Nursing Ethics

Introduction to the Study of Ethics

Ethics is the study of moral thought in which reasoned thinking results in sound decision making despite the presence of values conflict. The evolution of intellectual development and ethical reasoning span our collective history as an enlightened society, impacting all aspects of life. Medical ethics or bioethics is a relatively new discipline that focuses on the moral and ethical implications of research, technology, and decision making within the context of health care.

The Study of Ethics

The study of ethics and ethical reasoning is often misunderstood to mean that which is good and evil, right or wrong. Ethics alone does not determine good from evil, right from wrong. Rather, ethics is one process applied by individuals to balance benefits and consequences, individual and shared values, and fundamental truths from guiding principles to arrive at a morally acceptable solution when presented with an ethical dilemma. this applies to Nursing Ethics as well.

The Merriam-Webster online dictionary describes a dilemma (n.d.) as an instance in which one is faced with equally unsatisfactory alternatives, resulting in a distressful or painful situation as one is forced to make a choice one does not wish to make. Unlike instances in which one looks to socially-defined boundaries such as rules, laws, and professional guidelines for the answer to a given problem, dilemmas are not as easily solved. Dilemmas become evident when no alternatives lead to acceptable outcomes and no decision prevents an undesirable or harmful effect.

Consider the following ethical dilemma:

You are the parent of two, beautiful children. One falls ill and is eventually diagnosed with a terminal illness. Your other child becomes the only means of providing life-sustaining treatment. Although grateful that an intervention to save your child exists, you soon discover the painful truth that your decision will result in the loss of life for one or both children. You love them equally but must make a choice.

• What makes this situation an ethical dilemma?
• Faced with this dilemma, what will you decide to do?

Historical Roots of  Nursing Ethics

The roots of contemporary ethics are found in early society and its writings. These writings are influenced by classic philosophy, theology, and sociology.

The origins of moral thought can be traced to the Pentateuch, the first five books of the Bible. The guiding principles written in the Pentateuch constitute some of the earliest statements of beliefs relating to morality and moral reasoning. Early Christians codified these basic principles into written law known collectively as Mosaic Law. By codifying these principles into law, the people of Israel were provided with explicit directions upon which to live, according to God’s law.

The Code of Hammurabi

In time, moral and social issues began to grow and become increasingly complex. Hammurabi, king and priest of Babylon (1800 B.C.), responded to his people’s needs by creating laws intended to provide greater guidance in light of everyday problems. These laws became known as The Code of Hammurabi (Law Research Services, n.d.). While moral character and virtue were the cornerstones of everyday life in biblical times, the 282 laws created by King Hammurabi also demonstrated an expression of values extending beyond God’s law. The Code became the first account of civil laws to which all citizens, regardless of class, were held accountable.

While the Code contained specific punishments for individual transgressions, the pervading principles constituted the first statement of values with respect to civil rights and liberties. Specifically outlined in the Code were protection for women and slaves, regulations for legal procedures, fixed rates for services, and a description of property rights. These are principles that are still addressed in the legal codes of contemporary societies.

Medical/ Nursing Ethics

Nursing Ethics have roots in professional codes of conduct such as:

• The Greek Hippocratic Oath, which requires physicians to do good and avoid harm.
• The Nightingale Pledge, a similar oath that lists specific duties and principles related to nursing care.
• The Nuremberg Code applied to research ethics. It was established post-Nazi Germany as a guideline to protect subjects in all phases of research and experimentation (Caplan & McGee, 2004).

Classic Greek Philosophers

The classic Greek philosophers include Plato and Aristotle. The writings of Plato (427-347 B.C.) form the basis of “virtue” theory, which is most concerned with character and virtue over actions or outcomes themselves. Plato believed that even if an action produced a poor outcome, the intent of the individual to do good is itself virtuous. The prevailing moral principle, according to Plato, was to behave justly and align one’s character such that it intends to live justly for the sake of wholeness within the human soul (Rae, 2000).

Aristotle, a student of Plato (384-322 B.C.), advanced the work of his mentor by exploring human intellectual development. Though he believed that a virtuous character is necessary to achieve a just life, one’s intent was not simply the path to happiness. Rather, as intellectual beings, humans possess the capacity for moral reasoning. He postulated that there are two aspects of virtue:

1. Intellectual virtue which governs thought through reasoning and philosophy
2. Moral virtue or character which is obtained through intent and practical reason.

Aristotle focused on education as the means of developing virtue, which was seen as a balance between excess and deficiency. The moral reasoning required to achieve balance leads to a sense of wholeness within the soul (Rae, 2000).

Early Christian Ethicists

St. Augustine

St. Augustine (354-430 A.D.) attempted to articulate a Christian ethic for a world that was only beginning to consider Christianity as a way of life. St. Augustine took on Christianity as an adult and practiced a rigidly ascetic faith. He developed a decidedly pessimistic view of humans, seeing the world through his own sense of guilt and worthlessness. Consequently, he determined that human weakness could only be overcome through God’s grace, thus replacing any earlier emphasis on education and contemplation (Rae, 2000).

St. Augustine viewed humans as inherently individualistic and concerned with self-interest; as a result, many social activities (politics and government) were aimed at maintaining minimal peace and harmony as a restraint on essentially sinful people. One question often raised through his teachings was: Are humans inherently good and society evil as it tempts people to do evil or are humans inherently evil and society promotes people to do good?

St. Thomas Aquinas

Another early Christian ethicist, St .Thomas Aquinas (1224-1274 A.D.), was a Dominican monk who taught philosophy and theology at the University of Paris. Thomas Aquinas believed that developing goodness and acting for the common good were related. In contrast to St. Augustine, St. Thomas Aquinas believed that laws exist to mold essentially good people. This is consistent with Natural Law, which states that humans are basically good since they were made by God, who is good. Someone who espouses Natural Law would believe that man would make good choices because man is inherently good (Rae, 2000).

The Renaissance Thinkers

Hobbes

Hobbes, an English anthropologist (1588-1679) worked to bridge the end of the Middle Ages and its static view of orderly society, with the Renaissance, which is known as a period of rebirth. Characteristic of the Renaissance was an awakening of the mind as it thirsted for new knowledge. Hobbes saw law as simply functional, with no basis in religion or spiritual thinking. Hobbes is best known for his theory egoism which suggests that all people work for their own self interest, but are willing to give up some freedoms in order to enjoy prosperity that comes from working together. This may be the basis for the existence of communities in which individual freedoms come second only to the collective needs of society.

Hume

Hume (1711-1776) was a Scottish diplomat and historian who wrote from an empirical worldview; the only facts that can be relied upon are those that can be discerned by the senses. He is known as a moral sense theorist, which means the moral sense that an individual possesses makes the action right or wrong. Hume’s philosophy is that individuals set their own standard by which they determine ethical behavior (Rae, 2000).

Kant

Kant (1724-1804) was a Prussian scholar and professor of philosophy. He developed a principle-based ethic founded on reason alone. Unlike the Greek philosophers, he believed good will (or virtue) was what made an individual worthy of happiness. Good will unto others was a means of fulfilling one’s duty or obligation to foster relationships. A Kantian approach to moral and ethical decision making considers the good of the whole above the needs of individuals (Rae, 2000).

Professional Codes of Ethics

Most professions have a professional Code of Ethics that directs the practice of those involved in that profession. Nurses follow the Code of Ethics(Nursing Ethics) as a means of ensuring that their practice adheres to the ethical guidelines established by their peers.

The American Nurses Association (ANA) Code of Ethics was originally written in 1985 and revised in 2001. Its purpose is to assure the public that those in the profession of nursing are trustworthy and competent.

Most nursing training institutions provides a comprehensive Nursing Ethics code. Some common features of each of them are that they address patient rights and health care professionals’ responsibilities in protecting those rights.

Ethics Committees

Hospital ethics committees (HEC) provide a resource available for all health care professionals to assist them in resolving ethical dilemmas, Nursing Ethics. The Joint Commission of Healthcare Organization (JCAHO) requires that all accredited institutions have a mechanism available for staff and patients related to access to care, treatment of patients, and respect for patients and their families. While JCAHO does not mandate that an institution have an ethics committee, committees such as these tend to meet this standard most efficiently (Maricle, 1997).

The purpose of HEC is to offer guidance to hospital staff, physicians, patients, and families who are facing ethical dilemmas related to their health care. HEC offers suggestions as to how the situation might be best resolved. Their recommendations are not binding and those who brought the issue to the HEC may choose to follow or not follow the recommendations.

Conclusion

Ethics, and in particular Nursing Ethics, has its own discipline has emerged from the convergence of philosophical, theological, and sociological discourse throughout history. Moral thought and ethical reasoning are the cornerstones of ethical decision making. Applied to moral and social issues stemming from ethical dilemmas, moral thought and reasoned thinking result in sound, ethical decision making.

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Nursing Ethics References

Dilemma. (n.d.). In Merriam-Webster’s online dictionary. Retrieved August 26, 2008, from http://www.merriam-webster.com/dictionary/dilemma

Caplan, A.L, & McGee, G. (2004). An introduction to bioethics. American Journal of Bioethics. Retrieved July 30, 2008.

Law Research Services. (n.d.). The Code of Hammurabi (L. W. King, Trans.). Retrieved from http://www.lawresearchservices.com/admin/CodeHam.htm

Maricle, K. (1997). Ethics committee core curriculum−JCAHO: Patients rights and organizational ethics. Retrieved August 1, 2008, from http://wings.buffalo.edu/faculty/research/bioethics/man-jcah.html

Rae, S. B. (2000). Moral choices: An introduction to ethics (2^nded.). Grand Rapids, MI: Zondervan.