Ethics may seem an unlikely topic for a column about legal aspects of nursing, but the two are inseparably intertwined. Ethical principles underpin our laws and inform out professional conduct every day. As a lawyer, I find it almost impossible to give legal advice without considering the ethical aspects of a situation. As a nurse, and as a nursing school instructor, I can’t operate without frequent, conscious or unconscious consideration of ethics and law.
The American Nurses’ Association has said that ethics impact nursing on three levels – societal, organizational and at the patient care level. I think there is a fourth, the professional and personal level. From a legal standpoint, we have profession-wide ethics and we have personal professional ethics. I teach healthcare law classes to both undergraduate and graduate nursing students. Their assignment includes reading material about the ethical bases of nursing practice and I ask them to think about and identify the ethical values and principles that are most important to them. It’s a good exercise for each of us: what are your core professional values? Why? How do you use them in your practice, both with patients and with your colleagues? Most of us went to nursing school with a desire to help others but what else drives us, keeps us in the profession, and what troubles us when we see problems, either with another nurse or with a patient?
In a previous post, I mentioned checking your state board of nursing’s website for updates on laws and regulations. This is also a good place to look for ethics and position statements. Many state boards of nursing have either a code of ethics or a statement that at least in part lays out expected ethical standards for nurses. The most common include a patient’s right to autonomy, beneficence and non-maleficence – showing compassion and kindness, doing good and a purposeful intent to do no harm to patients – and justice, in the sense of fairness and equal treatment. Others may include personal courage, temperance/self-control, commitment, conscientiousness, honesty, integrity, tolerance and respect.
Besides your state board of nursing, your state nurses’ association and the American Nurses’ Association have statements and codes of ethics. The ANA Code of Ethics with Interpretive Statements is on the ANA’s website and access is free whether you are a member or not. The last update was in 2015 so if you haven’t looked at it lately, now is a good time.
Another interesting resource is Illinois Institute of Technology’s Center for the Study of Ethics in the Professions (CSEP), a central repository for codes of ethics in all sorts of professions, not just nursing. Their website is http://ethics.iit.edu/ecodes. There you will find over 140 documents addressing nurses and nursing alone. The healthcare section has codes of ethics for a number of healthcare professions and from a number of countries and international organizations in addition to the U.S.
The other area of ethics’ impact on nursing that I want to mention is in patient care. Virtually every nurse has experience with an ethical issue and where there are disagreements, there are sometimes threats of legal action. Use Google’s Scholar tool to run a search in your state’s cases for “patient ethics.” Nationwide there are nearly 6700 cases to date. If you read even just a handful of cases, I think you will be struck by the deep ethical roots of law and the struggle to do the right thing – whatever that is – for patients, their families, and ultimately the organization, the community and the healthcare professions.
Many healthcare facilities have ethics teams, committees or consultants available to help patients, family members and healthcare providers work through difficult situations. An online search for “ethical decision trees” or “ethical decision-making” will also give you a wealth of information and practical guidance. Even if there is no immediate answer or obvious course to follow, your ethicist, hospital clergy or social services can usually help sort out the issues and frame the essential questions, giving everyone involved some perspective and a chance to consider options.
There are entire textbooks and thousands of articles published on the subject of ethics in patient care. Haavi Morreim is a bioethicist who has published an article that has a practical as well as academic appeal. Take a look at “Conflict Resolution in the Clinical Setting: A Story Beyond Bioethics Mediation,” in the Winter 2015 issue of the journal, Privacy Laws and International Biobank Research. An excellent discussion of a difficult patient situation, the article also highlights how ethical conflicts in the care setting can affect – and be affected by – staff conflict. Conflict resolution skills such as outlined in Morreim’s article can benefit everyone, not just patients and family.
Most nurses only think about ethics when a situation thrusts itself in front of us. The resulting stress, legal implications and personal emotional toll for everyone involved are made worse if we don’t know our professional foundations and haven’t identified resources that can at least help us begin to analyze the problem. Look at the resources I’ve mentioned above. Find out who in your organization or community is skilled at and available to help work through ethical dilemmas. Problems rarely give warning that they’re coming, and if you’re staring at a tornado, it’s a bad time to ask where the shelter is.