Nursing ethics

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 relationships, human dignity and collaborative care.

Development of subject

The nature of nursing means that nursing ethics tends to examine the ethics of caring rather than 'curing' by exploring the relationship between the nurse and the person in care.^[1] Early work to define ethics in nursing focused more on the virtues that would make a good nurse, rather than looking at what conduct is necessary to respect the person in the nurse's care. However, recently, the ethics of nursing has also shifted more towards the nurse's obligation to respect the human rights of the patient and this is reflected in a number of professional codes for nurses.^[2] For example, this is made explicit in the latest code from the International Council of Nurses.^[3]

Distinctive nature

Although much of nursing ethics can appear similar to medical ethics, there are some factors that differentiate it. Generally, the focus of nursing ethics is more on developing a caring relationship than concerns about broader principles, such as beneficence and justice. ^[4] For example, a concern to promote beneficence may be expressed in traditional medical ethics by the exercise of paternalism. However, this approach arguably acts against important values found in nursing ethics.^[5] Nursing theory seeks a collaborative relationship with the person in care. Themes that emphasize respect for the autonomy and dignity of the patient by promoting choice and control over their environment are commonly seen. This is in contrast to paternalistic practice where the health professional chooses what is in the best interests of the person from a perspective of wishing to cure them.

The distinction can be examined from different theoretical angles. Despite the move toward more deontological themes by some, there continues to be an interest in virtue ethics^[6] in nursing ethics and some support for an ethic of care.^[4] This is considered by its advocates to emphasise relationships over abstract principles and therefore to reflect the caring relationship in nursing more accurately than other ethical views.

Some themes in nursing ethics

Nurses seek to defend the dignity of those in their care.^[7] In terms of standard ethical theory, this is aligned with having a respect for people and their autonomous choices. People are then enabled to make decisions about their own treatment. Amongst other things this grounds the practice of informed consent that should be respected by the nurse.^[5] Although much of the debate lies in the discussion of cases where people are unable to make choices about their own treatment due to being incapacitated or having a mental illness that affects their judgement. A way to maintain autonomy is for the person to write an advance directive, outlining how they wish to be treated in the event of them not being able to make an informed choice, thus avoiding unwarranted paternalism.

Another theme is confidentiality and this 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.^[5].

Also related to information giving is the debate relating to 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.^[8]

By observing the principles above, the nurse can act in a way that respects the dignity of the individual in their care. Although this key outcome in nursing practice is sometimes challenged by resource, policy or environmental constraints in the practice area.^[7]

See also

Nursing portal

• Bioethics
• Clinical governance
• Health care
• Human experimentation in the United States
• Medical ethics
• Patient advocacy
• Philosophy of healthcare

References

1. ^ Hunt, Geoffrey (1998). Craig E. ed. Routledge Encyclopedia of Philosophy. 7. London: Routledge. pp. 56–57. ISBN 9780415187121. 
2. ^ McHale, J & Gallagher, A (2003). Nursing and Human Rights. Butterworth Heinemann. ISBN 0-7506-5292-6. 
3. ^ "The ICN Code of Ethics for Nurses". International Council of Nurses. 2006. http://www.icn.ch/icncode.pdf. Retrieved 2009-06-27. 
4. ^ ^{a b} Tschudin, Verena (2003). Ethics in Nursing: the caring relationship (3rd ed.). Edinburgh: Butterworth-Heinemann. ISBN 9780750652650. 
5. ^ ^{a b c} Rumbold, G (1999). Ethics in Nursing Practice. Balliere Tindall. ISBN 0-7020-2312-4. 
6. ^ Armstrong, Alan (2007). Nursing Ethics: A Virtue-Based Approach. Palgrave Macmillan. ISBN 9780230506886. 
7. ^ ^{a b} Baille L, Gallagher A. & Wainwright P. (2008). Defending Dignity. Royal College of Nursing. http://www.rcn.org.uk/__data/assets/pdf_file/0011/166655/003257.pdf. 
8. ^ 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:10.1191/0969733004ne728oa. 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