Moral reasoning, self-transcendence, and end-of-life decisions in a group of community-dwelling elders

Persistent Link:
http://hdl.handle.net/10150/282824
Title:
Moral reasoning, self-transcendence, and end-of-life decisions in a group of community-dwelling elders
Author:
Decker, Ilene Marie, 1952-
Issue Date:
1998
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
A societal consensus has developed around the principle that decisions about life sustaining treatment should be guided by patient preferences. This view is supported by the American Nurses' Association, which promotes the patient's right to self determination in end-of-life decisions and the nurse's involvement in facilitating decision-making for patients making such choices. This idea is further evidenced by the Patient Self-Determination Act of 1991, where hospitals are required to ascertain whether or not the patient has an advance directive and to counsel patients about their rights to formulate an advance directive. Little is known about how people make decisions concerning their life in the midst of current biotechnical advances that extend life. This study attempted to gain insight into moral reasoning and other contextual, developmental factors that may account for elders' perspectives related to end-of-life care. Elders' perceptions about the end of life and the reasoning processes used to formulate preferences for treatment at the end of life were investigated. The advance directive decision, as one practice issue, was studied as an indicator of preferences for end-of-life treatment. Also, contextual factors (age, education, gender, self-reported health status, prior experience with an advance directive decision) and self-transcendence, regarded as an indicator of a developmental transition in older adults, were examined as correlates of moral reasoning about end-of-life choices as well as desires for end-of-life treatment. Findings revealed that older adults (N = 126) use an integrated and complex approach to reasoning in the context of end-of-life decisions. Self transcendence, an indicator of this unique characteristic of adult cognition, was significantly related to the level of integrated moral reasoning and may explain why reasoning about end-of-life treatment options takes on a more complex and integrated approach. In addition to elders' unique patterns of thinking, the context of their experiences impact preferences for end-of-life treatment. Level of education, prior experience with a life-threatening illness, and the decision to complete a living will are important indicators of the desired aggressiveness of end-of-life treatment. Thus, moral development in the context of end-of-life decisions may be explained in part through an understanding of a contextual-dialectic process.
Type:
text; Dissertation-Reproduction (electronic)
Keywords:
Gerontology.; Health Sciences, Nursing.; Psychology, Developmental.; Psychology, Cognitive.
Degree Name:
Ph.D.
Degree Level:
doctoral
Degree Program:
Graduate College; Nursing
Degree Grantor:
University of Arizona
Advisor:
Reed, Pamela G.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_US
dc.titleMoral reasoning, self-transcendence, and end-of-life decisions in a group of community-dwelling eldersen_US
dc.creatorDecker, Ilene Marie, 1952-en_US
dc.contributor.authorDecker, Ilene Marie, 1952-en_US
dc.date.issued1998en_US
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractA societal consensus has developed around the principle that decisions about life sustaining treatment should be guided by patient preferences. This view is supported by the American Nurses' Association, which promotes the patient's right to self determination in end-of-life decisions and the nurse's involvement in facilitating decision-making for patients making such choices. This idea is further evidenced by the Patient Self-Determination Act of 1991, where hospitals are required to ascertain whether or not the patient has an advance directive and to counsel patients about their rights to formulate an advance directive. Little is known about how people make decisions concerning their life in the midst of current biotechnical advances that extend life. This study attempted to gain insight into moral reasoning and other contextual, developmental factors that may account for elders' perspectives related to end-of-life care. Elders' perceptions about the end of life and the reasoning processes used to formulate preferences for treatment at the end of life were investigated. The advance directive decision, as one practice issue, was studied as an indicator of preferences for end-of-life treatment. Also, contextual factors (age, education, gender, self-reported health status, prior experience with an advance directive decision) and self-transcendence, regarded as an indicator of a developmental transition in older adults, were examined as correlates of moral reasoning about end-of-life choices as well as desires for end-of-life treatment. Findings revealed that older adults (N = 126) use an integrated and complex approach to reasoning in the context of end-of-life decisions. Self transcendence, an indicator of this unique characteristic of adult cognition, was significantly related to the level of integrated moral reasoning and may explain why reasoning about end-of-life treatment options takes on a more complex and integrated approach. In addition to elders' unique patterns of thinking, the context of their experiences impact preferences for end-of-life treatment. Level of education, prior experience with a life-threatening illness, and the decision to complete a living will are important indicators of the desired aggressiveness of end-of-life treatment. Thus, moral development in the context of end-of-life decisions may be explained in part through an understanding of a contextual-dialectic process.en_US
dc.typetexten_US
dc.typeDissertation-Reproduction (electronic)en_US
dc.subjectGerontology.en_US
dc.subjectHealth Sciences, Nursing.en_US
dc.subjectPsychology, Developmental.en_US
dc.subjectPsychology, Cognitive.en_US
thesis.degree.namePh.D.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.disciplineNursingen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorReed, Pamela G.en_US
dc.identifier.proquest9912131en_US
dc.identifier.bibrecord.b39124162en_US
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