Paternalism and Ethics in Nursing - Essay Example

Paternalism and Ethics in Nursing Introduction: Ethics in the context of nursing as elsewhere are distinct from legalities and law but given the special nature of nursing as a profession and the importance of healthy and ethical nursing practice, law and ethics have an overlapping relationship where nursing is concerned. So while moral right or wrong is distinct from a legal right or wrong, and while decision making requires consideration of law, morality of law have been questioned time and time again. There is therefore a need for a better defined and practicable system wherein ethically desirable nursing and issues such as confidentiality and respect for the patient along with issues of autonomy are dealt with. The following discussion seeks to understand paternalism in this context and the relevance of ANMC guidelines on values in the context of a patient. Paternalism is a common societal response for protecting another (usually someone the person perceives to have less knowledge and experience and/or fewer problem solving skills) from harm (Boseck and Savage, 2007). Paternalism is term that has been derived from the word parent and would naturally connote care in the sense that a parent cares for the child. The most widely accepted definition of paternalism defines the term as “interference with a person’s freedom of action or freedom of information or the deliberate dissemination of misinformation, where the alleged justification of interfering or misinforming is that it is for the good of the person who is interfered or misinformed. For paternalism to happen in the most tangible sense of the term there must be a violation of the patient’s autonomy. There must therefore be a usurpation of decision making, either by preventing people from doing what they have decided or by interfering with the manner in which the patient would arrive at his decision.   Paternalism can be distinguished along two basic lines, harmful and benefit paternalism as divided by early literature on the topic. While harm paternalism underpins the issue of maleficense is usually justified given the fact that it’s basic objective is the protect individuals from inflicting self harm, benefit paternalism was justified on the grounds that its objective was securing help for an individual that he would otherwise not get (Johnston, 2008).   The concept of paternalism in medicine and nursing like many other concepts is subject to debate. Pro-paternalistic views hold that paternalism in nursing is justified to protect individuals against themselves. In this instance, paternalism is justified as a kind of social insurance policy for our own benefit. Intervention in the form of paternalism is justified in cases of ignorance or other cases where the acts do not express the agent's settled values and preferences, or where temporary intervention is necessary to make a determination of these factors. Anti paternalism on the other hand holds that paternalism is never justified given the fact that it would always involve some sort of a violation of moral rules. The idea is that paternalism entails a violation of an individual’s privacy and a failure to treat the person as a moral equal of others. The final view is that of prima-facie paternalism that believes in a justification of paternalism though in the limited sense. Paternalism is justified where the evils prevented from occurring to the person are greater than the evils (if any) caused by violating the moral rules and its is universally justified under relevantly similar circumstances always to treat the person in that manner. Nurses value quality nursing care for all people The first duty of the nurse from the ethical point of view to ensure that quality health care is made available to the patent concerned in the capacity of a consumer. This would mean that the registered nurse in charge of a particular ward would have to take responsibility for the levels of nursing care being provided. This would help in raising the standard of nursing care and help the RN take relevant action in cases where the codes of ethics or nursing professionalism are being flouted. This includes a responsibility to question and report behavior that could be considered unethical and incorrect in the medical sense. There needs to be reasonable grounds for these assumptions. In the above case for, the communication faculties and the mental abilities of the patient are working well, the handicaps are mostly physical and thus there can be no case for justified paternalism. Given the basic duty of the nurse to ensure quality healthcare service, the RN should take appropriate action and ensure that paternalism with respect to the patient is halted. The patient needs to be treated as an autonomous individual and not as a dependant, the decision making ability of the individual is not hampered by his physical handicap and that needs to be made clear to the ward nurses. Nurses value respect and kindness for self and others The second most basic and core principle of ethical guideline would in essence connote the fact that it is the nurse’s responsibility to value and respect one’s self and manifest this basic sense of respect in the manner in which patients are treated. The idea is to help grow and understand the moral worth and dignity of oneself and in others. This would then mean that a nurse would have to respect the patient irrespective of his handicap as an individual. Respect for people who are health consumers recognizes their capacity for active and informed participation in their own health care. Nurses need to therefore work hard at ensuring that the dignity of people is preserved. This can be best achieved through practiced kindness and by recognizing the vulnerability and powerlessness of people in their care. In the specific case of the patient in the given context, the duty of the nurse therefore is to recognise the shortcomings of the man in their care and despite the restrictions that caring for a physically handicapped man would mean, there would need to be a certain respect for his thought and decision making abilities. The duty of the RN would therefore be ensure that the ward nurses understand and comply with this basic principle. Nurses value the diversity of people This would mean in essence that the nursing leader would have to value the diversity an distinctiveness in her/his patients, thereby learning the appreciation of varying cultures and languages and the influences that these might have both on the provision and receipt of nursing and health care (Cody, 2003). This would in turn mean that the nurse would have to respond to each patient as an individual and accept that there can be no single universal method of dealing with patients. This would therefore mean an acknowledgement of each person as a unique individual. This would in turn require the nurse to develop cultural knowledge and awareness. In the context of the above given case, the most prudent manner of ction therefore would be for the nurses to get familiarized with the patient’s cultural background and assimilate education with his cultural background thereby helping in making his rehabilitation process easier and simpler for him as opposed to compromising his autonomy by a practice of paternalism. Nurses value access to quality nursing and health care for all people Valuing nursing and health care for all people requires nurses to uphold the principles and standards of the right to nursing and health care as measured by the availability, accessibility, acceptability, quality, and safety of nursing and health care services. Specifically, access refers to the extent to which a person or community can obtain health care services. This includes knowledge of when it is appropriate to seek health care, the ability to travel to and the means to pay for health care. Nurses valuing non-harmful, non-discriminatory care provide nursing care appropriate to the individual that recognizes their particular needs and rights. They seek to eliminate prejudicial attitudes concerning personal characteristics such as race, ethnicity, culture, gender, sexuality, religion, spirituality, disability, age and economic, social or health status. The idea therefore should be the recognition of patient needs irrespective of the settings and the background that the patient comes from and ensuring quality nursing care support under all circumstances to the best of the staff abilities. Nurses value informed decision making As the leader of the team of nurses, the greatest duty owed is toward the one in his/her care (Elliot, Aitkin and Chaboyer, 2007). The idea should therefore be the perpetration of a culture that promotes a sense of informed decision-making. At the very core of the value system for nurses is the idea that nurses ideally would need to value the patient’s interests and the promotion of these interests by helping the patient make free and informed decisions. This includes people having the opportunity to verify the meaning and implication of information being given to them when making decisions about their nursing and health care. The idea therefore should be the promotion of independent and autonomous thought and action from the patient during the process of treatment. In our given case therefore, the need would be to help the patient regain strength and stamina by helping him in his decision making process. Paternalism is not correct for the patient in given the fact that it makes the patient dependant and hampers the process of rehabilitation. Nurses value a culture of safety in nursing and health care The basic principle underlying this value standard is that a nursing leader would need to attempt the fulfillment of what is right rather than that, which is convenient. So while it might be easier or more convenient for the nurse to make the decision on behalf of the patient, it is the duty of the nurse in the moral sense to recognise the vulnerability of the patient to injuries and illnesses, that could result from preventable human error and adverse events while in health care settings. The idea should therefore be the ability of the nurse to play a role in the recognition and deterrence of mistakes and adverse events in health care settings. This would therefore help in supporting in systems to identify circumstances where people are at risk of harm. For the purpose of the patient under observation therefore it would be most expedient to ensure that patient education and health factors are kept in check as these would then help in injury avoidance for the patient at a later date. Nurses value ethical management of information The ethical management of information would mean that there is a marked respect shown to the privacy that a medical system and health care management team would owe the patient, without a compromise on health or safety. This applies to all types of data, including clinical and research data, irrespective of the medium in which the information occurs or is stored. The patient in question is suffering from paraplegia, there it would mean that his movement in the lower part of his body would be restricted, thereby making him the subject of a few embarrassing incidents, his records would have to demonstrate these with some standard of objectivity apparent if in future his treatment is to proceed in a smooth manner. Nurses value a socially, economically and ecologically sustainable environment promoting health and wellbeing A nurse is supposed to value strategies aimed at preventing, minimizing, and overcoming the harmful effects of economic, social or ecological factors on the health of individuals and communities. This would mean in turn that that through a process of tact and diplomacy, tolerance and rehability, they are supposed to demonstrate their depth of purpose and understanding. In conclusion therefore it maybe reiterated that as a registered nurse of as a student of the discipline of nursing it is essential to understand the simple fact that paternalism is an undesirable practice in most cases, especially so in cases where the handicap that the patrient suffers from id physical much more than being mental. The duty of the nurse is not do make the patient’s decision for him but to aid the patient in making his own decisions by helping him think aboyt his condition in an appropriate manner and by ensuring that the patient is able to place his problem in perspective. References: Boseck M S D and Savage T A, 2007, The Ethical components of nursing education, pub, Wolters Kluwerth Health, p320 Johnston M J, 2008, Ethics: A Nursing Perspective, pub, Elsevier Health Science Publications, pp162-164 Elliot D, Aitkin L and Chaboyer W, 2007, ACCCN’s Critical Nursing Care, pub, Elsevier Australia, pp88-90 Paternalism, accessed September 28, 2009, < http://faculty.washington.edu/wtalbott/phil410/trpaternal.htm Cody W K, 2003, Paternalism in Nursing and Healthcare: Central Issues and their Relation to Theory, pub, Nursing Science Quarterly, Vol.16 No.4, pp288-296 Code of Ethics for Nurses in Australia, pub, Australian Nursing and Midwifery Council, Royal College of Nursing, Australia, Australian Nursing Federation Read More