Everyday Nursing Ethics
Abstract
To lie or not to lie measuring freedom cruel to be kind whose morals are they anyway? balance of power whose side are you on? justice for all the search for objectivity an easy death? acts of faith confidentiality ethics in context.
Chapters (12)
There are some things we take for granted which make the day-today business of living possible. One of them is telling the truth. No one would be so naïve as to suppose that lies, white and otherwise, are not told from time to time, but we must have some basic ground rules whereby we can expect to be dealing with the truth, until we have reason to believe otherwise. I refer here to the everyday sense of truth rather than to any philosophical notion of its nature.
One of the basic assumptions we all make is that, within the limits of the law, we have freedom to act as we choose. Of course, we all have certain constraints placed on us by work, family and our social environment but, generally, we make our own decisions and act accordingly.
Nurses and doctors have long taken the view that they know best how to treat and care for patients. Indeed, by the nature of the work they do doctors and nurses have a duty to care for their patients. A patient has to be able to trust his health care professionals and to presume that they will act in ways which serve his needs.
Today patients are more aware of their rights and health care professionals have had to take notice. Some argue that they have not taken enough notice, failing to create a consumer-driven health service. One result of all this may be that patients feel able to demand more of professionals and even to demand that which professionals are unable or unwilling to provide.
It has become increasingly fashionable to discuss health care in the language of rights — patients’ rights, nurses’ rights, the right to information, the right to choice, and so on. Rights may appeal to our libertarian instincts, but they are not without problems. Apart from anything else, they are not absolute in the sense that by claiming my rights I may well infringe yours.
Nurses have power. Like all other health care professionals, whatever strategies they use to make themselves more accessible, they cannot remove the power dimension in the professional—client relationship.
As health care becomes more ambitious and medical science creates more expensive treatments, a point is reached when choices have to be made and resources put into one service at the expense of another.
In the last chapter we considered the ideas of utilitarianism and questioned whether they had anything to offer when making decisions about the allocation of scarce resources. On the whole we found that it was not helpful to try to decide morality on the basis of the overall amount of good produced. We seem to have an overriding obligation to consider individual needs, even if they are met at the expense of the interests of the majority.
Euthanasia is a vast topic — so vast that it is difficult to grasp its full implications. Yet, at the same time it has become a familiar subject, often treated in a matter of fact sort of way.
Freedom of information is important in any walk of life, and health care is no exception. We all debate how much patients should be told about their condition. Health professionals have to consider where to draw the line between full disclosure, which is the patient’s right, and withholding certain information on the assumption that to disclose would not be in the patient’s interests.
Confidentiality is very much a topic of the 1980s. We have already examined patients’ rights and the rights of health care staff. Rapid developments in information technology have made the public aware that detailed information may be held about them. The Data Protection Act has seen to that, although in fact that act only gives us some safeguards when data are held in computerised form. It is hoped that the spirit of the act will spill over into other kinds of record keeping, but clearly alternative kinds of records will be potentially the most interesting if they are the ones to which the individual has no right of access.
Throughout this book I have tried to present everyday cases and issues which individual nurses may encounter within the context of a wider ethical debate. In clinical practice problems often occur which require action; there is not always time for much deliberation. There is a tendency to look for some kind of guide to reasonable action in these circumstances. On the whole ethical codes are of limited help in this respect. Generalised ethical statements and idealised positions are by their very nature not going to provide a programme for action in all eventualities. All along we have seen that personal and professional morality may be in conflict. Ethical principles often oppose one another. For instance we may wish to uphold the rights of an individual patient only to find that a more generalised notion of justice is being compromised.
... Zomorodi and Foley 25 highlighted that paternalism from a nursing perspective occurs when the preferences, decisions and actions of the patient are denied out of a nursing concern for the patients' well-being. Komrad 23 and Melia 24 identified the link between autonomy and paternalism as reciprocal; when autonomy is considered to be diminished, then paternalism is said to be needed to care for the individual's interests. ...
Customarily patient advocacy is argued to be an essential part of nursing, and this is reinforced in contemporary nursing codes of conduct, as well as codes of ethics and competency standards governing practice. However, the role of the nurse as an advocate is not clearly understood. Autonomy is a key concept in understanding advocacy, but traditional views of individual autonomy can be argued as being outdated and misguided in nursing. Instead, the feminist perspective of relational autonomy is arguably more relevant within the context of advocacy and nurses’ work in clinical healthcare settings. This article serves to highlight and problematise some of the assumptions and influences around the perceived role of the nurse as an advocate for patients in contemporary Western healthcare systems by focusing on key assumptions concerning autonomy inherent in the role of the advocate.
This article is designed to focus on the provision of nursing care in general medical wards following the admission of persons who have attempted suicide or who have a previous history of attempting suicide. The authors explore, analyse and synthesize how nurses, as key players in the health care team, may begin by recognizing the uniqueness of the individual, and by cotravelling therapeutically with the person on part of his or her journey towards recovery and healing. Efforts are made to demonstrate how nurses can influence the health gain of this group of people and their families. Professional attitudes and related ethical aspects, such as autonomy, respect for autonomy and paternalism, are also examined within the context of the nursing care of people who have attempted suicide. The need to enhance sensitive and caring communication skills for nurses who work with this group of people is tentatively considered. Some reasoning about why there may be difficulties in specific areas of communication such as empathy are contested and explored.
The purpose of this critical incident analysis is to demonstrate how knowledge of legal, moral and ethical issues has affected my nursing practice. This is a personal journey - an exploration of my own values and beliefs. The piece demonstrates how reviewing the literature has changed my stance on the issues discussed. Consequently the piece is written in the first person, but references are used to substantiate my findings.
The objectives of this chapter are for the members of the trauma team to understand the medico-legal aspects of:
confidentiality;
data protection;
the media;
consent;
professional accountability;
negligence;
criminal law.
The nurse-patient relationship, along with other professional-client relationships, is often described as special (Tschudin, 1986, p. 12). Fromer describes special relationships as ‘those in which particular duties and obligations are owed and in which certain duties and obligations go beyond the scope of ordinary social intercourse’. (Fromer, 1981, p. 335).
This chapter shows how a proper understanding of the concepts of liberty and autonomy is relevant to questions regarding the justification of compulsory treatment in the context of mental health nursing. Philip Ross proposes that the notion of ‘rational autonomy’ provides a ‘locus of unity’ for health-care work, that is to say, this provides an explanation of the point and purpose of health-care work. This seems a plausible claim in the light of the view that much health-care work involves fostering and enhancing the rational autonomy of patients and clients.
The issues surrounding death and dying are many, ranging from those that arise in relation to organ transplantation, such as how death is to be defined and when is it thought to occur, to those concerning how the dying person is to be treated. The focus of this chapter will be on the problems raised in the latter category, as these represent the concerns of many nurses in their day-to-day work.
Este articulo diseute los resultados de decir la verdad en cuidados paliativos, con particular atención hacia las personas que mueren de cáncer en ámbito hospitalario. El objectivo es examiner las preguntas que nacen desde perspectivas históricas y éticas asi como desde punto de vista practico. El rol de enfermeria en comunicar la informacion es incierta. Sin embargo, es asverado que enfermeria necesita ver como parte esencial de su trabajo, decir la verdad, en orden de mejorar los cuidados al paciente.
The application of the best interests principle in current legislation creates an ethical dilemma in relation to children's consent to treatment.
■ The guiding principle of the UN Convention on the Rights of the Child (1989) symbolises a formal expression of children's participation rights.
■ Children's rights to consent to treatment are granted on socially determined ideals of competency.
■ Children's participation in health care is increasingly advocated in legislation but many barriers remain.
■ Nurses can facilitate children's participation through communicating information and creating partnerships with children.
There is much controversy surrounding the issue of nurses in the role of patient advocate. Cancer patients are vulnerable due to their diagnoses, the anxiety that it generates, the nature of the disease and subsequent treatment and may have diminished autonomy as a result. It is questionable whether the nurse is able to promote the best interests of the patient in this situation. Models of advocacy and the nurse-patient relationship are discussed. The main arguments for taking on the role of patient advocate include: reference to long periods of time spent with the patient and the chance to build a relationship; the duty to care and the duty to do no harm. Criticisms of the appropriateness of the advocacy role for nurses include: inability for the patient to choose his or her nurse; promotion of self interests; charges of paternalism; challenges from other health care professionals and multiple and/or conflicting obligations. It is concluded that perhaps the most ethical way of caring is by empowering patients and promoting selfadvocacy. This concept needs to be further explored.
This study scrutinizes the ethical and moral dilemmas surrounding the removal of sexually abused adolescents from a community-based residential treatment unit to a locked, forensic adult psychiatric unit. Adolescent victims of sexual abuse exhibit a plethora of psychopathological symptomatology which can lead in many cases to the adolescent resorting to self-injurious behaviours in an attempt to relieve feelings of tension, anxiety and guilt. Because the unit in which the writer is involved is an open, community-based treatment centre with limited staffing levels, a completely secure environment may be compromised. Consequently self-injurious adolescents may become so disturbed that a more secure environment must be sought. The limited resources for disturbed adolescents in Northern Ireland means that occasionally the only option available to health care professionals who find themselves in this situation is to utilize the services of the psychiatric adult, forensic unit in Belfast which is contained within a large psychiatric hospital. Many would agree that such a placement for a disturbed adolescent seems inappropriate but is at the same time unavoidable. This study will examine the ethical and moral minefield that only recently has become a dilemma for health care professionals and particularly for nurses endeavouring to adhere to the code of professional conduct.
The current reform of nursing education is resulting in major changes in the curricula of colleges of nursing. For the first time, ethical and moral issues are being seen as an important theme underpinning the entire course. The moral theorist with whose work most nurse teachers are acquainted is Kohlberg. In this paper, it is suggested that his work, and the conventions of morality which he exemplifies, may not be the most appropriate from which to address the moral issues facing the nurse. The author suggests that the work of Carol Gilligan of Harvard university is of great significance, not only for nurses involved in the teaching of ethics, but for all nurses. Gilligan's emphasis on caring and relationships accords with the common experience of the nurse, and echoes the current revival of interest within nursing in examining, and valuing, the phenomenon of caring.
This paper examines the notion of risk assessment in relation to nursing patients with HIV infection or AIDS. Risk assessment consists in examining three features of a given hazard; its magnitude, its probability, and its acceptability. In relation to the last of these, an 'acceptability threshold' can be identified. If contact with HIV-infected patients is perceived to pass this threshold, nurses may seek to abrogate the usual 'duty to treat'. Rather than endeavour to pinpoint this threshold, the paper explores some of the factors which may either raise or lower it, and their ethical implications. In particular, the consequences of setting a high threshold, and thereby limiting or avoiding contact with patients infected with HIV, are examined. In this debate, the burden of proof is seen as resting firmly on nurses themselves, not on the patients at risk of being deprived of care.
This paper raises the questions: 'What do we expect from nursing ethics?' and 'Is the literature of nursing ethics any different from that of medical ethics?' It is suggested that rather than develop nursing ethics as a separate field writers in nursing ethics should take a lead in making the patient the central focus of health care ethics. The case is made for empirical work in health care ethics and it is suggested that a good way of setting about this is to ask practising nurses about the real ethical problems they encounter.
The ethical aspects of sports medicine have hitherto received little scrutiny, in contrast to its legal implications, which have recently been subject to much greater discussion. However, the differences that are apparent between sports medicine and 'mainstream' areas of clinical practice can shed new light on a number of the central issues within health-care ethics. By means of hypothetical case studies, this paper seeks to examine some of these issues within a sports medicine context. Specific attention will be paid to the concepts of autonomy and paternalism, issues to do with truthfulness, and the question of conflicting professional loyalties. It is suggested that the ethics of sports medicine warrant further and more detailed examination.
Nurse-patient encounters are influenced by the law and by morality. These frequently overlap and hold certain principles in common, such as justice and rights. Despite such close connections, the law and morality do not necessarily correspond. The difficulty in and complexity of reaching the right and just decision in the healthcare setting often highlight this.
Conscience is sometimes thought of as private, personal, individual, possibly religious, and not be questionned. This paper seeks to present and make plausible an account of conscience as social, possibly secular, and fallible (and hence corrigible). In the light of this account of professional conscience is offered and conclusions are drawn about the questions that should be answered in the event of a nurse making an appeal to conscience.
This article is concerned with the ethical relationship between autonomy and paternalism. In the health care setting both clients and professionals can be profoundly affected by the way in which this relationship is interpreted and this article sets out to explore this phenomenon. It began by offering some well established definitions of autonomy and paternalism and goes on to examine the two principles in detail as they relate to persons in good health and to those in ill health. Finally an attempt made to answer the question of whether the two concepts are in conflict or partnership.
Advocacy is an essential component of the registered nurse's professional role, yet experts provide no consistent definition of advocacy. The purpose of this study was to explore the experiences of military nurses as they engage in advocating practices and to describe their shared practices and common meanings. Heideggerian hermeneutic phenomenology, provided the framework and method for this study. Twenty-four U.S. Army nurses were individually interviewed and the researcher kept interview observational notes. The constant comparative method of analysis was used. The stories of these nurses revealed one constitutive pattern--safeguarding--and four related themes. The themes were advocating as protecting, advocating as attending the whole person, advocating as being the patient's voice, and advocating as preserving personhood. One conclusion was that military nurses must be prepared for the important safe-guarding role. They must be coached in how to deal with other members of the health team on the patient's behalf.
• A relative’s right to witness resuscitation is the subject of considerable discussion and debate.
• This paper explores the presence of relatives in the resuscitation room from a moral and ethical perspective.
• The focus of discussion is essentially upon the principle of respect for autonomy vs. what appears to be the counter‐argument, benevolent paternalism.
• It is concluded that recognition of a relative’s right to witness resuscitation is dependent upon health care professionals’ willingness to promote the principle of respect for autonomy.
This paper draws upon an empirical study and combines moral philosophical insights and sociological analysis to shed light on the ethical issues in intensive care. It is argued that moral philosophical debate often leaves aside the social context in which ethical decisions are taken and carried through. In order to gain an understanding of how intensive care is accomplished and specifically how ethical issues are handled, the study focused primarily on nurses' accounts of and views on the practices which form the everyday work of intensive care. A qualitative approach was adopted involving theoretical sampling and the constant comparative method of analysis. The paper argues that the most difficult ethical issue in intensive care, namely the withholding or withdrawal of treatment, is an area in which nursing and medical perspectives are often at odds. However, when the social context of clinical practice is taken into account, this paper argues. there is common ground between the two professions. It was found that the period during which the decision to withdraw treatment is being made, the members of the intensive care team closest to the bedside, nursing and medical staff. become impatient for some resolution of the situation. The differences of opinion which arise over the decision to withdraw are not simply to do with the way in which the situation is experienced by each professional group, proximity to the patient had a part to play in shaping their views rather than, as it is sometimes presumed. a simple rift between medicine and nursing. The data suggest that intensive care has to be a team effort. Even though there is no legal requirement for nurses to agree with the ICU decisions, there seems to be a strong desire within the intensive care team that moral consensus should be achieved in the interests of good patient care. Intensive care relies on the integrity of the team and the unfailing functioning of teamwork. Consequently, achieving this, it seems, is more important than other temporary lapses in interprofessional relations and disagreements over treatment in individual cases. Consensus is important and its achievement is a central, day to day working arrangement for insuring the solidarity of the team.
This paper attempts to raise issues surrounding children's rights against a backdrop of ethical principles and their subsequent interpretation and application in practice.
Key words have been used to search a selection of electronic databases and a range of 'grey' literature has been reviewed.
Over a decade ago the United Nations (1989) Convention on the Rights of the Child was ratified, with the exception of two member states (UNICEF 2000). The Human Rights Act (Department of Health 1998) became law in October 2000 in the United Kingdom (UK). Despite a decade of recommendations, guidelines and legislation, children's rights, particularly consent to health care, remain complex and inconsistent. As we move into a new era of human rights involving all members of society, it is timely for nurses in the UK to reflect on the challenges created in attempting to interpret the philosophy of such legislation because such complexity surrounds the interpretation of human rights for many other vulnerable clients within health care.
The interpretation of children's rights continues to be influenced by the evolution of the meanings of childhood. Adults view children's rights from multiple perspectives of best interest, which are determined by their beliefs about children's ability to understand and consent to health care and treatment. An ability and right to consent appears not to be balanced by the right to withhold consent. Inconsistency and ambiguity persist in the law and its interpretation. Adults need to develop a more pragmatic approach to children's rights. This requires better understanding of children and their experiences of health care.
Until adults develop a more pragmatic ideology in relation to children's rights then a true respect for children's autonomy will not be achieved. Consent will therefore remain an adult and legal prerogative.
As a requirement for the first year nursing subject 'Health Assessment' at Flinders University of South Australia, the task was given of examining Ethics and how this relates to the health assessment interview. Due to the negative stereotypes of older people and the subsequent treatment of the older patient, focus is placed on this particular age group. A definition of Ethics is given, with further discussion relating specifically to autonomy, respect and justice. This paper is not intended to be a major dissertation on Ethics and the Four Principles, because at the time of writing this the author had not studied ethics. Instead, it is hoped that other nurses and nursing students may learn as much about the difficulties of the older patient as the author has herself, and examine possible prejudices towards patients of any age, particularly the vulnerable older patient.
ResearchGate has not been able to resolve any references for this publication.