< Previous48 American Nurse Journal Volume 15, Number 2 MyAmericanNurse.com Moral space Understanding the problems of living and dying By Leah Curtin, RN, ScD(h), FAAN From Where I Stand A NUMBER OF YEARS AGO , I was caring for a woman who had acute leukemia. She was be- ing given one of the new, experimental che mo - therapeutic agents. She was in constant pain and frequently asked to be allowed to die. One afternoon she regurgitated and aspirated some coffee ground material. I was ready to let her die quickly, but by choking to death? I would like to tell you that she died peacefully, but I can’t. To my knowledge, the best I could do was ease her suffering a bit. People, and particularly people in health- care, are struggling with a dilemma: Who is to choose how and when someone is to die? As our ability to prolong life increases, the prob- lem grows. The ancient biblical imperative is to choose life, but the contemporary dilemma is: Under all circumstances? Whether we want to or not, each of us will confront this issue in clinical practice. I don’t pretend to know the answer (in fact, I think that probably no one answer exists), nor do I presume to tell you what to do. However, this I believe: We all stand accountable for the de- cisions we make and the actions we take. Each human being—each moral agent—must an- swer for what she or he does. To be sure, we work in teams; we are interdependent. Howev- er, no one of us is more qualified than any oth- er to make unilateral decisions about death for someone else. And no one of us has the moral authority to force someone else to do some- thing she or he sincerely believes is wrong. In 1919, the noted American jurist Harlan Fiske Stone put it this way: “…liberty of con- science has a moral and social value which makes it worthy of preservation at the hands of the state. So deep is its significance and so vital, indeed, is it to the integrity of man’s moral and spiritual nature that nothing short of the self-preservation of the state should warrant its violation; and it may well be ques- tioned whether the state which preserves its life by a settled policy of violation of the con- science of the individual will not, in fact, lose it by the same process.” Thus, legal space was created for conscientious objectors to military service even in times of war. Please note that I’m not advocating moral chaos or promoting mass insubordination, nor am I suggesting we should ignore a patient’s clearly expressed wishes. I’m merely suggesting that, within civilized limits, institutional policies should provide some moral space for nurses. Ethicist Paul Ramsey said that “…moral per- sons need social space. Otherwise, outward behavior and job descriptions will drive pro- fessional, moral, and religious ideals or beliefs into irrelevant inwardness, and personal in- tegrity will be destroyed.” We need to have a genuine conversation with one another. This is a plural and chang- ing world. If we are to participate in it hu- manely, we must exchange words we can all understand. Integrity, for instance. Pain and the desire for surcease—we understand that, too. I don’t have the answers to this dilemma, but I do know that unless we preserve our own integrity, answers never will be found. The real battleground isn’t in boardrooms or courtrooms, but rather on hospital units and in solitary hearts among the people who have altogether too intimate a familiarity with the problems of living and dying. Leah Curtin, RN, ScD(h), FAAN Executive Editor, Professional Outreach American Nurse Journal PRACTICE MATTERSBERXI IS PART OF BERKSHIRE HATHAWAY SPECIALTY INSURANCE CO. © Copyright 2019. The information contained herein is for general informational purposes only and does not constitute an off er to sell or a solicitation of an off er to buy any product or service. Any description set forth herein does not include all policy terms, conditions and exclusions. Please refer to the actual policy for complete details of coverage and exclusions. Savings + Simplicity + Security It all adds up with Berxi. Get a medical malpractice insurance quote and check our math at berxi.com.Next >