title: Ethical decision-making in hospice care.
abstract: BACKGROUND
  Hospices are based on a holistic approach which places the physical, psychological, social and spiritual welfare of their patients at the forefront of their work. Furthermore, they draw up their own mission statements which they are at pains to follow and seek to conduct their work in accordance with codes of ethics and standards of care.
  Our study researched what form the processes and degrees of latitude in decision-making take in practice when questions of an ethical and ethically relevant nature arise. We used a qualitative approach. Data collection and evaluation was based on the methods of grounded theory.
  
  
  METHODS
  The study was reported to the relevant Ethics Commission who had raised no objections following the submission of the study protocol. The study at the hospices was approved by the directors of the hospices and the nursing teams. The rights of the participants were protected by obtaining informed consent.
  
  
  RESULTS
  Medication in the prefinal phase and questions affecting the provision of solids and liquids in the end-of-life phase have an ethical dimension. In the context of these two fields, decisions are taken collectively. A nurse's individual (and ethically relevant) leeway in decision-making processes is restricted to the nurse's own style of administering care. The nurse's decision-making often depends to a far greater degree on her ability to adapt her concept of ideal care to fit the practical realities of her work than to any conceptual framework.
  
  
  CONCLUSIONS
  An adaptive process is necessary for the nurse because she is required to incorporate the four pillars of hospice care - namely, physical, psychological, social and spiritual care - into the practice of her daily work.
  
  
  CONCLUSIONS
  Ethically relevant decisions are often characterised by nurses adjusting their aspiration levels to the practical conditions with which they are confronted.
authors: Westfälische Wilhelms-University of Münster, Germany andreas.walker@uni-muenster.de.
authors: Andreas
authors: A
authors: Walker
authors: Westfälische Wilhelms-University of Münster, Germany.
authors: Christof
authors: C
authors: Breitsameter
mesh_terms: D003657:Decision Making / Q000941:ethics*; D004993:Ethics, Nursing; D017051:Hospice Care / Q000941:ethics*; D006806:Human Rights; D006801:Humans; D036301:Qualitative Research
keywords: Aspiration adaptation; end-of-life decision-making; hospice care; nursing ethics; palliative care