A HISTORY OF NURSING ETHICS
The Nuremberg trials at the close of WWII offered disturbing questions. How can “good” people in traditionally honor-bound professions become complicit in some of the worst violations of humanity in history? What happens when individual professionals are not held to account by their peers, professions, and society as a whole? The trials showed how moral individuals within organizations can engage in morally “wrong” functions. “I was just following orders,” complicit healthcare providers, doctors, and nurses claimed.
Morality refers to principles that help determine what is “right” and what is “wrong.” Ethics is the related field that puts these principles to work to:
apply moral principles to choose “right” actions,
conduct relationships in an ethical manner, and
manage situations where a “right” action is clear but for some reason not possible.
Read the ethical dilemma below and explain your response and actions:
Nurse Is Instructed to Have Patient with Low Literacy Level to Sign Consent for Treatment
Scenario: Nurse Gloria is instructed by the attending physician to have Mr. Isaacs sign a consent form before a scheduled colonoscopy. As Nurse Gloria goes over the form with the patient, she notices he seems confused and is unsure where or how to sign the paperwork.
Ethical Dilemma: It is common for nurses to be the ones to get signatures on consent forms, especially for procedures like the one described in this scenario. When faced with a situation like the one here when the nurse is not sure that the patient understands what he is being told or if he can read, the decision of whether to delay a busy schedule to have the doctor come back and talk to the patient or explain to the best of her knowledge and get the patient's signature may seem difficult to make.
Sample Solution
Nurse Gloria is in a difficult ethical dilemma. She has been instructed by the attending physician to have Mr. Isaacs sign a consent form for a scheduled colonoscopy, but she is not sure that he understands what he is signing.
Ethical Principles
The following ethical principles are relevant to this scenario:
- Autonomy: Patients have the right to make their own decisions about their healthcare.
- Informed consent: Patients have the right to be informed about the risks, benefits, and alternatives to any proposed treatment before they consent to it.
- Beneficence: Healthcare professionals have a duty to act in the best interests of their patients.
- Non-maleficence: Healthcare professionals have a duty to avoid harming their patients.
Full Answer Section
Nurse Gloria's Options Nurse Gloria has a few different options in this situation:- Follow the doctor's instructions and have Mr. Isaacs sign the consent form. This would be the quickest and easiest option, but it would also be the most unethical. If Mr. Isaacs does not understand what he is signing, he is not giving true informed consent.
- Delay the procedure and have the doctor come back to talk to Mr. Isaacs. This would be the most ethical option, but it would also be the most time-consuming and disruptive.
- Try her best to explain the consent form to Mr. Isaacs and get his signature. This is a middle-ground option, but it is still risky. If Mr. Isaacs does not understand what he is signing, even after Nurse Gloria's explanation, he is still not giving true informed consent.