Ethical competence in DNR decisions


Decisions not to resuscitate are frequently made within hematology and oncology care. Nurses and doctors involved in the decision-making face ethical dilemmas. To act in the best interest of the patient, they need to trust their ethical judgements. To do that, they need ethical competence. 

In a paper in BMC Medical Ethics, physicians and nurses reflect on their ethical competence in relation to DNR decisions. They share their views on what their ethical competence should include and how it could develop. The severity and stigmatization of cancer causes vulnerability in patients and their families. This imposes major ethical demands on DNR decision-making.

Mona Pettersson, one of the authors, describes that to make ethically sound DNR decisions, nurses and doctors need to develop appropriate virtues and improve their knowledge of ethical theories and relevant guidelines. For nurses and physicians, ethical competence is closely tied to work tasks. Therefore, nurses and physicians experience the decision-making processes differently. There is a need for nurses and physicians to communicate with each other about the decisions.

The ethical training of nurses and physicians take place during their formal education. However, the authors describe that the workplace needs to offer opportunities to reflect and discuss ethics in end of life care in oncology and hematology. Enhancement of ethical competence is necessary to improve cooperation between nurses and physicians regarding patients and DNR decisions. This is a prerequisite for their ethical competence to remain at high level.

Full article: Pettersson, M. Hedström, M Höglund, Anna T. (2018) Ethical competence in DNR decisions –a qualitative study of Swedish physicians and nurses working in hematology and oncology care, BMC Medical Ethics

By Anna Holm

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