Date of Award


Document Type

Campus Access Dissertation


College of Nursing


Nursing Practice

First Advisor

JoAnne Herman

Second Advisor

Joan M Culley


Burn injuries devastate lives. Mere survival demonstrates both the amazing recuperative capacity of the human body and the remarkable advance of modern healthcare. The Patient Protection and Affordable Care Act of 2010 (PPACA) mandates the early identification of goals-of-care through shared decision-making. Survival, even for very large burns, is an expectation for every patient population with one notable exception, the elderly. The following clinical question is posed: 'Does the provision of curative care versus comfort care meet the ethical obligation of distributive justice in elderly patients who sustain greater than 60% total body surface area burns?' The elderly continue to see comparatively disproportionate mortality in these large burns regardless of care intensity and present unique challenges to the U.S. healthcare system. Ethical codes prescribe moral conduct and role responsibilities for healthcare professionals. The ethical principle of distributive justice, both theoretical and applied, is considered in light of the outcome evidence for this vulnerable population. In terms of both social economy and human burden distributive justice, the reflexive pursuit of futile curative care is inappropriate. A less expensive, more humane alternative to curative care exists,comfort care, that produces similar outcomes. A clinical algorithm for the care of elderly burn patients with very large body surface area burns is presented as supported by clinical evidence. In addition, an individualized patient decision aid (PtDA) is proposed as mandated by PPACA, that aims to engender compassion, dignity and relief of suffering during the difficult process of shared decision-making in the face of mortal burn trauma. In burn care, success is often measured by survival, functionality, and quality of life. When the historical measures of successful care cannot be applied, PPACA, professional ethics and human compassion can help to definitionally expand successful care to include the provision of a good death.


© 2011, Christina Pacileo Blottner