Nursing Ethics - An Introduction

Alabama Nurse,  Dec 2003-Feb 2004  by Bross, William

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As members of the nursing profession, we are each held accountable to and have adopted certain obligations specific to this profession or role. Many of the standards that we are held accountable to are specifically developed in the Alabama Nurse Practice Act and the Alabama Board of Nursing Administrative Code (available on the Alabama Board of Nursing website: http://www.abn.state.al.us/)). Our roles are further defined in our knowledge of and our adoption of the Board of Nursing Mission Statement:

"The mission of the Alabama Board of Nursing is to safeguard the public's health, safety and welfare through the regulation of nursing education, entry to nursing practice, and promotion of continuing safe nursing practice."

The Board of Nursing Value and Vision further reflect the commitment to this mission. As nurses, we are aware of this role and our responsibility to the profession. However, what happens when we are confronted with situations that are not clearly defined? What happens when the area between right and wrong is not black and white, but rather gray? in this issue I would like-to explore what health care ethics might entail, what our roles are, and the differences between ethics and law. In subsequent issues, I would like to explore particular ethical issues faced by nurses in our rapidly changing profession and seek input from you as to other issues you would like to see addressed.

Ethics can be defined in many, I like to think of ethics as the branch of philosophy or thought that attempts to determine how human actions are judged right or wrong. It is one thing to attempt to quantify ethical principles, but as professionals it is further complicated by the nature of our profession and the conditions under which the field of nursing operates. The term I see used often is that of "Professional Ethics," a term with no clear definition or application. Nursing has numerous Codes of Ethics and, indeed, within each Specialty of Nursing, unique and specific codes emerge. The International Council of Nurse? (ICN) established a code in 1953 (a copy of which can be viewed at: http://www.icn.ch/icncode.pdf), and it has been frequently revised since that time to reflect new thoughts and technologies. What this shows us is that ethical decision-making is not clear. There is often no distinct right and wrong, as there is within a legal framework.

Laws were established to differentiate between what is right and what is wrong. The legal system attempts to express judgments about the tightness or wrongness of actions that might affect the public good. While law is concerned with the public good and the protection of our rights collectively, ethics does this and goes one step further to look at the obligation of each person to himself as well as to others and to society. Additionally, our ethical judgments andd our role as nurses are influenced greatly by emotions. As health care professional we are committed to a concern for others and we develop a feeling or concern for them. Without this desire, we would probably not have become nurses. However, it presents a problem because we feel a need to go beyond simply helping others. We become involved in their decision-making processes, sometimes to a fault. We have to be mindful of informed consent and surrogate-decision making, topics which will be addressed at future times.

As nurses, we serve various roles. Models have been developed over lime to reflect our relationships with patients, physicians and institutions. We have come a long way since our role was seen simply as an extension of the physician's hand. Indeed, now in an emergency situation, the nurse's disregard for a physician's orders is not looked on as a breakdown in the professional relationship. In the bureaucratic model, we were to focas on the institution and a learn approach. Now, though, much of nursing is carried on outside the intitution in home health, nurse practitioner, and hospice roles. The patient-advocate model requires the nurse to provide the best possible care for the patient, and not serve the institution and physician. However, this role is riot always clear. I bring these roles up, because one can easily see that the role of nursing is going through tremendous changes as a result of new health professions and rapidly changing technologies. Also, we are dealing with a patient population that is much more informed about health choices and is afforded greater protection under the recently enacted HIPAA regulations. We must keep all of these factors in mind when attempting to make a decision.

One can see that ethical decision-making is complex and constantly changing. How we view situations might change on a daily basis. Further, our perception is altered by our emotions and technology. What was riot possible today in healthcare, might be so next week, Ethical issues are present in informed consent, conflicts of interest, death and dying, assisted suicide, living wills and advanced directives, slow or no-codes, methods of reproduction including invitro and artificial insemination and the rights of surrogates, transplants and the sale of organs, research and our role, applications of genetics, and artificially providing nutrition and hydration. We will explore some of these and other topics in coming issues.