A National Survey on Moral Obligations in Critical Care

Carol L. Pavlish, PhD, RN; Katherine Brown-Saltzman, MA, RN; Joseph A. Raho, PhD; Belinda Chen, MPH


Am J Crit Care. 2019;28(3):183-192. 

In This Article


This study advances empirical understanding of how critical care clinicians share common perceptions about ethically difficult situations and yet perceive moral obligations differently, which may hamper teamwork during ethically complex situations. Evidence of shared and entwined obligations also emerged from this study. Nurses expected physicians to be timely, honest, and comprehensive in discussing prognosis and treatment options with patients so nurses can provide informational and psychosocial support. It is interesting that the 4 moral obligations rated highest by physicians complement the 4 obligations rated highest by nurses. Teamwork in ethically complex situations could be eased if team members clearly identify, discuss, and understand responsibilities and accountability. Philosopher Margaret Urban Walker defined institutional moral spaces as "patterns, structures, routines, and channels of communication that clarify the moral responsibilities and mutual accountability of all parties."[50] (p45) Given the nature of so many competing ethical commitments in critical care practice, clinicians and health care organizations must reflect on and come to understand each other's and their shared moral obligations, build intersections for routine dialogue, and create an authentic foundation for teams to collaborate effectively when confronted with ethical uncertainty, differences, or conflict.