Exploring New Zealand Paramedic Attitudes Towards Advance Directives: An Ethical Analysis

Abstract

Introduction Advance directives are known to present challenging ethical issues in health care practice, however there is a paucity of research into paramedic perspectives of advance directives. In situations where the patient has not considered end-of-life provisions, or is unable to communicate their wishes, this contributes to an ethically complex decision-making environment for practitioners. Ethical deliberation contributes to practitioners’ critical thinking skills and helps prepare them for decision-making under uncertainty. This research aims to highlight and explore underlying values within ethically complex practice-based decisions. Methods An exploratory, interpretive study using the ‘Values Exchange’, a web-based ethical decision-making tool, explored 18 urbanbased New Zealand paramedics’ deliberative perspectives on a controversial end-of-life scenario. Results Thematic analysis of participants’ responses ascertained the breadth of views on advanced directives, with the emergence of three dominant themes; legal tensions, multiple constructs of dignity and seeking solutions that support clinical practice. Conclusion Findings revealed that when considering situations involving advance directives, participants regarded the duty to uphold patient dignity as paramount. There was a desire for greater legal guidance and a call for increased professional education in law and ethics. This study provides insight into New Zealand urban-based paramedics’ views and experiences of this ethically challenging aspect of patient care.