What are ethics?  What role do they play in your nursing care every day?

Ethics are a branch of philosophy that focuses on the moral life. It is the method used to understand and examine such things as social customs, norms and rules that help define right and wrong.  Ethics are not absolute; they do not have clear answers.  They must adjust to cover ever-changing social and cultural contexts and are influenced by individual and cultural morals.  Laws are guided by society norms and morals that define the culture’s perceptions of right and wrong.  Ethics are generally the basis of right and wrong which guides the formation of societal law.

However, it is possible to have legal actions that are considered unethical by some groups.  Point in case: assisted suicide, which is legal in Oregon, is considered unethical by many.  Conversely, other acts may be illegal and still debated as ethical- such as euthanasia.  Other examples would include debates over abortion, capital punishment, and the common ethical theme involving honesty in interactions with the patient and the information given. If information may be deemed more harmful, rather than helpful, is it acceptable to withhold that information from the patient?

Nurses should demonstrate a basic understanding ethical principles and concepts that influence healthcare and nursing.  They also should be knowledgeable about the laws that govern nursing care and the ethical positions of professional nursing organizations.  Historically, nursing ethics were an extension of medical ethics. Nurses shared many ideals with the medical community; such as, confidentiality.  But, as nursing evolved as a separate discipline, key differences began to appear.

One significant difference is that medical ethics is generally centered on the belief that the practitioner knows what is best for the patient.  Nursing emphasizes a collaborative effort with the patient, allowing them to maintain autonomy in the health care setting. Codes of conduct for nurses tend to focus on the rights of the patient and the duties of the nurse to provide quality of life care for their patients.  Physicians are charged with determining the patient’s competence and ability to make decisions for himself and establishing other means of decision making when necessary.  Nurses are charged with providing the best care possible at the patient’s own autonomy level.

One main role of the nurse is to act as advocate for the interests of the people in their care. Nurses should emphasize each person’s right to make decisions about their own care while providing them with the information that they need to make an informed decision. This supports the principle of informed consent: a person understands fully the implications of having or refusing a treatment and is free to make his own decision based on that information.  Thus, another important nursing role during ethical dilemmas supports the role of advocate. Nurses provide patient and family education.  Nurses can provide unbiased, scientifically based information about all available options to be considered.  This enables patients to consider all options and choose from those that fit within their value system, beliefs and anticipated outcomes for their own care.

Nurses can help address ethical issues by working closely with patients, families and physicians within his or her scope of education, experience and practice.  Clinical data must be gathered that incorporates information about the patient's family's values and goals, identification of key decision makers and consideration of the ethical principles that influence the situation.  A problem-solving approach, such as the use of the nursing process, should be used to resolve ethical dilemmas.  Resolution of ethical dilemmas means that the best choice is made based on all the information considered.  Ethical dilemmas can often be resolved without input from the legal system.  However, ethics consultations may be requested when difficult conflicts exist or dilemmas become complex with no clear answers.

The last important aspect of ethics to note is conscientious objection.  Conscientious objection supports the right of persons to refuse to participate in acts that they deem unethical.  This can encompass medical treatments or the withholding thereof.  It is widely accepted in healthcare practice and works in the favor of both the patient and the provider or nurse.  It allows patients to accept or refuse treatments based on their religious, ethical, or moral background.  It also allows clinicians who are morally opposed to such acts as abortion, capitol punishment and assisted suicide to refrain from caring for these patients as it relates to such acts based on their personal religious, ethical, or moral grounds.  No special permission from a governing board is required to act as a conscientious objector; however, nurses must still insure that the patient is not abandoned and his wishes are still legally honored.  It should be noted as well, that a lack of knowledge regarding the situation is not considered an acceptable reason to object to caring for a patient based on conscientious objection.

References:

Ferrell, B. R., Coyle N. Textbook of Palliative Nursing. Second Edition. New York: Oxford University Press, Inc. 2006.

Nursing Ethics. Wikipedia. January 17, 2008.

Copyright 2008- American Society of Registered Nurses (ASRN.ORG)-All Rights Reserved