Defense Date

4-7-2022

Graduation Date

Spring 5-14-2022

Availability

One-year Embargo

Submission Type

dissertation

Degree Name

PhD

Department

Nursing

School

School of Nursing

Committee Chair

Joris Gielen

Committee Member

Marsha Fowler

Committee Member

Melanie Turk

Committee Member

Eric Vogelstein

Keywords

nurse, end-of-life, ethics, limited resuscitation, moral agency, moral disengagement, slow codes, CPR, relational autonomy, ethical comportment

Abstract

This dissertation offers a novel approach to support nurses when they face conflict between clinicians and families or alternate decision-makers over potentially inappropriate end-of-life goals of care. This dissertation will provide a normative analysis of the moral permissibility of limited resuscitation, with arguments supported by analyses of families’ and nurses’ perspectives and actions in the EoL decision-making process. Limited resuscitation is a cardiopulmonary resuscitation effort where full pharmacologic and mechanical intervention is not used, or the length of the resuscitative effort is shortened. It is typically associated with deception because it is performed without the knowledge of patients and families. This dissertation argues nurses may participate in limited resuscitation so long as it is performed transparently and without deception, and with full disclosure to patients and alternate decision-makers. It is morally permissible for nurses to participate in disclosed limited resuscitation because it acknowledges patients’ and families’ vulnerability and autonomy, establishes trust between nurses and families, and is a beneficent act that respects cultural humility and allows alternate decision-makers to have an active role in end-of-life decision-making. Nurse participation in disclosed limited resuscitation is also morally permissible because it mitigates threats to a nurse’s moral identity and ethical comportment by eliminating physically intrusive acts that cause suffering, which can contribute to moral distress, and moral disengagement.

This dissertation offers to reframe limited resuscitation as a new end-of-life option that is transparently communicated to families in culturally appropriate ways to nudge family members towards the acceptance of choosing the least harmful EoL interventions that preserve dignity and avoid suffering for their loved ones. Solutions designed to promote transparency and minimize conflict in end-of-life decision-making include tailored resuscitation orders, consultation with ethics committees, family presence at the bedside, nurse’s explicit commitment to nondeceptive end-of-life practice, moral leadership that fosters an ethical environment, and nurse-led time-limited trials. These interventions are all mechanisms to eliminate deception which can build trust, mitigate nurses’ moral distress, preserve patient autonomy, and cultivate a shared acceptance of limited resuscitation as a morally permissible end-of-life option.

Language

English

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