Nurses’ views of the causes of ethical dilemmas during treatment cessation in the ICU: a qualitative study

Background: Technological advances in intensive care units (ICUs) have prolonged the dying process, with an increased number of patients dying after treatment has been withheld or withdrawn. Often the patient is unable to participate in decisions being made about their treatment. This creates an ethical dilemma for those involved and can create discord. Aim: The aim of this study was to explore ICU nurses’ experiences of caring for patients having treatment withheld or withdrawn, with an emphasis on their perceptions of the ethical principles used in decision making. Methods: A qualitative exploratory approach was used to gain insight into the ethics of withholding and withdrawing treatment. A purposive sample of six ICU nurses participated in the study. Semi-structured interviews were conducted and thematically analysed. Results: The participants identified three interacting themes as forming the ethical foundation of treatment cessation: their personal set of moral beliefs, their experience and the decision-making process. An ethical dilemma emerges when the relationship between these breaks down. Conclusion: Caring for patients for whom treatment is withheld or withdrawn can create significant professional and personal dilemmas. Open discussion, collaborative decision making and consistency in practice are crucial to avoiding moral distress during treatment cessation. Consensus in decision making is key to minimising ethical discord, and personal beliefs and experience are crucial factors.