A HISTORY OF NURSING ETHICS

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The Nuremberg trials at the close of WWII offered disturbing questions. How can “good” people in traditionally honor-bound professions become complicit in some of the worst violations of humanity in history? What happens when individual professionals are not held to account by their peers, professions, and society as a whole? The trials showed how moral individuals within organizations can engage in morally “wrong” functions. “I was just following orders,” complicit healthcare providers, doctors, and nurses claimed.

Morality refers to principles that help determine what is “right” and what is “wrong.” Ethics is the related field that puts these principles to work to:
apply moral principles to choose “right” actions,
conduct relationships in an ethical manner, and
manage situations where a “right” action is clear but for some reason not possible.

Using what we have learned this week- read the ethical dilemma below and explain your response and actions:

Nurse Is Instructed to Have Patient with Low Literacy Level to Sign Consent for Treatment

Scenario: Nurse Gloria is instructed by the attending physician to have Mr. Isaacs sign a consent form before a scheduled colonoscopy. As Nurse Gloria goes over the form with the patient, she notices he seems confused and is unsure where or how to sign the paperwork.

Ethical Dilemma: It is common for nurses to be the ones to get signatures on consent forms, especially for procedures like the one described in this scenario. When faced with a situation like the one here when the nurse is not sure that the patient understands what he is being told or if he can read, the decision of whether to delay a busy schedule to have the doctor come back and talk to the patient or explain to the best of her knowledge and get the patient’s signature may seem difficult to make.

Now that you have read the ethical dilemma below WHAT IS THIS PERSON FOCUSING ON EMOTIONALLY? What are the ASSOCIATED ETHICAL PRINCIPLEs AT PLAY IN THIS SCENARIO? WHAT ARE THE IMPLICATIONS OF THE NURSE’S ACTIONS? explain your responses and your current actions.

Sample Solution

Emotional Focus

Nurse Gloria is likely experiencing a conflict between duty and compassion. On one hand, she has a professional duty to follow the physician’s order and obtain the patient’s signature. On the other hand, her compassion for the patient, who seems confused and possibly unable to comprehend the consent form, is pulling her in the opposite direction. She may also feel pressure from the demands of a busy schedule, which could add to her emotional stress.

Associated Ethical Principles

Several ethical principles are at play in this scenario:

  • Autonomy: The patient has the right to self-determination and to make informed decisions about their healthcare.
  • Beneficence: The nurse has a duty to act in the best interest of the patient.
  • Non-maleficence: The nurse has a duty to avoid harming the patient.
  • Justice: The patient has a right to fair and equitable treatment.

Implications of the Nurse’s Actions

The nurse’s actions will have significant implications for the patient. If she obtains the patient’s signature without ensuring his understanding, she may be violating his autonomy and putting him at risk of harm. This could lead to legal and ethical consequences for both the nurse and the healthcare facility. Additionally, it could erode the patient’s trust in the healthcare system.

On the other hand, delaying the procedure to involve the physician could lead to disruptions in the clinic’s schedule and potentially inconvenience the patient. However, it would prioritize the patient’s right to informed consent and demonstrate respect for his autonomy.

My Actions:

As a nurse in this situation, I would prioritize the patient’s right to informed consent. I would respectfully explain to the patient that I believe he is confused about the consent form and that I want to ensure he fully understands the procedure before signing. I would then request the physician to return and personally explain the procedure to the patient.

If the physician is unable to return promptly, I would document the situation in the patient’s chart, including the patient’s apparent confusion and my request for clarification. I would also explore alternative methods to ensure the patient’s understanding, such as using simpler language or providing additional written materials.

Ultimately, my goal would be to protect the patient’s rights and ensure that he makes an informed decision about his care.

 

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