Ethical Theories and Principles, Essay Example

Abstract

In the profession and practice of nursing, the relationship between legal considerations and ethical concerns is heavily intertwined. Legal mandates are often in place to secure what is deemed ethical practice, and ethics influence legal decisions either in a formation stage or as an object of dispute. In an emergency room environment, this duality of purpose is brought into sharp focus by the very immediacy of the situation, and a reliance on strong ethics is typically essential when quick, and often life-saving, decisions must be made. Ultimately, however, only a strong code of professional ethics can be relied upon, as legalities sometimes lag behind true ethical conduct in determining what is right, and may not even be known in certain circumstances.

Legal and Ethical Values

Legalities and ethics have always been a perpetual conundrum, and this is the case because the two are mutually dependent. It is a cart-and-horse dynamic, and at any given moment it is often unclear just which set of values is in front.

On a very basic level, however, laws are set into place to accommodate and preserve ethical codes universally believed to be essential for a civilized society. In the medical arenas, this translates primarily to the welfare of the patient as the paramount concern, and ‘ethical treatment’ of the patient is that which best secures his health and well-being. So generally accepted and set forth, few would argue with this assessment.

It is when specific areas of potential conflict arise, however, that ethics may clash with the legal values pertaining to them. A drastic but not uncommon example of this is in an ER situation wherein a patient is so badly injured that the probability of survival is slight, and decisions as to how much effort should be made to save a life must be made quickly, and often with the knowledge that the patient may suffer so much loss of brain function that quality of life will be minimal at best. Law suits abound where surviving family disputes the decisions reached by the attending physicians, or feels that the necessary information for them to render a verdict was not provided. While unfortunate, it is unlikely that any set of laws can properly cover this sort of occurrence; the variables are too many and, in such situations, the ethical codes of the doctors and nurses must take the reins and guide the process.

Personal Values within Nursing

Perhaps more so than the profession of teaching, nursing must be, first and foremost, a calling. It is not a career path entered into through convenience or a studied determination of the best available jobs in the market, although these factors may play a role in how and where the nurse practices. The profession is one sought because the individual feels that it is the career which best suits his or her innate desire to be of service in the medical field; the job exists to fulfill needs already within the holder of it.

Caring is perhaps the most readily identified personal value of the nurse, and with good reason. Without a genuine desire to care for others in need of medical help, the nurse is not a nurse. This sense of caring is truly at the core of the nurse’s own ethical value system; it is what makes the nurse need and want to function in that capacity, to begin with, and all other values and considerations are adjuncts to it. “…An approach to ethics from caring is rooted in receptivity, relatedness and responsiveness. Thus is it clear that the relationship….between nurses and patients is so significant that a whole approach to ethical reasoning can be based on it” (Tschudin, 2003, p.1).

As vague as that may seem, it is the foundation of nursing, and the ‘bioethics’ of the profession. When patients refer to hospital stays, either the more traumatic experience of the ER or the relatively calmer one of being treated over a period of days, they tend to reflect only on the sense of caring they perceived, and particularly from the nursing staff. The average patient will be largely ignorant of how well or poorly a nurse carries out his or her technical duties, and it is assumed that the nurse in these instances is merely following a doctor’s instructions anyway. Yet patients uniformly note, even in minor occasions, evidences of real concern from the nurse, as they will be quick to condemn a hospital because the nurses there ‘don’t care’. It may be hard to define, but this awareness of an empathy is crucial to the patient.

It is as well impossible to train. Caring is not a skill which may be instructed; it can only be tempered and adjusted, when too much is evident and interfering with the patient’s best interests. A serious lack of it, however, cannot be remedied. Once again, the ethics of the nurse revolve around this nucleus.

Professional Ethics

The caring nurse – and we acknowledge that there is no other kind worth considering – is seen as a go-between by the patient, and as an intermediary between the highly technical and often frightening scope of the doctor’s abilities and powers, and the patient’s own status as a regular person. While this view may appear derogatory to the nurse, it is quite the contrary because, as with nursing itself, the role is there and must be occupied. This ‘softening’ agent of the nurse is not a needless comfort factor, but a vital artery within the entire framework of the patient’s experience.That said, modern nursing brings with it potential conflicts of a very wide variety, and some arising from an otherwise wholly beneficial and new view of nurses. Traditionally, nursing was an almost entirely female profession, and the presence of the male nurse is a relatively new phenomenon, going back only decades. This in itself is not especially noteworthy in any examination of nursing ethics, except when a wider view is applied and the increase in female doctors is added in. Then it is seen that this gender factor greatly changes the power structure of the historically accepted male-female roles in the hospital, in regard to both genders and within both doctors and nurses. Authority is now by no means established by the masculine presence because that presence may not, in fact, be male. Thus, ethical decision-making is no longer trusted to any single set of hands.

Related to this is the responsibility both enjoyed by and taken on by the modern nurse.

Not merely a hand-holding functionary of the doctor, the nurse is empowered to voice opinions and render decisions formerly out of a nurse’s purview. With empowerment comes consequences. As the nurse is seen today with greater respect, he or she is expected to take a more assertive role in patient care, and is subsequently liable to fallout when treatment fails.

“…Respect for the individual, including respect for autonomy, means a more equal doctor-patient, nurse-patient relationship in health care” (Spouse, Cook, Cox, 2008, p.107). That is all very fine. Nonetheless, the perils involved within all this mutual respect are many when ethical decisions are unexpectedly required, and these decisions are standard business in an emergency room. For example: a patient may be undergoing severe and life-threatening trauma following a car accident, and the attending physician may determine that, given the extent of the injuries and the patient’s failure to respond to emergency measures, further intervention is useless. The nurse assisting him may have doubts, but chooses to say nothing and be guided by the doctor’s greater expertise.

Months later, the patient’s family sues the hospital because they have found credible sources who, upon reviewing all the ER data, feel that additional effort may have saved the life. To what extent, then, is the nurse involved, or even culpable? The job requires the nurse to carry out the doctor’s orders, but in today’s climate of a widened empowerment, that is no longer enough to secure safety from what may have been a sin of omission, in not speaking up at the time.

Such cases, again, occur all the time, and bring into play issues which are, ultimately, unresolvable because speculative outcomes can never be known after the fact. The nurse today walks on a far more vast, but also greatly more dangerous, territory. He or she has only one recourse, and that is to adhere to a code of professional conduct in accord with the ethical code maintained by this person. What exactly constitutes ‘professional’ conduct in an ER is a murky terrain and modern, more educated patients render it more difficult. The days of the doctor-as-all-knowing are long gone, and everyone, including patient and nurse, is imbued with far greater entitlement in dealing with the medical situation at hand. Only a powerful connection to a core of ethical values can see the nurse safely through this.

Nursing Ethics in Practice

One of the greatest and most common dilemmas the ER nurse faces is born from the immediacy of the destination itself. An ER exists to confront first the accident, the crime, and the inexplicable circumstance which requires immediate attention. Unfortunately, this translates as well to patient perceptions of their own degree of need, and the nurse often must take the lead in what is not unlike a battlefield situation.

A man can enter the ER, driven there by his wife, because he is suffering from shortness of breath. He may not appear to be in any immediate danger, but his own fears are greatly adding to his view of his case. Nor is he alone in this, and both wife and patient may well demand that this situation they deem to be of the utmost urgency be attended to at that moment. They are either ignorant of or uninterested in the car crash which has just brought four severely injured people into the same ER. At some level, it is for the nurse to confront the couple and explain, in a caring and professional manner, how critical it is that the doctors see the accident victims first.

That anecdote, occurring thousands of times daily within ER waiting areas, serves to illustrate how complex and challenging this one facet of the nurse’s job is, in regard to ethical considerations. An initial impulse, even from a caring non-professional, would be to sternly request the complaining couple to sit still and wait, and abruptly explain that there are life and death matters demanding precedence. Yet here is where the sensitivity of the nurse, along with professional training and demeanor, reveals its full scope, for the true nurse understands that the couple in question is reacting primarily out of fear, and not with any intent to be disagreeable. With this understanding in place, he or she can address the unhappy couple in a rational and soothing manner, and without condescending.

Equally prevalent in an ER environment is the relation or friend of the emergency patient, and such people can be demanding and vocal in their concern. Nurses are always more accessible in any hospital scenario, and are often expected to act as a buffer, or go-between, for the doctor. The friend or relation, moreover, who would not dare to approach the ER doctor in action will think nothing of pulling aside a nurse, to voice his anger or impatience. In which cases, again, the largely unheralded task of the nurse is to first understand the motive behind the unacceptable behavior, and then diffuse it with calm and honest response.

Conclusion

“Many nursing ethicists view nursing ethics as a unique field… because of a wife array of ethical problems that surface in relationships between nurses and patients, families, physicians, and other professionals…” (Butts, Rich, 2005, p.6). Simply put, that is an understatement. However, in regard to legal and ethical codes and practices, the reality remains unchanged in one respect: only through observance of ethics believed in and maintained internally can a nurse today seek to succeed. This core must carry them through eventualities in ethical dilemmas not yet foreseen, as it must enable them to navigate the difficulties in the room down the hall today.

References

Butts, J.B., and Rich, K. (2005.) Nursing Ethics: Across the Curriculum and into Practice. Sudbury, MA: Jones & Bartlett Publishers.

Spouse, J., Cook, M.J., and Cox, C. (2008.)  Common Foundation Studies in Nursing. Philadelphia, PA: Elsevier Health Sciences.

Tschudin, V.  (2003.)  Ethics in Nursing: The Caring Relationship. London, UK: Butterworth-Heinemann.