The moral certainty or uncertainty of nurses regarding end-of-life treatment decisions

Abstract

<p>Much has been written about the importance of decision-making in nursing ethics, but few research studies have been completed which examine nurses' ethical decision-making. In order to address this absence of research, two concepts that are integral to nurses' ethical decision-making were analyzed: moral certainty and moral uncertainty. These concepts were studied in the context of the issue of withholding or withdrawing artificial nutrition and hydration. This issue was chosen as an exemplar of issues about which nurses feel morally certain or uncertain. The research questions addressed by this research were: (a) Are nurses morally certain or uncertain about whether artificial nutrition and hydration may be withdrawn from an elderly person in the end stages of life in long-term care? (b) If nurses are morally certain, what is the experience of this moral certainty? and (c) If nurses are morally uncertain, what is the experience of this moral uncertainty? A qualitative design was used to describe nurses' experiences of moral certainty or uncertainty. A convenience sample of BSN- and MSN-prepared nurses employed in long-term care in Northeastern and Southeastern Wisconsin was used. Twenty-five participants completed the Brim Desire for Certainty Scale, a demographic data sheet, and an interview. Five categories of conviction emerged from the data: Absolute moral conviction (AMC), strong moral conviction (SMC), moderate moral conviction (MMC), moral uncertainty with conviction (MUWC), and moral uncertainty (MU). The majority of participants (80%) believed, with varying degrees of conviction, that it should be permissible to withhold or withdraw artificial nutrition and hydration from elderly persons in the end stages of life in long-term care. The remaining 20% were uncertain about whether it should be permissible. The experiences of moral certainty and moral uncertainty, described by these nurses, are compared and contrasted. The additional findings supplied by the Brim Scale and the Demographic data sheet are discussed. Finally, the findings are interpreted and suggestions made for future research.</p>