rationale. Ethical problems are a source of tension for health professional s. Misunderstandings or conflicts may result from differing perceptions of ethical problems. If true collaboration is to be achieved, it is important to understand the perspectives of others, particularly when difficult end-o f-life decisions must be made. Methods. In this qualitative study a total of seven doctors and 14 nurses w orking in acute care adult medical-surgical areas, including intensive care , were asked to describe ethical problems that they frequently encounter in practice. Interviews were taped and transcribed. Thematic analysis followe d. Results. All participants experienced ethical problems around decision maki ng at the end of life. The core problem for both doctors and nurses was wit nessing suffering, which engendered 3 moral obligation to reduce that suffe ring. Uncertainty about the best course of action for the patient and famil y was a source of moral distress. Competing values, hierarchical processes, scarce resources, and communication emerged as common themes. The key diff erence between the groups was that doctors are responsible for making decis ions and nurses must live with these decisions. Each group, therefore, aske d different questions when encountering and interpreting sources of moral d istress. Conclusions. 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, r esults suggest that doctors and nurses need to engage in moral discourse to understand and support the ethical burden carried by the other. Administra tors should provide opportunities for discourse to help staff reduce moral distress and generate creative strategies for dealing with this.