Ethical Foundations and Moral Reasoning - Essay Example

? Ethical Foundations and Moral Reasoning Ethical Foundations and Moral Reasoning Today’s era of nursing practice offers great autonomy for the nurses unlike the former years where nursing practice are dependent of the physician’s decision on most times. With the increasing power held by nurses in their everyday practice comes equivalent responsibility on their execution of nursing care. This autonomy poses great challenge on making sound decisions for each nurse which is expected to be guided by the professional, ethical, and moral standards. From basic nursing care to the advance and critical nursing practices, to researches and home care system, every procedure to be carried out must be done with utmost understanding of the procedure itself and its implications for both the patient and the nurse practitioner. Butts and Rich (2012) stated in their book Nursing Ethics: Across the Curriculum and Into Practice that “Rules and theories matter little without the formation of good character” and believed that nurses are faced with ethical issues every single day. They added that imbibing textbooks ethics serves as a sturdy foundation for nurses to develop practical wisdom and virtuous character in practice. Assessment is the initial step in every nursing procedure therefore it is vital to first determine the nurse’s understanding of what ethical issue really means. A lot of people misunderstood ethics as mere observance of social norms, religious beliefs or the law instead of it being an impartial concept of its own (Paul and Elder, 2006). It may be understood as a moral principle of a specific individual, group, or custom and other author allows its usage to be interchangeable with “morality” (Deigh, 1995). Paul and Elder (2006) define ethics as "a set of concepts and principles that guide us in determining what behavior helps or harms sentient creatures." Therefore it can be understood that ethical issues are problems that involves organizing, verifying, and advocating concepts of right and wrong conduct in solving them (Fieser, 2003). Varcoe, et al. (2004) studied on the nurses’ perspective on the ethical practice in nursing and results depicted that the subjects understands ethics as “both a way of being and a process of enactment.” There is no absolute right or wrong in responding to ethical dilemmas but the goal for deciding how to act upon it is based on the basic notion of beneficence and non-maleficence. The knowledge on General Principles of Nursing Ethics is vital in facing these situations. It is important that nurses are aware of these virtues in order to be properly guided in decision making. These are beneficence, non-maleficence, respect for autonomy, justice, and respect for person. Beneficence is active promotion of good while non-maleficence means duty to do no harm. Respect for autonomy is acknowledging the patient’s rights, values and choices so as respect for person which equates to treating all patients as worthy individual. And lastly, justice is the promotion of equity or fairness in every situation a nurse encounters (Barnett, 2003). Ethical issues faced in the nursing practice can be clinical problems relating to patient right and care, professionalism, philosophical, organizational and societal (Bosek, 2009). One of the most common face is conflict between patient autonomy and nurse’s belief such as denial of blood transfusion for the Jehova’s Witness or withdrawal from life sustaining treatment even if it can cause fatal consequences, or tending to post-operative abortion patients that are done not for medical purposes. An example of this was the quandary faced by nurses of University of Medicine & Dentistry of New Jersey when they were directed by the hospital in September 2011 that all nurses are required to assist in pre- and post-operative care of abortion patients (Katarsky, 2011). Clearly this presents ethical battle against the nurses’ morality especially if they are pro-life or have opposing cultural and religious beliefs. The hospital insisted that there is nothing wrong with this memorandum and that pre- and post-operative care for these patients have no difference in caring for patients under other surgical procedures. Pro-choice advocates debates that nurses do not have the right to choose the patient they will care for in the pre- and post-operative stage. They acknowledge that nurses are protected by the law in refusal to participate in the actual procedure of abortion. For these nurses, caring pre- and post-operatively to non-therapeutic abortion patients are almost equivalent to assisting in the procedure of ending one’s life itself. With this, they filed a lawsuit against their institution and the court granted them with restraining order on this matter. Analyzing the situation, it is clear that the nurses stand by their moral principle of being pro-life. It may be right for some while this action may seem to be negligent for the women’s health advocated or those in pro-choice. This is on great disadvantage when all of the nurses on duty are on the same side leaving the abortion patient with no attendants of care. This poses great danger since they are at high risk of hemorrhage and other post-operative complications if not properly monitored. Utilizing the Scope of Practice Decision Making Model (Arkansas State Board of Nursing, 1999) which bases decision making on the provisions of the law and the nurse’s knowledge, capabilities, and training on the practice, it can be concluded that nurses in the given situation are bound to attend to all pre- and post-operative patients not excluding those who undergone abortion. Since the nurses are well trained and knowledgeable on the pre- and post-operative care and that abortion is permissible by the law of New Jersey, therefore, the path to be followed in this model is the execution of the procedure. Unfortunately, this model does not consider any ethical or moral duty on the part of the nurse. Another decision making model which can be utilized is the Greipp’s model (Greipp, 1992) which offers examination of all factors that enter into the ethical decision making process as shown in the figure below. Fig. 1. Greipp’s Model of Ethical Decision Making (Greipp, 1992). Processing the situation through this model, dilemma on execution may be encountered on the second stage where the nurse’s culture and belief system will be in incongruity with their profession. Education may balance this through helping an open mind to weigh the situation. The third stage processes it with the Nursing Code of Ethics. Respecting autonomy, responsibility and accountability for competence, and beneficence may all point to execution of pre- and post-operative care of abortion patients. Nevertheless, if the life in the womb or the fetus’ rights will be considered, justice, beneficence, and non-maleficence leads to its salvation and non-execution of the procedure. Utilizing ethical decision model will definitely guide the nurses to act upon everyday situations based on existing guidelines and principles. This will therefore provide clarity on the mind of the nurses that can sometime be clouded by mere emotions and sentiments. Using the ethical decision models, sane and wise decisions will be made thus protecting both the patient and the nurses from harmful or wrong practices brought by reckless or ill-considered decisions. References Arkansas State Board of Nursing. (1999). The Practice of Nursing. Retrieved from http://www.arsbn.org Barnett, J. (2003). Navigating the Ethical Decision Making Maze. The Maryland Psychologist, 49(2), 7. Bosek, M. (2009). Identifying Ethical Issues from the Perspective of the Registered Nurse. Journal of Nursing Administrators Healthcare Law, Ethics, and Regulation, 11(3), 91-99. Butts, J., Rich, K. (2012). Nursing Ethics: Across the Curriculum and Into Practice. Burlington, MA: Jones and Bartlett Learning. Deigh, J. (1995). The Cambridge Dictionary of Philosophy. United States. Fieser, J. (2003). Ethics. [Web log post]. Retrieved from Internet Encyclopedia of Philosophy http://www.iep.utm.edu/ethics/ Greipp, M. (1992). Greipp's model of ethical decision making. Journal of Advanced Nursing, 7, 734-738. Katarsky, C. (2011). Nurses sue to avoid tending pre- and post-op abortion patients. Health Exec News. Retrieved from http://healthexecnews.com Paul, R., Elder, L. (2006). The Miniature Guide to Understanding the Foundations of Ethical Reasoning. United States: Foundation for Critical Thinking Free Press. Varcoe, et al. (2004) Ethical practice in nursing: working the in-betweens. Journal of Advanced Nursing, 35(3), 316-325. DOI: 10.1046/j.1365-2648.2003.02892.x Read More