Moral Distress in Nursing in Response to Medical Futility in the Geriatric Population at the End of Life
Each day, in the life of a nurse, they deal with issues that address respect for life and doing what is ethically and morally right. Promoting the patient’s self esteem and personal independence, and doing what is right and preventing harm are nursing care’s utmost priorities. Since nursing is a centrally ethical profession, morals and values play an important role in making a nurse perceive that their work is more meaningful (Ferrell, 2006). In Jameton’s (1984) influential book, Nursing Practice the ethical issues, he differentiates ethics from morals by contrasting professional versus personal values. According to Jameton (1984) professional values are set of rules that publicly state a profession’s ethical beliefs, such as the Code for Nurses, while personal values are morals that a person strongly believes in. In short, ethics refers to the more professional and theoretical term, while morals are more personal and informal. Mohammed and Peter (2009) defines medical futility as medical interventions and treatments that will unlikely result in any positive outcome and further divides it into two categories: physiologic and qualitative. Physiological futility involves interventions that are unlikely to produce a specific medical outcome that will resolve symptoms nor prolong the patient’s survival (Mohammed & Peter, 2009). An example of physiologic futility is performing Cardiopulmonary Resuscitation (CPR) on a patient with a ruptured dissecting aneurysm. Physiologic futility is often based on the clinician’s past experience, their colleague’s shared experience and based on statistical data that an intervention would have no desired effect (Mohammed & Peter, 2009). However, even with a given statistical data, collective analysis will not usually show that an intervention is 100% guaranteed ineffective, hence the issue of whether to terminate a treatment or not (Mohammed & Peter, 2009). Qualitative futility on the other hand, are situations that may violate the clinician’s sense of integrity, misuse of healthcare’s limited resources, and involve treatment that may be harmful rather than beneficial, when the goals of the patient and their decision maker are considered unreasonable (Mohammed & Peter, 2009). An example of qualitative futility is the aggressive treatment of an end stage cancer patient that may disregard the patient’s pain and comfort. The patient would be in overwhelming amounts of discomfort with a likelihood of remission being zero. According to Ferrell (2006) nurses are often placed in a difficult position being in the core of health organizations, direct contact with patients, and the dominance of medicine. When nurses are faced with situations that are against their values as a result of inappropriate medical treatment, nurses often experience moral distress (Ferrell, 2006). Moral distress in nursing arises when one recognizes the right thing to do, but is unable to act on it due to organizational constraints (Jameton, 1984). In an attempt to face such ethical dilemma, nurses will often choose to act as a patient advocate. Ferrell (2006) notes three possible actions that a nurse faced with an ethical situation might do: the nurse recognizes the negative effects that their action might do, to avoid being reprimanded they will therefore do nothing; a nurse may try to act as a patient advocate but will avoid direct confrontation with the physician by using communication strategies that will covertly get their point across; or a nurse will strongly advocate for the patient and confront the physician. Often times, according to Ferrell (2006), nurses are unsuccessful in their attempts to directly advocate for the patient. As a result, nurses feel hurt, powerless, anger and frustration which are all signs of moral distress (Ferrell, 2006). According to Pendry (2007), nurses will not...
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