Exploring New Zealand Paramedic Attitudes Towards Advance Directives: An Ethical Analysis

Introduction
Advance directives are known to present challenging ethical issues in health care practice, however there is a paucity of research
into paramedic perspectives of advance directives. In situations where the patient has not considered end-of-life provisions, or
is unable to communicate their wishes, this contributes to an ethically complex decision-making environment for practitioners.
Ethical deliberation contributes to practitioners’ critical thinking skills and helps prepare them for decision-making under
uncertainty. This research aims to highlight and explore underlying values within ethically complex practice-based decisions.
Methods
An exploratory, interpretive study using the ‘Values Exchange’, a web-based ethical decision-making tool, explored 18 urbanbased
New Zealand paramedics’ deliberative perspectives on a controversial end-of-life scenario.
Results
Thematic analysis of participants’ responses ascertained the breadth of views on advanced directives, with the emergence of
three dominant themes; legal tensions, multiple constructs of dignity and seeking solutions that support clinical practice.
Conclusion
Findings revealed that when considering situations involving advance directives, participants regarded the duty to uphold patient
dignity as paramount. There was a desire for greater legal guidance and a call for increased professional education in law and
ethics. This study provides insight into New Zealand urban-based paramedics’ views and experiences of this ethically challenging
aspect of patient care.