Respecting the Wishes of Patients in Intensive Care Units

• Published in: Nursing ethics 2007-09, Vol.14 (5), p.651-664
• Main Author: Kinoshita, Satomi
• Format: Article
• Language: English
• Subjects: Adult; Advance Directive Adherence - ethics; Advance Directive Adherence - organization & administration; Advance Directive Adherence - psychology; Advance Directives - ethics; Advance Directives - psychology; Attitude of Health Personnel; Attitude to Death; Conflict (Psychology); Critical Care - ethics; Critical Care - organization & administration; Critical Care - psychology; Decision making; Decision Making - ethics; End of life decisions; Ethical dilemmas; Ethics; Female; Health Knowledge, Attitudes, Practice; Hospitals, University; Humans; Intensive care; Intensive care units; Japan; Male; Middle Aged; Motivation; Nurses; Nursing; Nursing Methodology Research; Nursing Staff, Hospital - ethics; Nursing Staff, Hospital - organization & administration; Nursing Staff, Hospital - psychology; Palliative care; Patient Advocacy - ethics; Patient Advocacy - psychology; Patient care; Patients rights; Perceptions; Physicians; Questionnaires; Right to Die - ethics; Surveys and Questionnaires; Terminal Care - ethics; Terminal Care - organization & administration; Terminal Care - psychology; Withholding Treatment - ethics
• ISSN: 0969-7330; 1477-0989
• DOI: 10.1177/0969733007075890

This study examined why intensive care unit (ICU) nurses experience difficulties in respecting the wishes of patients in end-of-life care in Japan. A questionnaire survey was conducted with ICU nurses working in Japanese university hospitals. The content of their narratives was analyzed concerning the reasons why the nurses believed that patients' wishes were not respected. The most commonly stated reason was that patients' wishes were impossible to realize, followed by the fact that decision making was performed by others, regardless of whether the patients' wishes were known, if the death was sudden, and time constraints. Many nurses wanted to respect the wishes of dying patients, but they questioned how patients die in ICUs and were therefore faced with ethical dilemmas. However, at the same time, many of the nurses realized that respecting patients' wishes about end-of-life care in an ICU would be difficult and that being unable to respect these wishes would often be unavoidable. The results thus suggest that there has been insufficient discussion about respecting the wishes of patients undergoing intensive care.