Implementation of the Patient Self-Determination Act has transferred moral decision-making from the responsibility of health care professionals to the responsibility of family members. Moral dilemmas occurring as a result of this responsibility may cause stress and conflict among family members. Little is known about how family members make moral decisions or about the factors influencing these decisions.

Kohlberg (1978) and Gilligan (1982) have offered theories to explain the process of moral decision-making. These theories were used as sensitizing frameworks in this study whose purpose was to describe the process of moral decision-making and factors affecting moral decision-making by family members of patients with life-threatening cardiovascular disease.

Purposive sampling was used to select 10 wives of patients with life-threatening cardiovascular disease. Data were gathered through unstructured interviews and analyzed using grounded theory and theory triangulation.

Analysis of the data resulted in a theory of wives' moral decision-making which included factors influencing decision-making, decision-making patterns and a process of decision-making. Factors influencing decision-making included information, physician/nurse relationships, social support, husband's wishes, quality of life/prevention of suffering, and spirituality. Three patterns of decision-making were described and included advocacy, acquiescence and abdication. A five step process of decision-making was described and included searching, seeking, reflecting, accepting, and decision-making. Repeat interviews were conducted with seven of the wives to validate the theory.

Results from theory triangulation comparing the grounded theory of moral decision-making with Kohlberg's (1978) and Gilligan's (1982) theories showed that moral decision-making among participants was most closely linked with aspects of care included in Gilligan's (1982) theory. The grounded theory of moral decision- making was found to describe decision-making among participants better than existing theory.

In conclusion, findings from this study have facilitated an understanding of the moral decision-making process of wives of patients with life-threatening cardiovascular disease and factors impacting these decisions. This understanding will ultimately contribute to nursing practice through facilitating interventions to assist wives in making moral decisions.