LIVING WILLS: A NURSING PERSPECTIVE

This research examines the concept of the living will from a nursing perspective. A living will is a written and witnessed advanced directive that communicate a patient's care preferences (Singleton, Dever, and Donner, 1992, pp. 4146). Living wills generally apply in the context of terminal illness or irreversible coma (Grant and Huntington, 1989b, p. 93). Living wills provide a means by which patients and families may describe their wishes and set forth legal guidelines for nurses and physicians (Bellocq, 1988, pp. 168175; Shook, 1992, pp. 3034).

Nurses in the 1990s, as is true of all health care professionals, are being confronted with an array of issues that contain moral dimensions (Clarke, 1991, pp. 2225). These issues include considerations of a patient's right to die (Laben, 1990, pp. 12) to adhering to physicians' "do not resuscitate" orders (Yarling, 1990, pp. 327334).

That nursing is based on a moral foundation is recognized (Yarling, 1990, pp. 335342). The professional obligations of nurses demand that nursing personnel have a grasp of the ethical bases of their profession (Hussey, 1990, pp. 13771382. One issue within this context concerns the efficacy and feasibility of the relating of natural sociology and moral questions within the nursing context (Johnson, 1990, pp. 13581362).

The practice of nursing takes place within a culture (McElmurry and Zabroki, 1989

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and varied uses of the construct make definition difficult. Value is a more abstract construct than attitude. Values may express either personal or social preference, and they may serve either as ends or as means to ends. There is general agreement that values cause attitudes, but there is not a onetoone relationship between particular attitudes and particular values. Rather, a single attitude is caused by many valuesby one's whole value system, in fact. In what are generally called consistency theories, investigators have attempted to discover the relationships among beliefs, feelings, and behavioral tendencies. Chief among these consistency theories is the theory of cognitive dissonance. According to this theory, inconsistency between cognitive elementsbeliefs, attitudes, and so forthleads to dissonance. This dissonance, in turn, leads an individual to change one or more cognitive elements,in an attempt to eliminate the unpleasant state. The nuclear family is a major influence on the development and formation of values by an individual in early life (Parish and Nunn, 1988, pp. 519521). For nursing, an appreciation of this relationship is significant, as it helps explain both the nurse's values and the values

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