Online Companion: Fundamentals of Nursing Standards and Practice 2E


Chapter Summary

Nurses face ethical issues in practice on a daily basis. Chapter 24 explores ethics, values, decision-making and how these concepts apply to clinical situations. Ethics is the study of the rightness of conduct. There is a close but distinct relationship between legal and ethical aspects of nursing actions. At times, there are discrepancies between law and ethics; reasons for this include: individual differences in ethical opinions and laws changing according to social and political influences. Among the frequently occurring ethical dilemmas in health care are issues around informed consent, client's refusal of treatment, use of scarce resources and incompetent health care providers. The nurse can get guidance in these situations from understanding and using ethical principles within an ethical decision-making model. For example, the nurse is caring for a client who refuses to follow the diet and medication guidelines for his diabetes mellitus. The nurse recalls the ethical principle of autonomy, which refers to the individual's right to decide for himself, even when his choices are not in the best interests of his health. This can be difficult to accept but the nurse understands that personal liberty is a dominant value in American society. There is a close relationship between ethics and values; nurses seek to balance their own value systems with that of the client and the values held in health care. Values clarification is a process of analyzing one's own values to better understand what is truly important. Nurses should not impose their own values on clients. The professional organizations, the American Nurses Association and the Canadian Nurses Association, have each developed a code of ethics to guide professional nursing actions. The ANA Code specifies in one of its provisions that the nurse must safeguard the client's right to privacy by protecting information of a confidential nature. Another published document that guides health care providers in ethical dilemmas is the American Hospital Association's Patient's Bill of Rights which is presented in Chapter 24. When conflict arises between two or more ethical principles or when the nurse's code seems at odds with the client's rights, a dilemma exists. At times, the nurse is faced with two equally unsatisfactory choices to make. Ethical reasoning is the process of thinking through what one ought to do in an organized manner. The authors present a model for ethical decision-making to assist in this process and offer two examples, euthanasia and refusal of treatment, of how the model can be applied. Nursing practice involves making ethical decisions. Communicating with the client about his concerns, his understanding of the illness and treatment and his values provides the foundation for ethical care. Many health care agencies have formed Ethics Committees to facilitate dialogue regarding ethical dilemmas.