A blog from the Centre for Research Ethics & Bioethics (CRB)

Month: June 2014

Nurses’ experiences of do not resuscitate orders

PÄR SEGERDAHL Associate Professor of Philosophy and editor of The Ethics BlogWhen a critically ill patient has such a poor prognosis that resuscitation would be of no use, doctors can write a so-called do not resuscitate order. The decision means that if the heart stops beating, the medical team should not, as otherwise, perform coronary pulmonary rescue.

The decision is made by the physician on the basis of a medical assessment. But the decision affects the patient, the relatives, and the nurses who care for the patient and family.

Mona Pettersson at CRB is writing her thesis on the decision not to resuscitate. In a study recently published in Nursing Ethics, she interviewed 15 nurses about their experiences of do not resuscitate orders at Swedish hematology and oncology departments.

The nurses describe problems that may arise. The nurses have daily close contact with patients and notice when they are no longer responding to treatment. The nurses can then expect a do not resuscitate order, which may not always come. The decision may be taken by the doctor on the spot, when a resuscitation attempt already started. Sometimes decisions are unclear or contradictory: decisions are taken while continuing to give the patient full treatment. And if the patient and family are not informed about the decision, or the nurse is not present when the information is given, it becomes difficult for the nurse to care for the patient and family – for example, to answer questions afterwards.

Mona Pettersson concludes that nurses need clear, well-documented orders. Patients and families need to be informed and involved in the decisions, and nurses should be present when the information is provided. Finally, regular ethical discussions between nurses and doctors are needed, to understand each other and the different perspectives on do not resuscitate orders. Here you find a link to the article:

Co-authors are Mariann Hedström and Anna Höglund.

Before I finish this post, I want to mention a recently made compilation of our research on nursing ethics:

There you will find our publications with abstracts and links to the publications that are available online.

Pär Segerdahl

We have a clinical perspective : www.ethicsblog.crb.uu.se

Our publications on biobanks and registries

PÄR SEGERDAHL Associate Professor of Philosophy and editor of The Ethics BlogBiomedical research does not always require research subjects who are prepared to experimentally try new treatments or diets. Increasingly, research on health and disease is carried out on stored biological samples and personal data in different registries.

Handling human biological material and personal data raises unique ethical issues. People who volunteer as participants in such research are unlikely to be harmed by experimental treatments, but their samples and data are stored for a long time. Samples and data can also be shared by several groups, and be used in different research projects.

One can therefore speak of unique ethical challenges in biobank and registry research. At the Centre for Research Ethics and Bioethics, we have long been working to clarify these challenges and discuss ways to deal with them responsibly. Our work has resulted in numerous publications, often together with biomedical researchers and in international collaborations.

In May 2014, we published an updated compilation of these publications:

The above link will take you to the online version, which also contains further links to the articles that are available online. A printed report can be ordered from crb@crb.uu.se.

The report contains abstracts of all the publications. What is new is that we now arranged the publications thematically:

  1. Ethical frameworks and policy
  2. Regulatory aspects
  3. Informed consent
  4. Ethical review
  5. Integrity concerns
  6. Trust
  7. Genetic testing
  8. Incidental findings
  9. Commercialization
  10. Public and patient perceptions
  11. Rare diseases
  12. Children & biobanks & genetics

We hope you take a look at the report and find something that interests you!

Pär Segerdahl

Part of international collaborations - the Ethics Blog

Intellectualizing morality

There is a prevalent idea that moral considerations presuppose ethical principles. But how does it arise? It makes our ways of talking about difficult issues resemble consultations between states at the negotiating table, invoking various solemn declarations:

  1. “Under the principle of happy consequences, you should lie here; otherwise, many will be hurt.”
  2. “According to the principle of always telling the truth, it is right to tell; even if many will be hurt.”

This is not how we talk, but maybe:

  1. “I don’t like to lie, but I have to, otherwise many will be hurt.”
  2. “It’s terrible that many will suffer, but the truth must be told.”

As we actually talk, without invoking principles, we ourselves take responsibility for how we decide to act. Lying, or telling the truth, is a burden even when we see it as the right thing to do. But if moral considerations presuppose ethical principles of moral rightness, there is no responsibility to carry. We refer to the principles!

The principles give us the right to lie, or to speak the truth, and we can live on with a self-righteous smile. But how does the idea of moral principles arise?

My answer: Through the need to intellectually control how we debate and reach conclusions about important societal issues in the public sphere.

Just as Indian grammarians made rules for the correct pronunciation of holy words, ethicists make principles of correct moral reasoning. According to the first principle, the first person reasons correctly; the other one incorrectly. According to the second principle, it’s the other way round.

But no one would even dream of formulating these principles, if we didn’t already talk as we do about important matters. The principles are second-rate goods, reconstructions, scaffolding on life, which subsequently can have a certain social and intellectual control function.

Moral principles may thus play a significant role in the public sphere, like grammatical rules codifying how to write and speak correctly. We agree on the principles that should govern public negotiations; the kind of concerns that should be considered in good arguments.

The problem is that the principles are ingeniously expounded as the essence and foundation of morality more generally, in treatises that are revered as intellectual bibles.

The truth must be told: it’s the other way round. The principles are auxiliary constructions that codify how we already bear the words and the responsibility. Don’t let the principles’ function in the public sphere distort this fact.

Pär Segerdahl

We challenge habits of thought : the Ethics Blog