Often times, in life and death issues, ethical concerns are not clear-cut. When a patient is confronted with a decision and all the facts have been told, obviously it is up to the individual to determine the course they want to take. It is, in fact, their life and health that is at stake. Each situation, and the ramifications it carries, is unique. You can’t always rely on that which you consider “right” or “wrong”.
Given the individual nature of patient care, it stands that what may be right for one is not necessarily right for another. You, as a nurse and caregiver, are invested in the outcome of your patients care and, therefore, may be confronted with ethical concerns at some point in your career. Discerning your ethical concerns and the direction you may want to take can be, at best, a grey area.
Guidelines and Code of Ethics
In an effort to avoid confusion when it comes to your ethical concerns, the International Council of Nurses, in it’s wisdom and foresight, has adopted a code of ethics to guide nurses in their patient care and help them review their ethical concerns to ensure the situation is in line with what is ethically responsible. Along with the core responsibilities of preventing illness and injury, promoting health, providing quality patient care, and easing suffering, “a respect for human rights, including cultural rights, the right to life and choice, to dignity, and to be treated with respect,” is also an essential understanding and part of your vocation.
The code goes on to outline the primary professional responsibility of the nurse to people requiring nursing care, while specifying the nurses additional responsibilities to families and the community. As diverse as society is in present day, this can be quite a juggling act for the dedicated nurse caregiver. There are bound to be ethical concerns at some point for the nurse and her patients.
Common Ethical Concerns for Nurses
Patients Right to Reject Medical Advice
Because of their education nurses are highly qualified to determine the best course of medical intervention and action when appropriate. By their vocation nurses are honor-bound to provide for the welfare and care of their patients and to uphold the standards of their profession. Given that, the dilemma may arise when a patient refuses to follow your advice. A laboring mother-to-be, for instance, may refuse any intervention, even when it comes to the possible health of her baby. Some patients may refuse pain medication when it would be in their obvious best interests. Others may deny all food. Many of these scenarios can present an ethical concern for nurses.
This one is a very personal ethical concern and one that nurses are confronted with quite often. For those who are staunchly pro-life a patient who desires to terminate her pregnancy can give rise to an ethical concern. Likewise the patient who opts to go through with a pregnancy when terminating is advisable can cause a dilemma for the pro-choice nurse.
Very often, a well-meaning next-of-kin will request distressing information be withheld from the patient. This is typical when the information is grave and the prognosis is terminal. Withholding that information, when it is quite basically the patient’s right to know, can make final days better for the family and their loved one. However, this can create an ethical concern for the nurse who has been asked to withhold information.
Minors and Medical Care
Pediatric nursing opens up an entirely separate set of ethical concerns for nurses dealing with children and their families. As with all of these ethical concerns the nurse’s first responsibility is to their patient. Should the patient (minor child) request information be withheld from a parent or adult an ethical dilemma could arise. Should the parents or guardians be tasked with making difficult decisions regarding the minor child, the nurse may be asked to withhold information from the patient.
Religious and personal beliefs often clash with that which the nurse believes is true. Science is often seen as subjective in relation to many religious principles and strongly-held doctrine. Some religions forbid life-saving procedures such as blood-transfusions. Ultimately it is up to the patient to decide the course of treatment, or the individual who is speaking on behalf of the patient. The nurse must support and protect the patient’s right to decide, even if it is in direct conflict with what the nurse believes and knows to be true.
Where to Turn With Your Ethical Concerns
Nurses consistently receive high ratings as trustworthy professionals, outranking physicians, police officers and even members of the clergy when it comes to ethical standards and honesty. With this high esteem comes responsibility. Ethical concerns should never be taken lightly.
When you are confronted with an ethical concern you should immediately refer to your ANA guidelines and ICN Code of Ethics. Take your concerns to your nurse manager or professional nursing advisor. If you work for a healthcare organization with a board of ethics reach out and ask them to help you with your concern. Ultimately the reason for your ethical concerns is coming from a place of professionalism and dedication to patient care. These are the strengths and qualities that make you an amazing nurse.