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Nursing ethics is a branch of applied ethics that concerns itself with activities in the field of nursing. Nursing ethics shares many principles with medical ethics, such as beneficence, non-maleficence and respect for autonomy. It can be distinguished by its emphasis on maintaining dignity and collaborative care.
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Human rights and nursing practice
Ethics has been an integral part of nursing practice from the earliest foundations of modern nursing in the late nineteenth century. This has always entailed a respect for human rights of the persons in their care. However, early attempts to define ethics in nursing were focused more on the virtues of the nurses themselves, rather than looking at how the rights of the patient or client might be promoted in particular. In the modern era, the ethics of nursing has shifted more toward the promotion of these rights and the duties of the nurse.1
The importance of human rights in nursing was made explicit in a statement adopted by the International Council of Nurses in 1983.
Distinctive nature
Although much of nursing ethics has been derived from medical ethics, there are some factors that, arguably, differentiate it. This can be seen by examining beneficence. This is a well established principle of medical ethics, which although acknowledged in nursing ethics, is not applied in the same way. The key difference is that beneficence, when expressed through paternalism, is not considered compatible with nursing ethics.2 This is because nursing theory seeks a collaborative relationship with the person in their care. It therefore emphasizes respect for the autonomy and dignity of the person being nursed by promoting choice, rather than paternalistic practice where the health professional chooses what is in the best interests of the person. Codes of conduct for nurses tend to be written in the ethical framework of deontology and are therefore based on the rights of the patient and the duties of the nurse rather than on utilitarian concerns of the consequences justifying the action.
Common themes in nursing ethics
The nurse's role is one of advocate for the interests of the people in their care. In terms of ethical theory, this means having a respect for the autonomy of the person to make decisions about their own treatment and to provide information for this purpose. The principle of informed consent is where a person understands (to a reasonable extent) the implications of having or refusing a particular treatment. This should be respected by the nurse when carrying out interventions 2. This principle is not absolute as people are sometimes unable to make choices about their own treatment due to being incapacitated or having a mental illness that affects their judgement. A way of a person maintaining autonomy is for them to write an advance directive, outlining how they wish to be treated in the event of not being able to make an autonomous choice. When an autonomous decision is not possible, the nurse has a duty of care to act in the best interests of the individual. Best interests are controversial due to the problematic nature of measuring these interests objectively. An example of how they are measured by the use of quality-adjusted life years.
Another common theme is confidentiality and is an important principle in many nursing ethical codes. This is where information about the person is only shared with others after permission of the person, unless it is felt that the information must be shared to comply with a higher duty such as preserving life. 2.
Also related to information giving is the debate about truth telling in interactions with the person in care. There is a balance between people having the information required to make an autonomous decision and, on the other hand, not being unnecessarily distressed by the truth. Generally the balance is in favour of truth telling due to respect for autonomy, but sometimes people will ask not to be told, or may lack the capacity to understand the implications. 3
Codes of ethics
- Australian Nursing and Midwifery Council Code of Ethics
- Nursing and Midwifery Council code of professional conduct (UK)
- American Nurses Association code of ethics for nurses
See also
References
- ^ McHale, J & Gallagher, A (2003). Nursing and Human Rights. Butterworth Heinemann. ISBN 0-7506-5292-6.
- ^ a b c Rumbold, G (1999). Ethics in Nursing Practice. Balliere Tindall. ISBN 0-7020-2312-4.
- ^ Tuckett, Anthony (2004). "Truth-Telling in Clinical Practice and the Arguments for and Against: a review of the literature". Nursing Ethics (SAGE Publications) 11 (5): 500–513. doi:. PMID 15362359, http://nej.sagepub.com/cgi/content/abstract/11/5/500.
External links
- International Centre for Nursing Ethics, University of Surrey, UK
- Nurses and Human Rights from Amnesty International
- Links to codes of ethics by country
- Nursing Ethics journal
- NursingEthics.ca
