Healthcare professionals' moral reasoning on the ethical challenges of 'do-not-resuscitate orders' in intensive care units

Abstract

The research study was set to explore the healthcare professionals' moral reasoning concerning the Do Not Resuscitate orders (DNR) in intensive care units in Malta. DNR is a very complex issue and its moral understanding is very vague. However, this study explored this phenomenon throughout the ethical and legal considerations. Additionally, the decision process of DNR was investigated to highlight the moral reasoning of healthcare professionals in ICU. This research adopted a qualitative approach to (a) determine what ethical issues are involved in DNR decision-making, (b) examine the understanding of DNR from an ethical perspective (c) explore the extent to which DNR is practiced in the local scenario and the health carers' moral reasoning. The data of this study was gathered by means of semi structured interviews. The sample consisted of 20 healthcare professionals ranging from physicians and nurses with more than 3 years of experience in either the Intensive Therapy Unit or the Cardiac Intensive Care Unit. The results of this study illustrate that healthcare professionals are very much aware of the moral implications of DNR orders. However, quality-of-life and autonomy have been highlighted in this study. Additionally, a strong association between futility, pain and suffering was determined. It was concluded that sanctity-of-life, despite being an unpopular concept, has great influence on healthcare professionals because of the Maltese culture. The data collected in this study has reaffirmed the strong relationship between legislation and DNR orders together with the impact it has on healthcare professionals. Through this study it was determined that, although nurses might contribute to DNR decision-making, physicians have the ultimate responsibility to establish DNR orders. Moreover, this study highlights several recommendations that will hopefully trigger further exploration of this phenomenon in Malta's healthcare setting. It is hoped that the findings of this study are given consideration for the patient's best interest.