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Nursing Ethics
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Incorporating Patients' Spirituality Into Care Using Gadow's Ethical Framework

Barbara Pesut

University of British Columbia Okanagan, FIN 344 Faculty of Health and Social Development, 3333 University Way, Kelowna, BC, V1V 1V7, Canada, barb.pesut{at}ubc.ca

Incorporating patients' spiritual beliefs into health care decision making is essential for ethically good care. Gadow's three-level ethical framework of ethical immediacy, ethical universalism, and relational narrative is presented as a tool for enhancing nurses' ability to explore and deepen understandings of patients' spiritual beliefs, given that these and their experiences are often expressed in a language that seems foreign to nurses. The demographic and cultural shifts that lead to the necessity to understand patients who use principles and metaphors that, while commonly understood within their spiritual tradition, may seem incomprehensible to outsiders, are here set in the Canadian context. A case study on palliative sedation is used to illustrate how the ethical framework can help to reveal the spiritual certainties, principles and narratives patients bring to their health care experiences.

Key Words: ethical framework • health care decision making • patient—provider relationships • relational narrative • religion • spirituality

Nursing Ethics, Vol. 16, No. 4, 418-428 (2009)
DOI: 10.1177/0969733009104606
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