Term Paper on "Ethics the Nursing Profession"

Term Paper 9 pages (3034 words) Sources: 1+

[EXCERPT] . . . .

Ethics

The nursing profession, perhaps more than any other, is a veritable minefield of ethics issues and dilemmas. Because it is a caring profession, the focus of the nursing business is its clients and their care. Hence, nurses often need to make a distinction between their personal values, their professional values, and what is commonly accepted as the ethical viewpoint. In ethical dilemmas, these distinctions become vague, and critical thinking becomes of utmost importance. Complicating the issue even further is the issue of culture and its impact upon values. Relationships and personal ethics vary among cultures, and nurses often find themselves in need of being aware of this. In order to make a truly ethical decision when faced with vague guidelines and distinctions among values, the nursing professional then also needs to take cultural values into account. In the case of Mr. Z, for example, the issue does not only concern the commonly held nursing ethic of doing no harm, but also the individual's right to autonomy, as well as the cultural relationships surrounding Mrs. Z.

Ethical Theory

The focus of the nursing profession is its clients. More than most other professions, nursing involves ensuring that people become not only physically as well as possible, but also that they are emotionally supported throughout the healing process. Because there are many different types of values and viewpoints in the world, nursing often becomes a battle ground of conflicting ethical concerns. For this reason, a common set of ethics is important to help the nursing professional in the decision-making process, and also to honor age-old professional values such as doing no harm.

According to Marquis and Huston (2009, p.69), for example, not only nursing, but all professions require an ethical norm according to the purpose of that profession. Nursing concerns making people physically as well as possible, while emotionally supporting them to enhance the healing process. As such, values and norms exist as a foundation for ethical decision making, especially where the best possible decision is not immediately obvious. These values there fore provide a valuable starting point for the critical thinking process often required to make the soundest possible decision for the circumstances involved.

If a patient is terminally ill, for example, one major ethical decision concerns whether to grant the person's request for euthanasia, or whether the principle of life should be honored above all else. Without ethical and value-based filters to make such decisions, the profession could become a veritable suicide tool for persons claiming to be not only in physical, but also in emotional pain.

Ethics is also important when nurses are faced with the limitations of confidential information. In some cases, it is simply not ethically viable to keep information confidential, even if a patient has requested this. In the case of severe illness, for example, the nurse simply cannot withhold such information from a person's family members, who will be affected by the illness and the person's need for care.

Confidentiality and Reasonable Limits.

In all professions where confidentiality is at issue, reasonable limits clauses tend to be included for the purpose of not only protecting the professional institution, but also the rights of those affected by withheld information. In the legal profession, for example, attorney-client privileges can be withdrawn should the client reveal that he or she intends to continue causing harm to the public. The same is true in the nursing profession. While it is true that clients' autonomy and privacy are to be respected, it is sometimes required that a wider perspective be taken in terms of how withheld information can affect the person's loved ones or other interested parties.

According to Goodman (2008, p. 28), problems often arise from the fact that clinicians learn delicate information from their clients. This information places the clients in a vulnerable position in terms of the clinician, who now shares the sensitive information. Diagnoses such as cancer or HIV, for example, count among the top pieces of information that clients prefer to keep confidential. There are various reasons for maintaining confidentiality in the nursing profession: if patients do not trust clinicians with their information, they would be unlikely to disclose sensitive information, which could result in frustrated diagnosis. Another reason is that clients prefer to maintain some control over who has access to their information, especially in the case of debilitating disease, such as cancer or schizophrenia.

At its basis, the principle of confidentiality therefore entails that the right of the patient to privacy and confidentiality is respected. It also creates trust in the medical profession, which in turn results in greater honesty by and better diagnoses of patients. Without this basis of trust, the profession would not be able to accomplish its goals of healing and care.

There are however times when reasonable limits must be imposed upon the confidentiality clause. This entails that, if more harm than good is done by retaining confidentiality, then limits should be imposed upon this. Absolute confidentiality can therefore not be guaranteed, and each situation needs to be taken into account before decisions can be made regarding confidentiality.

It is, however, important to notify patients of the possible need to break confidentiality in certain cases. This is the element of informed consent. Clients need to be made aware of the kind of circumstances under which confidentiality would have to be broken. If there is, for example, a reasonable expectation of more harm than good as a result of retained confidentiality, this would provide a rationale for breaking the confidentiality code.

If clients are not, however informed of the limitations of confidentiality, and such confidentiality is then broken, the institution in question could be liable for damage suits or other legal action. This is why clinicians should be very careful to explain all the elements of confidentiality, as well as the limitations of such confidentiality, to their patients. Patients must at all times be aware of the circumstances under which limitations come into effect. Therefore, medical professions should be legally required to provide this information before providing treatment.

Confidentiality should only be broken if a medical professional believes that the client poses a significant risk of harm to him- or herself, or to others in the environment. Also, if limitations have not been explained, it could be said that the client has assumed complete confidentiality. Breaking this assumption under any circumstances would be ethically questionable at best.

In other words, confidentiality should be broken if there is significant risk, and only if the client has been informed before hand of the limitations to the confidentiality clause.

One might therefore say that there are considerable conflicts between the ethical principle of retaining confidentiality under all circumstances and imposing limitations on this confidentiality. In order to resolve this issue in practice, the best principle is to follow a documented ethical viewpoint, such as utilitarianism. This means that the greatest good results for the greatest amount of people involved. It applies specifically to nursing, since it is a profession that places the needs of the client at the top of all priorities. However, if these needs cause harm, they can no longer take precedence over the lives or well-being of others.

Marquis and Huston (2009, p. 71) describe these issues as ethical dilemmas, where the only choice is between two relatively undesirable choices, and where the best choice is inevitably the one that causes the least harm. In the medical profession, this sometimes means breaking confidentiality to serve the greater good.

In the case of Mr. And Mrs. Zee, the ethical principle that would be broken in this case is patient autonomy. Mrs. Zee is clearly fully aware of her position and is able to make a rational decision regarding her wishes to disclose her condition to her family. To deny her the right to privacy in terms of this is to deny her right to choose whether or not, and when, to disclose her condition to her family.

On the other hand, one must also keep in mind that Mrs. Z is causing considerable harm, not only to her family members, but also to herself by not disclosing her condition. The main reason is that treatments are available for the condition. If she does not receive treatment, she is bound to die, leaving her family without a wife and mother. It is therefore in the best interest of everybody, both ethically and materially, to disclose her condition for the purpose of obtaining the necessary treatment.

An appropriate ethical theory in this case would therefore be utilitarianism or consequentiality theory. According to Marquis and Huston (2009, p. 72), utilitarianism means judging the consequences of an action, rather than the ethical considerations that precede it. On this basis, whether Mrs. Z was initially informed of possible limitations to her privacy, the best consequence of all involved would be to disclose her condition to her family. The needs and wants of the individual then take a secondary position to the common good.

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