Abstract
Background: moral-uncertainty-distress (MUD) is defined as moral distress related to moral conflict about best course of action, impacting the clinical decision making process in morally complex situations. This study aims to correlate physician’s perception about advance directives (AD) with presence or absence of MUD, identifying the impact that AD promotes on clinical decision making.Methods: this is a qualitative, cross-sectional, exploratory study. Data was collected through semi-structured interviews with physicians of a hospital in southern Brazil. Interviews content was submitted to categorization analysis content technique by Laurence Bardin.Results: eight physicians were interviewed. The analysis contend identified two categories: (1) AD as a morally challenging element and (2) recognition of AD as instruments that exercises patient’s autonomy. In the first, paternalistic attitude; insecurities in uncertain prognoses; uncertainty about patient values and motivations to write the document; and little previous knowledge about AD, were elements of MUD for physicians. In second category, autonomy in AD was seen as prima facie principle and as shared autonomy.Conclusion: although AD were comprehended as instruments of exercise of patient’s autonomy by the participants, some elements were morally challenging for them, which can be a source of MUD to physician during decision making process.
Moral-uncertainty-distress related to Advance Directives: a qualitative study