Experiencing moral uncertainty in practice

Abstract

<p>Within the past thirty years, ethical questions have come to the forefront of nursing practice.&nbsp; Books on the subject of nursing ethics attest to the fact that nursing ethics as a subject distinct from medical ethics is seen as important, not only by nurse scholars, but also by practicing nurses and philosophers of biomedical ethics. Little has been written about the moral uncertainty experienced by nurses while making ethical decisions.&nbsp; In order to address this absence of research, the author has studied moral certainty and moral uncertainty related to the issue of withholding or withdrawing artificial nutrition and hydration from elders in the end stages of life in long-term care and acute care nurses' experiences of moral certainty (Wurzbach, 1993; 1995; 1996).</p> <p>The author found that there was a difference in reactions to the moral uncertainty of an ethical event.&nbsp; If there was time, nurses experienced "standing back" or "going through" moral uncertainty.&nbsp; If there was not time to consider options the phenomenon of &ldquo;just keep going" occurred.&nbsp; The nurses who experienced "just keep going" were the most likely to "look back", wondering whether what they had done was &ldquo;right&rdquo;, sometimes ruminating for years.</p> <p>This study examined the experience of moral uncertainty in practice and its effect on the nurses who experience it. Humility is coming to an understanding of the complexity of ethical understanding.&nbsp; This means acknowledging that moral beliefs may exist that are equally fundamental and yet contradictory within a given situation. It also means recognizing and acknowledging moral uncertainty.&nbsp; Instead of pursuing a search for moral certainty, living with the ambiguities of the ethical life is not only suggested, but recommended. Although even statements of fact may be tentative, one can have sufficient knowledge to take moral action, subject to revision of one's point of view, with the accumulation of more evidence.</p>