One of the hardest things for healthcare professionals is that everything we do is not always in the best interest of our patients. This is where nursing ethics come in. Some patients would be better off not surviving, as much as we would like them to. How many life and death situations have you been in, where a life was saved only to wonder after the fact, why?
So how do we know we are making the right decisions for our patients? Nurses have the responsibility to be altruistic, which means, as nursing professionals, we have the ethical obligation to serve others without self-interest. The nurse that is altruistic will make decisions that are in the best interest of the patient. Thus, being a patient advocate and practicing good nursing ethics.
Today, with modern technology, we can keep people alive indefinitely, but is that always the best option for the patient or their family? We put patients on life support, hook them up to multiple tubes, pump them full of nutrients and medication, but will they ever have a chance at a productive life? These are the difficult questions that healthcare providers have to continually ask themselves.
During a code situation the adrenaline is pumping, we are in a life saving mode, we feel like a good nurse who could save the world or at least one person. Be honest, isn't that the way you feel during a code that goes extremely well? Then it hits us, the patient is on a ventilator, the EEG doesn’t show any brain activity and now we have more questions to ask.
New nurses have the hardest time with life and death decisions. When my father-in-law was actively dying in the hospital, the young nurse was hesitant to increase his morphine drip. My husband’s family was having a difficult time because his breathing was so labored they were afraid he was suffering. Eventually, she did increase the morphine as ordered, but I could understand her dilemma, she did not want to be the cause of his death. Maturity brings wisdom, and the more knowledge, the more certitude. Ethics in nursing drive all decisions, good and bad.
As nurses, we also must respect the cultural beliefs and values of others. Just because we think it is the right thing to do, does not necessarily make it so. A Jehovah’s Witness has the right to refuse blood products, even when their life is in jeopardy. We must respect that belief. A patient may decide not to receive chemotherapy; that is his choice. It may not be right for us, but we have to honor the wishes and beliefs of the patient.
Unfortunately, decisions made by families are sometimes due to grief and lack of understanding. That is when a strong Ethics Committee can be an invaluable service.
Ethics committees can help to make final decisions that are in the best interest of the patient, while taking different cultural beliefs, the patient’s wishes, and the expected outcomes all into consideration. Many times, a good ethics committee can take a huge burden off the patient and his family. Families don’t always want to be the ones to make the difficult decision to stop life sustaining treatments because they then have to live with the outcome. Ethics committees can facilitate these difficult decisions.
The Code of Ethics and the Nurse Practice Act are very good guidelines for how we should behave, but these documents are not specific. They do not tell us what is right and what is wrong, we have to decide that for ourselves. Ethics, especially in nursing, is something which encompasses individual interpretation. It is based on individual morals and values. So although both the Code and NPA are guidelines, they don’t absolve us from making appropriate individual decisions. We need to ask ourselves, are we doing it because it is the right thing to do, or are we doing it “because we can?”