'Futile' orders and morally distressed nurses: professionally sanctioned conscientious objection is not the solution

Abstract

There are differing views on the exact nature of moral distress in nursing, but essentially, most empirical work indicates that it is the nurse’s inability to do the right thing because she feels impeded from doing so, due to constraints such as organisational structures or lack of authority in medical decision making.

This thesis will begin with a philosophical analysis of the meaning of moral distress. It will be argued that it is a poorly defined concept but that even so, the emotional and rational challenges that it brings to the nurse, are valid and worthy of more exploration.

It will be argued that moral distress is more or less synonymous with ‘troubled conscience’. Thereafter Catlin et al’s (2008) claim that the nursing profession ought to sanction conscientious objection to doctors’ orders when nurses are morally distressed by perceived futile care will be examined.

I will oppose this position, and argue that instead, nurses can limit their sense of responsibility for actions performed on the behalf of doctors. To defend my position will require the construction of arguments based on current legal and professional practice and philosophical concepts such as erroneous conscience, moral luck and the ethics of care.

In seeking to defend my alternate view of how the nursing profession ought to behave under such circumstances, I will propose a new resolution to moral distress. This will involve ethical reasoning that includes consequetialist justifications within the paradigm of the ethics of care. It will also involve addressing the emotional and spiritual challenges of nursing care, which I will argue have so far not been recognised as significant components of moral distress.

Catlin A, Volat D, Hadley M., Bassir R., Armigo C., Valle E., Gong W. and Anderson K. (2008) Conscientious Objection: A Potential Neonatal Nursing Response to Care Orders That Cause Suffering at the End of Life? Study of a Concept. Research in Nursing 27 (2) p. 101 – 108.

Citation

(2012). 'Futile' orders and morally distressed nurses: professionally sanctioned conscientious objection is not the solution