Holding her as she took her last breath on Easter Monday in Canada irrevocably changed my understanding of care. The moment was heartbreaking, yet her peaceful passing stood in stark contrast to the ensuing confusion when CPR began despite a clear do-not-resuscitate (DNR) order.I felt utterly helpless.
That experience ignited a commitment to advocacy and ethical clarity. It revealed how even well-intentioned medical interventions can violate patient autonomy and erode trust when systems fail to honor advance directives.
Grief as a Bridge to Empathy
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how shared loss can foster deeper connections in healthcare.
Returning to the U.S. for my residency, I encountered a similar situation, supporting another daughter as her mother underwent resuscitation. My own grief unexpectedly became a bridge, allowing me to offer genuine empathy and a quiet presence.
I discovered that the most valuable gift isn’t offering solutions or empty words, but simply being present: truly listening and holding space for another’s pain. In those moments, families need someone who can absorb their anguish without judgment or haste.
Ethical Implications: Autonomy and Systemic Failures
A DNR order embodies a patient’s autonomous choice, a foundational principle of medical ethics. Initiating CPR despite such directives compromises several core ethical tenets:
- Autonomy: Disregarding a DNR directly disregards the patient’s expressed wishes.
- Nonmaleficence: Performing CPR on a frail patient can inflict harm without providing benefit.
- Justice: Systemic failures-like poor documentation or communication breakdowns-create inequities in honoring end-of-life preferences.
Creating Space for Families
These experiences have shaped my approach to spiritual care. I prioritize:
- Sacred space: Offer families uninterrupted time to process tough decisions. A quiet room, a compassionate presence, and active listening can transform a chaotic moment into one of dignity.
- Reflect and debrief: After ethically challenging events, debrief with yoru team. Moral distress is a real phenomenon.Processing these experiences fosters resilience and prevents burnout.
Small gestures, lasting impact
My calling has led me to palliative care, where I’m passionate about educating patients and families on advance directives and goals of care. Late referrals frequently enough limit opportunities for meaningful conversations, yet small gestures-like sharing an interfaith prayer card-can leave a lasting impact.
I was deeply moved when a patient with no religious background requested that I conduct her funeral and include the prayer card I had given her. It was a humbling reminder that we rarely fully grasp the extent of our influence.
The enduring Mother-Daughter Bond
A recurring theme in my work is the profound mother-daughter relationship. I’ve witnessed the immense dedication,love,and sacrifice daughters demonstrate as caregivers. Their strength and vulnerability inspire me, and I strive to provide a safe, nonjudgmental space for them to process complex emotions.
Through active listening and compassionate presence, I hope to help them find meaning, resilience, and even moments of peace amid their challenges.
A call to Courage and Compassion
Ultimately, caregiving is both a heavy burden and a spiritually uplifting gift. By meeting people where they are and allowing space for vulnerability, we help others navigate moral and ethical dilemmas, find inner peace, and emerge from their journeys with renewed purpose.
May we meet vulnerability with courage, listen with wisdom, and offer compassion that transforms lives-including our own.
Sheryl J. Nicholson is a spiritual care coordinator.
