Paper
Wednesday, 19 July 2006
This presentation is part of : End-of-Life Models and Studies
Ethical Problems in End-of-Life Decision-Making for Norwegian Healthcare Professionals, Elders, and Family Members
Marjorie A. Schaffer, PhD, RN, Nursing Department, Bethel University, St. Paul, MN, USA
Learning Objective #1: Explore ethical problems encountered in end-of-life decision-making experienced by Norwegian health care professionals, elders, and family members.
Learning Objective #2: Discuss nursing practice and health care organizational strategies for improving end-of-life care for elders.
In the context of a society’s laws and ethical standards, end-of-life decisions are influenced by the goals and values of individuals, their family members, health professionals, and health care organizations.  Interview questions were designed to explore these contributing perspectives to end-of-life decisions for elders in Norway.  This qualitative study identified ethical problems, resolutions, and rationale experienced in end-of-life decision-making by heath care professionals, elders, and family members in Norway.  In addition, Norwegian laws, policies, and standards relevant to health care at the end of life were analyzed to determine the societal context for end-of-life ethical decision-making.  Health care professionals (n = 25), who were nurses, physicians, ministers, and a social worker from nursing homes, hospitals, home care, or hospices, identified 94 ethical problems in eight categories.  The highest frequency of ethical problems occurred in interactions with family members and concerns about the quality and adequacy of health care services.  Six elders, all living independently, identified 21 ethical problems in four categories concerning end-of-life decision-making. Elders were primarily concerned about treatment that was given at the end of life and making decisions for themselves or others.  Five family members named 13 ethical problems in three categories. Their greatest concern was about dissatisfaction with health care services provided to an elderly parent who had recently died.  Family members described ethical conflict about how to talk to a parent about end-of-life decisions.  All three participant groups experienced ethical problems regarding quality of health care services and interactions with family members.  Analyses of resolutions and rationale for the responses to the ethical problems suggest implications for enhancing conversations between professionals, family members, and elders as well as strategies for improving health care organizational approaches to end-of-life care for elders and their family members.

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