Ethics in Nursing
“The focus
on caring, particularly for vulnerable people, establishes the ethical
dimension of nursing practice; the NMC and the general public expect high
standards in nursing practice” (Convey,
2012, p. 51). The expectation
that nurses practice ethically is wholly embedded into the nursing profession, the care
that nurses give at the bedside, and is evidenced by the high level of respect
that the public gives to the nursing profession.
The
principles of ethics include beneficence, non-maleficence, justice, fairness,
fidelity, and veracity. These principles
were defined by the Greeks and, briefly, the “goal of ethics is to delineate
moral duties and obligations within a manageable set of rules or principles”
and are based on “rightness …viewed in terms of good produced as consequences
of action” (Racher, 2007). The
principles of ethics seek to give autonomy to persons so that they have control
of their own life and outcomes while ensuring that those decisions are informed
and that the person making their own decisions is competent to make those
decisions. Ethics committees are asked
to be involved when these principles are either being denied to a person, or
when two or several parties have conflicting interests. Ethical dilemmas arise
when, “there are at least two courses of action, but with each option being
problematic” (Fletcher et al. 1995).
To give
excellent care, to seek and protect the autonomy of patients, all while using the
principles of ethics is rewarding when patients are easily able to first advocate
for themselves. In cases where a patient
is unable to express their wishes, family members have differing views, or when
medical staff does not act in the best interest of the patient, ethical
dilemmas arise.
This class
explored the role of ethics committees in solving ethical dilemmas. Unfortunately, after using ethical
committees, we’ve seen in cases studied in this class, there may not be one
glaringly obvious “good” choice. Ethical
dilemmas, in fact, may end up not being solved, but perhaps being decided on in
terms of the greatest good for most of the parties involved while keeping the
focus on the patient.
The class
continued to explore the difficulty in advocating for patients when ethical
dilemmas arise. We explored barriers to
advocacy and how nurses may face institutional resistance when met with ethical
dilemmas and advocating for vulnerable patients. Iyer (2012) recounts the story
of Amanda Trujillo who was on welfare and a single mother with a dream of
becoming an RN, which she eventually did, achieving a master’s degree in
nursing. After calling a hospice consult
for her patient, the patient decided against liver transplantation and Amanda
was the subject of the doctor’s fury, sent to the board of nursing by her
institution, and fired (Iyer, 2012).
Because Amanda discovered that her patient knew little about her
scheduled liver transplant, she thought the consult would be helpful. Despite not needing a doctor’s order for the
consult, her institution said she was operating outside of her scope of
practice (Iyer, 2012). Ms. Trujillo is
now back on welfare (Iyer, 2012).
Not
only
did the class explore difficult ethical dilemmas through actual cases,
but issues of unequal access, language barriers, and a multitude of
social barriers
such as poverty that constitute breaches of ethics.
Nurses, doctors, nurses’ associations and institutions must all work
together as advocates for those that are vulnerable to conquer lack of access and
resources.
References
Convey, H. (2012). Ethical practice in nursing care. Nursing
Standard, 27(13), 51-56.
Fletcher,
N., Holt, J., Brazier, M., and Harris, J. (1995). Ethics, law and nursing.
Manchester University Press, Manchester.
Iyer, P. (2012). Amanda Trujillo RN
– fired for being a patient advocate. Nursing Malpractice(4th
ed.).
Retrieved from: http;//medleague.com/blog/2012/030120amanda-trujillo- rn-fired-for-being-a-
patient-advocate/
Racher, F. (2007). The evolution of
ethics for community practice. Journal of Community
Health
Nursing, 24(1), 65-76.
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