Abstract

Although ethicists, clinicians, and researchers have written extensively about ethical problems in health care, scholarly literature lacks research on clients' lived experience of ethical problems. An ethical problem is a situation involving conflict about the morally right thing to do. By understanding clients' experiences, nurses can be knowledgeable advocates and deal more effectively with ethical problems on personal, professional, and societal levels. ;Persons with AIDS face difficult ethical problems. The purpose of this research is to develop and advance an understanding of their lived experience of ethical problems involving AIDS. The conceptual framework and methodology combine phenomenology, the study of lived experience, with the three levels of ethical inquiry: Descriptive ethics, normative ethics, and metaethics. ;Including the pilot study, the participants consisted of a cross section of 25 PWAs and five non HIV infected persons who were a sexual partner or parent of one of the PWAs and provided contextual understanding. To maximize diversity, 37% were women and 53% were people of color. A United States Public Health Service Confidentiality Certificate protects the participants. ;During an indepth audiotaped interview, each participant responded to the question, "What situation involving AIDS has caused you the most conflict about the right thing to do?" Two weeks later in a second interview, the participant validated the written analysis of the first interview. Seven experts validated conclusions drawn from the 30 analyses. ;From 117 ethical problems, 10 general essences emerge: Ethical problems involving alcohol and drugs, chronic illness, death, discrimination, finances and business, health care, personhood, relationships, service, and sexuality. The essential structure of each ethical problem consists of conflict, resolution, and rationale. In a serendipitous finding, the participants described a good death. ;To help clients with ethical problems, nurses and other health care workers can facilitate a good death, engage in ethical listening, address integrity and meaning in ethics education, conduct additional ethics research, deliver ethical health care, and work for a more ethical society. ;This research leads to better understanding of ethical problems and effective resolutions. The findings facilitate ethical inquiry and improved care for clients