The lived experience of surrogate decision maker and request for DNR orders on behalf of incompetent patients

Abstract

Modern medicine's ability to save and sustain life has created a new imperative to balance technology with humanity. The question of whether and under what circumstances medical intervention should cease and a person be permitted to die is one of the most controversial issues facing society today. Medical choices are moral choices and the need to balance fundamental and competing values in the delivery of care inevitably gives rise to conflict and uncertainty both with the nurse and the person making the moral health care decisions. This challenge is especially relevant to decisions about cardiopulmonary resuscitation (CPR), an emergency treatment designed to prevent death from cardiac or respiratory arrest. The emergence of do not resuscitate (DNR) orders reflects the growing consensus that the availability of the technology does not create a medical or moral imperative for its use with and for all patients. The questions about when to withhold resuscitation, on what grounds, and by whose consent have surfaced as issues. The purpose of this dissertation is to explore the meanings of the experiences of surrogates as they request DNR orders on behalf of patients who are incompetent, that is persons who lack the decision making capacity. Hermeneutic phenomenology provided the philosophical base to investigate and interpret the meanings of surrogate decision making and request for DNR orders on behalf of incompetent patients. Texts generated from conversational dialogues are transcribed and shared with colleagues and advisors and confirmed with the participants to ensure accuracy of information shared. Reflection on conversations and interactions with the participants made it possible to develop new insights into the meaning of surrogate decision making and request for DNR orders. Engaging in reflective dialogues enabled participants to see new possibilities of their lived experiences as surrogates. It is hoped that nurses will be more comfortable to assist surrogates in dealing with their experiences. The better the nurses understand what it means to be a surrogate decision maker for incompetent patients, the better they will be able to support them. Research findings about the phenomenon of surrogate decision making on behalf of incompetent patients suggest the need for a combination of value analysis appointment of health care agent and post-decision follow-up care as necessary factors that support decision making at end of life.