-
6: Moral Meanings of Caring for the Dying
- University of Wisconsin Press
- Chapter
- Additional Information
6 Moral Meanings of Caring for the Dying shelley raffin bouchal What is it like for nurses to care for dying individuals who are suffering? I have experienced and reflected upon this experience in countless ways. As an educator I found that this particular journey heightened as I pursued and completed doctoral studies. I began this inquiry at the side of nine palliative care nurses who willingly, openly, and quite profoundly participated in my journey to understand nurses’ experience of caring for dying individuals who are suffering. Their willingness to open up their experience to me exemplified their commitment and obligation to palliative care nursing. Nursing has made many important contributions to palliative care. Historically, nurses have cared for dying individuals who are suffering, and the alleviation of suffering has been a cornerstone of caring, compassionate nurses (Lindholm & Eriksson, 1993). “Nurses are, or should be[,] . . . people who have professed an allegiance to those who suffer lives of enormous and sometimes unbearable pain” (Caputo, 1993, p. 243). Nurses who are committed to caring for the very ill accept full responsibility for their actions; they are willing to risk suffering with others and willing to be a witness to suffering. Those who refuse commitment by becoming detached, callous, or cynical in the face of suffering are “spectators” to life rather than “witnesses” (Taylor, 1991). Nurses create embodied relationships by making a conscious choice to be fully aware of their own bodies and to remain present to the patient, thereby creating a moral space for suffering. Their actions stem from a moral obligation to 232 suffer with others. Nurses are called to consider their moral obligations in all situations, in all encounters, and with all patients. Nurses do not have the luxury of simply looking in on or overseeing the dying journey; they must engage with illness and pain, becoming fully present to the suffering person. “Nursing practice situates us in the midst of the lives of people where suffering takes place” (Moules, 2000a, p. 5). The obligation or intention to understand suffering is a deeply ethical one. “Obligation is what is important about ethics” (Caputo, 1993, p. 18). Beyond obligation, nurses also have a passion to understand, and this passion moves us beyond assumption. In the local moral worlds or cultures of nurses who care for those who are suffering, we are, as nurses, obligated to understand, as Kleinman (1992) states, [w]hat precedes, constitutes, expresses, and follows from our actions in interpersonal flows of experience, it is important to understand, what is most at stake for us, what we most fear, what we most aspire to, what we are most threatened by, what we most desire to cross over to safety, what we jointly take to be the purpose , and the ultimate meaning of our living and our dying. (p. 129) Nurses have the opportunity to bring personal context to the suffering experience. Each nurse, as a person, embodies a private experience of suffering. Suffering evolves from a particular biographical journey through time in relation to professional experiences, threatening some aspect of our personal identities (Ferrell, 2001). Holding the fragility of life in their hands as part of their everyday work permits nurses to be themselves (Maeve, 1998). This everydayness creates opportunities for nurses to face their own death as well as their patient’s death. Nurses engage in the death-and-dying experience through a certain projection of themselves as the meaning of life and death is considered on a daily basis. Nurses involved in the intimate journey to death “cannot hide behind technology or a veil of omniscience as other practitioners. . . . [N]urses are there to hear secrets, especially the ones born of vulnerability” (Fagin & Diers, 1983, p. 117). Giving of themselves and sharing heartfelt emotion are seen as beneficial to their patients, and to give any less might interfere with nurses’ ability to know and understand suffering. The importance of relationships in caring for suffering individuals cannot be underestimated. Relationships in health care are important Moral Meanings of Caring for the Dying 233 [44.220.41.140] Project MUSE (2024-03-28 17:46 GMT) 234 shelley raffin bouchal determinants for health outcomes, for the experiences of family members, and for the quality of work life of health care providers (Rodney , 1997). The quality of nurses’ relationships with patients is central to understanding and experiencing suffering. We have only begun to know and understand the phenomenon of suffering and the moral relationship that exists between nurses...