July 5, 2013 1 Comment
By: Jennifer Chaikin, RN-BC, MSN, MHA, CCRN Executive Director of Educational Initiatives, Nurse.com
I love talking about ethics. Even more, I love talking about nursing and healthcare ethics. As a nurse who has written articles, taught classes, and written chapters in books about nursing ethics, I love to hear important conversations about it.
One of those conversations happened back in March of this year. An 87-year-old woman from California collapsed and later died in an assisted living center — after a nurse made the decision to call 911, then subsequently not perform CPR or ask someone else to do it.
Per the executive director of the facility, “Our practice is to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives. That is the protocol we followed.” The woman’s daughter, who also happens to be a nurse, was satisfied with the care her mother received.
I spoke to many colleagues, read many blogs and articles, and still struggle to make sense of one thing. Why call 911 and then wait to do anything? What is the ethical reasoning for this to be in a policy? Was ethics even a consideration when forming this policy? Maybe liability issues were only considered. I agree with Arthur Caplan, PhD, head of the Division of Ethics at NYU Langone Medical Center who writes: “Even without training someone might be able to help if guided by a knowledgeable person. The dispatcher offered to walk the caller through what to do but the caller still declined. And liability is not really much of a worry unless you do something extremely absurd every state shields those who try to be Good Samaritans against lawsuits.”
The truth is that we don’t know any of the details about this case, so we can only have the conversation concerning the “what ifs.”
Have you ever had this type of ethical dilemma? Ever had to breach patient confidentiality? Or face the issue of a family insisting on withholding medical information from your patient? What about working with a patient whose life could be saved because of a blood transfusion, but he or she refuses it because of religious beliefs? Nurses face ethical dilemmas every day and they are ever-changing because of healthcare changes. Whether we are helping patients, members of the community, or friends or family, nurses are guided by ethical standards.
Ethics is a term for understanding and examining moral life and for what the acceptable moral norms of a society are and why they are acceptable (Beauchamp & Childress). Healthcare ethics focuses on meeting the expectations of the profession and fulfilling those expectations in specified ways toward patients (ANA). The Code of Ethics for Nurses means ensuring integrity and safety, competence and personal and professional growth.
Nurses have to consider these issues when advocating for patients and families as well as consider their own personal beliefs when caring for others. We also have the added ethical obligation to seek out and to enhance their professional development and growth opportunities. Educating ourselves on not only clinical and medical advancements and practice changes, but also on the ethics of what we do and how they are ever changing is vital to remaining the most trusted profession. Ethics should make us stop what we are doing and ensure it is “the right thing to do.”
So in keeping with our Code of Ethics to ensure our professional growth, this month’s Nurse.com Webinar initiative on nursing ethics will provide you with more information on ethics and ethical issues facing nursing and healthcare today. Enjoy!