Nursing ethics

The ethical concerns that I have related to this dilemma are many. What is the doctor’s responsibility to try to stop the mother’s contractions? What are the limits of the attempts that should be made to save the child?   Should the mother be allowed to risk her own life to attempt to save the life of a child that is probably not viable outside the womb? Should the doctor plan a cesarean section despite the fact that the infant will probably die as soon as it is removed from the mother’s womb?   I can’t imagine making this decision personally, but many mothers are forced to make it every day. Here is the situation that lead to my ethical quandary.I have a patient who is 3 week ante partum and has had premature rupture of membranes. This condition could cause hemorrhaging for her and death of the infant in uterus. In layman’s terms, both she and the infant are at risk of death. She is starting to contract and the physician will not do anything si nce the fetus is not considered viable. The physician has described the issues of having a vaginal birth versus a cesarean section with this patient because the fetus is breech.The patient wants everything to be done to save this baby. As described above, the issues are exceedingly complex. The physician appears to have determined that the child is a lost cause and is thinking only of the health of the mother, but this is contrary to her wishes. Should the mother’s desire to save her child be allowed to override her own survival instincts? And, what role, if any, should the child’s father have in decision-making process?My literature survey for this situation was amazingly frustrating. I expected there to be a great deal of study materials available regarding this topic. It is, in essence, the quintessential ethical debate: do you save the life of the mother or the life of the child?   And, there is the question of the doctor’s ethics. Should he be able to det ermine the best medical course of action if it is contrary to the mother’s wishes? And, who determines when a fetus is viable? Can we allow it to be based on an arbitrary date?I found a lot of older research regarding the ethics of abortion and approaching the discussion of fetal viability from that point of view, but there was nothing recent and nothing than dealt with miscarriages as opposed to abortion. And, there was nothing that talked about the discussion of the life of the mother versus the life of the child. I think this would clearly be a great place for additional study.I think specifically the ethical question of whether medical decisions should be made contrary to the patient’s wishes should also be considered. Right now, as a society, we allow a person to make their own decisions about their health care even though we do not allow them to determine when or how they die.What I did find were several articles regarding the mental trauma that miscarriage and s tillbirth inflict on the mother and an interesting article promoting the development of advanced directives regarding pregnancy health care. Of all the articles, this is the one that I found most interesting and directly applicable to the situation at hand.In this article, Anita Caitlin proposes that obstetricians think outside the box and promote the development of advanced directives for prenatal and delivery care.   The proposal is simple, just as a person can create a living will for care during a terminal illness or traumatic injury, a pregnant woman would in her early weeks of pregnancy discuss in depth with her doctor the potential things that could go wrong and develop a plan of action.   For instance, a woman would decide at the very beginning of the pregnancy what circumstances would lead to her decision for a cesarean section (Caitlin, 2005).This would eliminate the need to make the decision during a high stress time, since we can assume that such decision would cause stress, and at a time that the mother’s mental and emotional state is impacted by the high levels of hormones associated with pregnancy. I understand that being able to hold a woman to the advanced directives would be impossible, but a woman could elect to rely on the already issued directive and not add the trauma of making a decision to an already stressful time.This would also allow the person to discuss the eventualities with those whom she believes have a right to have a say in her life instead of just those that the laws say have a right to assist with her decision-making (next of kin, when the patient is incapacitated).Another article that drew my attention that I found in my literature review was a discussion about the ethical concerns some doctors have about making medical recommendations that are contrary to their own moral and ethical beliefs.â€Å"A growing number of doctors, nurses, and pharmacies are refusing to provide, refer, or even tell their patients abou t care options that they feel are not in keeping with their own personal religious beliefs,† stated Barbara Kavadias, Director of Field Services at the Religious Coalition and leader of the three-year project that created In Good Conscience. â€Å"Institutions are refusing to provide essential care, citing their religious commitments.† (Bioweek, 2007)This is a growing ethical trend in medical care that I have some major concerns with. Take, for instance, the case of my current patient. If she were (or is) being treated by a doctor who believes all life is sacred, he might be willing to risk the life of the mother in an effort to try to save the child. In this case, it is difficult to determine how a person with these moral concerns might treat the patient. Taking the child via c-section is probably the best for option to preserve the mother’s life. It may result in the immediate death of the fetus. Waiting and trying to abate the mother’s contractions may provide the child with a greater chance of survival, but also puts extra risk on the mother’s life. At that point, what are the criteria used by those with this moral outlook to determine the proper course of action?These questions are likely to grow in controversy as technology increases and the fetus is increasingly viable outside of the womb. The more that society becomes able to keep a child alive without the benefit of the mother, the more questions regarding the ethics of doing so or not doing so will grow in prominence. It is absolutely possible that with increasing medical technology and the ability to prolong life we will have additional debates regarding who gets to determine what lives are worth saving and what lives are lost.I believe that a trend toward making informed decisions is a good one and a move in the right direction, taking people away from having to make a decision in a crisis situation. I also think that it is worthwhile to discuss the role of the fat her in the decision-making process. Because of the trend toward increasing women’s rights and in an effort to prevent a return to the days of the complete male dominance, society appears to be moving away from the rights of a souse to have a say in decisions that affect them.For example, the birth of a child is an 18-year (minimum) commitment for men as well and in an effort to secure the rights of women, we have completely removed the father from the decision-making process. As a human, I believe that ultimate control of a person’s body should be his or her own, but it is also reasonable to believe that a spouse (or life partner) should have some say in the decision. In the case of m patient, I cannot believe that a loving partner would encourage her to risk her own life for the tiny chance to save a child which would already have been lost if not for technology.Works CitedCaitlin, Anita. â€Å"Thinking Outside the Box: Prenatal Care and the Call for a Prenatal Advan ce Directive†Journal of Perinatal & Neonatal Nursing. Frederick: Apr-Jun 2005. Vol. 19, Iss. 2; pg. 169.Geller, Pamela A. â€Å"Understanding distress in the aftermath of miscarriage† Network News. Washington: Sep/Oct 2002. Vol. 27, Iss. 5; pg. 4.Klier, C. M. , P. A. Geller, J. B. Ritsher. â€Å"Affective disorders in the aftermath of miscarriage: A comprehensive review†,Archives of Women's Mental Health. Wien: Dec 2002. Vol. 5, Iss. 4; p. 129.‘Religious Coalition for Reproductive Choice; Religious Leaders Call for New Efforts to Reverse Growing Imposition of Sectarian Religious Beliefs on Reproductive and End-of-Life Care† Biotech Week. Atlanta: May 9, 2007. pg. 973 Nursing Ethics Nursing EthicsCaring has long been claimed as a concept at the heart of nursing, sometimes described as the thing that distinguishes nursing from other professions. Care is increasingly recognized as the moral foundation, ideal and imperative of nursing. What counts as caring at any particular historical moment is highly dependent on context; meanings of care are historically contingent and change over time. Caring is not just a subjective and material experience but one in which particular historical circumstances, ideologies and power relations create the conditions under which caring can occur, the forms it takes and the consequences it will have for those who undertake it.Ethical selves are shaped by social discourses that situate care in relation to broader formations of gender, religion, class and ethnicity as well as factors such as age, nationality and physical location. Since 1900 no decade has passed without publication of at least one basic text in nursing ethics with one of the first discrete texts on nursing ethics being published as early as 1888 (Orr   2004). Since the inception of modern nursing in the last century, nurses globally have taken seriously their moral responsibilities as health care practitioners; they have also taken seriously the issues which have emerged as a consequence of their attempts to fulfill these responsibilities effectively.As professionals working in the health care domain, very clear that nurses like other health care professionals cannot escape the tensions that are being caused by the radically opposing and competing moral viewpoints that are presently pulling the health care arena and indeed the world apart. An important question to arise here is: how can the nursing profession best respond to this predicament? There is, of course, no simple final answer to this question.Nevertheless there is at least one crucial point that needs to be made, and it is this: it is vitally important that nurses learn to recognize t he cyclical processes of social and cultural change, and realize that they themselves are participants in this change. Once realizing this, they also need to learn that, as participants in these cyclical transformations, they are positioned and have a stringent moral responsibility to sensitively and artfully advocate for the mediation of the extreme and multiple positions they might (and very often do) find themselves caught between. They also have a moral responsibility to facilitate this mediation by acting as mediators themselves.Nursing ethics can be defined broadly as the examination of all kinds of ethical and bioethical issues from the perspective of nursing theory and practice which, in turn, rest on the agreed core concepts of nursing, namely: person, culture, care, health, healing, environment, and nursing itself (Narvà ¡ez & Rest 1994). In this regard, then, contrary to popular belief, nursing ethics is not synonymous with (and indeed is much greater than) an ethic of c are, although an ethic of care has an important place in the overall moral scheme of nursing.Nursing, like other health professionals, encounter many moral problems in the course of their everyday professional practice. These problems range from the relatively simple to the extraordinarily complex, and can cause varying degrees of perplexity and distress in those who encounter them. For instance, some moral problems are relatively easy to resolve and may cause little if any distress to those involved; other problems, however, may be extremely difficult or even impossible to resolve, and may cause a great deal of moral stress and distress for those encountering them.In making an interpretation of the particular situation in which there is a moral problem, persons who have empathy and can take the perspective of others, and who care for others – even people who are quite different from themselves – are likely to exhibit high levels of moral sensitivity. A person must be able to reason about a situation and make a judgment about which course of action is morally right, thus labeling one possible line of action as what ought morally to be done in that situation (Narvà ¡ez & Rest 1994). Both a strong desire to do what is most morally defensible and a strong caring for other humans is necessary in order for a professional person to put aside a possible action that would serve self-interest in favor of the most ethical alternative action.Nurses have as much independent moral responsibility for their actions (and omissions) as they have independent legal responsibility, and are just as accountable for their practice morally as they are legally. Nurses must be accorded the recognition and legitimated authority necessary to enable them to fulfill their many and complex responsibilities as professionals bound by agreed standards of care. It can be seen that the prospects of virtue ethics are indeed promising in nursing ethics.The agreed ethical standards o f nursing require nurses to promote the genuine welfare and wellbeing of people in need of help through nursing care, and to do so in a manner that is safe, competent, therapeutically effective, culturally relevant, and just. These standards also recognize that in the ultimate analysis nurses can never escape the reality that they literally hold human wellbeing in their, and accordingly must act responsively and responsibly to protect it (Bioethics for beginners). These requirements are demonstrably consistent with a virtue theory account of ethics.The nursing profession worldwide has a rich and distinctive history of identifying and responding substantively to ethical issues in nursing and health care domains. In today's highly technical health-care system, there seems to be general agreement that nurses must be rational, logical thinkers who can incorporate the tradition of justice that draws on long-established modes of moral reasoning. Nursing should be a relationship in which c ompassion, competence, confidence, justice, prudence, temperance, caring, honesty, responsibility and commitment are mobilized by the care-giver to promote the health and well-being of those in need of care.The neglect or overemphasis of any one of these would cause for an imbalance in care. Hospital conditions are not those of ordinary life. Nursing deals with the unusual and the abnormal. Within the walls of the hospital nurses find that they must accept all people as they are, and devote themselves mainly to their physical betterment. However, an integrative theory of nursing ethics that synthesizes caring and justice has yet to be developed. Tensions in nursing among loyalty to patients, to physicians, to self, and to employing agencies provide a context for the development of ethics in nursing over the past century and nursing's participation in health care reform today.BibliographyBotes, A. (2000). A comparison between the ethics of justice and the ethics of care.   Journal of Advanced Nursing, 32, 1021.Chin, P. L. (2001). Nursing and ethics: The maturing of the discipline. Advances in Nursing Science, 24(2), 63-64.Edwards, N. (1999). Nursing ethics: How did we get here, and what are we doing about it? Surgical Services Management, 5(1), 20-22.Botes, A. (2000). A comparison between the ethics of justice and the ethics of care. Journal of Advanced Nursing, 35, 1071.Elder, R., Price, J., & Williams, G. (2003). Differences in ethical attitudes between registered nurses and medical students. Nursing Ethics, 10, 149-164.Gatzke, H., & Ransom, J. E. (2001). New skills for the new age: Preparing nurses for the 21st century. Nursing Forum, 36(3), 13-17.Narvà ¡ez, D. and Rest, J. (1994). Moral Development in the Professions: Psychology and Applied Ethics. Lawrence Erlbaum Associates: Hillsdale, NJ.Orr, Robert D. (2004). â€Å"Ethics & Life's Ending: An Exchange.† First Things: A Monthly Journal of Religion and Public Life, 145.Peter, E., & Morgan, K. P. (2000). Exploration of a trust approach for nursing ethics. Nursing Inquiry, 8(3),  10. Nursing Ethics Caring has long been claimed as a concept at the heart of nursing, sometimes described as the thing that distinguishes nursing from other professions. Care is increasingly recognized as the moral foundation, ideal and imperative of nursing. What counts as caring at any particular historical moment is highly dependent on context; meanings of care are historically contingent and change over time. Caring is not just a subjective and material experience but one in which particular historical circumstances, ideologies and power relations create the conditions under which caring can occur, the forms it takes and the consequences it will have for those who undertake it.Ethical selves are shaped by social discourses that situate care in relation to broader formations of gender, religion, class and ethnicity as well as factors such as age, nationality and physical location. Since 1900 no decade has passed without publication of at least one basic text in nursing ethics with one of the first d iscrete texts on nursing ethics being published as early as 1888 (Orr   2004). Since the inception of modern nursing in the last century, nurses globally have taken seriously their moral responsibilities as health care practitioners; they have also taken seriously the issues which have emerged as a consequence of their attempts to fulfill these responsibilities effectively.As professionals working in the health care domain, very clear that nurses like other health care professionals cannot escape the tensions that are being caused by the radically opposing and competing moral viewpoints that are presently pulling the health care arena and indeed the world apart. An important question to arise here is: how can the nursing profession best respond to this predicament? There is, of course, no simple final answer to this question.Nevertheless there is at least one crucial point that needs to be made, and it is this: it is vitally important that nurses learn to recognize the cyclical pr ocesses of social and cultural change, and realize that they themselves are participants in this change. Once realizing this, they also need to learn that, as participants in these cyclical transformations, they are positioned and have a stringent moral responsibility to sensitively and artfully advocate for the mediation of the extreme and multiple positions they might (and very often do) find themselves caught between. They also have a moral responsibility to facilitate this mediation by acting as mediators themselves.Nursing ethics can be defined broadly as the examination of all kinds of ethical and bioethical issues from the perspective of nursing theory and practice which, in turn, rest on the agreed core concepts of nursing, namely: person, culture, care, health, healing, environment, and nursing itself (Narvà ¡ez & Rest 1994). In this regard, then, contrary to popular belief, nursing ethics is not synonymous with (and indeed is much greater than) an ethic of care, although an ethic of care has an important place in the overall moral scheme of nursing. Nursing, like other health professionals, encounter many moral problems in the course of their everyday professional practice.These problems range from the relatively simple to the extraordinarily complex, and can cause varying degrees of perplexity and distress in those who encounter them. For instance, some moral problems are relatively easy to resolve and may cause little if any distress to those involved; other problems, however, may be extremely difficult or even impossible to resolve, and may cause a great deal of moral stress and distress for those encountering them. In making an interpretation of the particular situation in which there is a moral problem, persons who have empathy and can take the perspective of others, and who care for others – even people who are quite different from themselves – are likely to exhibit high levels of moral sensitivity.A person must be able to reason about a situation and make a judgment about which course of action is morally right, thus labeling one possible line of action as what ought morally to be done in that situation (Narvà ¡ez & Rest 1994). Both a strong desire to do what is most morally defensible and a strong caring for other humans is necessary in order for a professional person to put aside a possible action that would serve self-interest in favor of the most ethical alternative action.Nurses have as much independent moral responsibility for their actions (and omissions) as they have independent legal responsibility, and are just as accountable for their practice morally as they are legally. Nurses must be accorded the recognition and legitimated authority necessary to enable them to fulfill their many and complex responsibilities as professionals bound by agreed standards of care. It can be seen that the prospects of virtue ethics are indeed promising in nursing ethics.The agreed ethical standards of nursing requ ire nurses to promote the genuine welfare and wellbeing of people in need of help through nursing care, and to do so in a manner that is safe, competent, therapeutically effective, culturally relevant, and just. These standards also recognize that in the ultimate analysis nurses can never escape the reality that they literally hold human wellbeing in their, and accordingly must act responsively and responsibly to protect it (Bioethics for beginners). These requirements are demonstrably consistent with a virtue theory account of ethics.The nursing profession worldwide has a rich and distinctive history of identifying and responding substantively to ethical issues in nursing and health care domains. In today's highly technical health-care system, there seems to be general agreement that nurses must be rational, logical thinkers who can incorporate the tradition of justice that draws on long-established modes of moral reasoning. Nursing should be a relationship in which compassion, com petence, confidence, justice, prudence, temperance, caring, honesty, responsibility and commitment are mobilized by the care-giver to promote the health and well-being of those in need of care.The neglect or overemphasis of any one of these would cause for an imbalance in care. Hospital conditions are not those of ordinary life. Nursing deals with the unusual and the abnormal. Within the walls of the hospital nurses find that they must accept all people as they are, and devote themselves mainly to their physical betterment. However, an integrative theory of nursing ethics that synthesizes caring and justice has yet to be developed. Tensions in nursing among loyalty to patients, to physicians, to self, and to employing agencies provide a context for the development of ethics in nursing over the past century and nursing's participation in health care reform today.Bibliographyâ€Å"Bioethics for beginners.† Available from: dttp://www.med.upenn.edu/~bioethicBotes, A. (2000). A co mparison between the ethics of justice and the ethics of care.   Journal of Advanced Nursing, 32, 1021.Chin, P. L. (2001). Nursing and ethics: The maturing of the discipline. Advances in Nursing Science, 24(2), 63-64.Edwards, N. (1999). Nursing ethics: How did we get here, and what are we doing about it? Surgical Services Management, 5(1), 20-22.Botes, A. (2000). A comparison between the ethics of justice and the ethics of care. Journal of Advanced Nursing, 35, 1071.Elder, R., Price, J., & Williams, G. (2003). Differences in ethical attitudes between registered nurses and medical students. Nursing Ethics, 10, 149-164.Gatzke, H., & Ransom, J. E. (2001). New skills for the new age: Preparing nurses for the 21st century. Nursing Forum, 36(3), 13-17.Narvà ¡ez, D. and Rest, J. (1994). Moral Development in the Professions: Psychology and Applied Ethics. Lawrence Erlbaum Associates: Hillsdale, NJ.Orr, Robert D. (2004). â€Å"Ethics & Life's Ending: An Exchange.† First Things: A M onthly Journal of Religion and Public Life, 145.Peter, E., & Morgan, K. P. (2000). Exploration of a trust approach for nursing ethics. Nursing Inquiry, 8(3),