Vince is a technical writer working in the medical research field. He also enjoys exploring literature in his free time.
When Ethics Becomes an Issue in Nursing
A common ethical issue in nursing is that of religious restrictions. While it is the official stance of those working in the healthcare field in America that spiritual accommodations must be made for patients, and there is evidence that such accommodations improve patient quality of care, there are also times in which a patient’s religious beliefs conflict with that of medical staff—to the point of creating an ethical dilemma.
These dilemmas arise from a difference in morality. To a nurse, what is moral is the preservation of life, the reduction of suffering, and the autonomy of a patient to choose a path of care, so long as that path does not lead to self-harm. To a patient of a religious background, morality is serving God without regard for personal well-being, since reward will come in the afterlife. Morals are very strong and guide people’s decisions. When moralities clash, the debate can be quite heated. However, nurses have an obligation to respect the beliefs of others, so when their morals clash with their patients, it produces an ethical dilemma between two competing beliefs. This article will briefly explore how ethical dilemmas that derive from competing beliefs can impact the practice of nursing (Purtilo & Dohurty, 2011).
A commonly encountered ethical dilemma is when health care professionals care for children of parents whose religion prevents certain medical interventions. Christian Scientists and Jehovah’s Witnesses are known to hold such beliefs, either believing that God will heal their illnesses, or that certain medical practices such as blood transfusion are inherently wrong. This issue would not be so problematic if it were the parent who is sick. An individual has a right to decline treatment, but declining treatment on behalf of a child in one’s custody carries an entirely different ethical connotation.
In this situation, medical staff can either acknowledge the parent’s wishes and do nothing, or they can seek legal counsel and attempt to show that the parent does not have the child’s best interest in mind, thus gaining the right to perform the procedure anyway. A third option exists in which the staff act on their own and treat the child against the parent’s wishes. This is not advisable, since working within proper protocol and with legal support is safer.
Autonomy and justice are competing principles in this case. Autonomy defines one’s right to make one’s own medical decisions. Since parents have custody over children and make medical decisions for them, autonomy extends to their right to guide their children’s medical care. However, parents may not do as they please with their children. Abuse and neglect are still punishable offenses, and justice dictates that the child must not be a victim of these (Masters, 2017).
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Beneficence and non-maleficence are also issues in this situation that must be carefully balanced. A doctor has an obligation to keep a dying patient alive, even if the only way to save the patient is a blood transfusion, regardless of what the parents say. This is an example of non-maleficence. Beneficence can be more complicated. For example, a cochlear implant may help a child hear, but a deaf parent may not elect to have this done. In this case, the child may still go on to live a full and happy life. Weighing the risk for harm against the benefits involved is as important as weighing the parent’s right to medical decisions against the child’s right to just treatment (Masters, 2017).
Importance and Impact
The more decisions nursing and medical staff are allowed to make regarding the care of juvenile patients, the more responsibility and liability they take on. This is not something that can be taken lightly. Additionally, nurses have a duty to uphold the primacy of the patient’s interests. How these cases, in which a parent’s wishes are pitted against the nurse’s ethical code, are handled set a precedent for identifying who exactly it is that the nurse is serving. Whether primacy is given to the parent, or to the child regardless of the parent’s decisions is impacted by how this ethical dilemma is resolved (American Nurses Association, 2015).
Autonomy and Justice
The ethical dilemma presented to nursing staff when their morals are not in line with those of parents who are making medical decisions for their children presents a difficult challenge. There is room for both the parents and the staff to be in the wrong and to make a decision that does not benefit the child. For this reason, autonomy, justice, beneficence, and nonmaleficence must all be considered to resolve the issue. Each time this dilemma is resolved in individual cases, it sets a precedent for future nursing staff to look to and shifts the nature of ethics in the fields slightly.
American Nurses Association (2015). "Code of ethics for nurses with interpretive statements." Retrieved Nov. 3, 2016 from http://nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-Nurses.html
Masters, K. (2017). Role Development in Professional Nursing Practice (4th Edition). (13: 978-1284078329) Jones and Bartlett: Sudbury, Massachusetts.
Purtilo, R., Dohurty, R. (2011). Ethical Dimensions in the Health Professions (5th). St. Louis, MO: Elsevier Saunders.
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