Ethical Theories in Nursing Practice

Health care includes three main groups of participants: the patient, the family and the providers. Although this may sound simple, these groups often have different views on how issues should be handled. The situation complicates when considering bioethics, the theory of physicians, nurses, social workers, psychiatrists, philosophers and society coming together to address ethical questions in health care. Ethical codes aim to find the proper balance between technology and human life. Nurses carry the burden of analyzing the worth of human life and the values of themselves, their patients and others.

ANA Ethics

• The American Nurses Association Code of Ethics outlines many factors. The first provision states "the nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems." The provisions continue state that the nurse is responsible for the patient and must strive to protect the rights of the patient.

ICN Ethics

• The International Council of Nurses also has an ICN Code for Nurses, stating that nurses have four fundamental responsibilities: "to promote health, to prevent illness, to restore health and to alleviate suffering." This code puts the people requiring nursing care first.

Major Theories Related to Nursing Ethics

• The first major theory used in nursing is the teleological (or utilitarianism) theory, which suggests that the outcome defines what is morally good. In other words, what is the best thing to do that will result in the most good for the most people? The second major theory is the deontological theory, which suggests that a certain decision is right if it is what most people consider moral. Also, what rights do the people involved have and whose rights supersede the rights of others? Another major theory is the relational theory --- how does a nurse's caring influence a nurse's action or belief about what to do? In others words, the morally good act is the one that shows caring and concern for other people and what might be important to the patient.

Ethics in Health Care

• If an ethical issue arises, nurses can take the case to an ethical committee. Brittany Hruska, 27, is a registered nurse at a Neonatal Infant Care Unit (NICU) in Des Moines, Iowa. She has done ethical case studies on prolonging life, palliative care and saving extremely premature infants. She has also done special needs pediatrics, and says these experiences have helped her understand more about end-of-life care and being sympathetic. Hruska is living proof that there are constant ethical battles in the nursing field. When it comes to pain management, studies have shown that your body releases endorphins to ease pain, thus medication is not a priority, Hruska says. "However, seeing a baby in agonal breathing for days pulls against every fiber in my being in what is right, wrong and inhumane," says Hruska. "I've seen children who can't eat, move, breathe or close their eyes. I still think that those kids feel pain --- their vital signs and body color would change. It really bothers me to see them suffering," says Hruska. "Many believe these children don't suffer; they believe they don't feel. However, after spending day after night with some of these children, I disagree." According to Hruska, doctors in Des Moines are "great about pain control." She adds that the field continues to progress. For example, she refers to Dr. Teri Wahlig starting palliative care for pediatrics at a local non-profit organization that houses children with special health care needs called ChildServe, as reported by The Des Moines Register. Hruska says she would advocate implementing a do not resuscitate (DNR) for these children who could be suffering. Ultimately, the parents and ethical board determine what they find to be the appropriate solution.

The Ideal Treatment

• Ethical codes were created to protect quality of life, patient interest, informed consent and alternative treatment options. Nurses are directly responsible for all of these, thus the necessity of ethical codes. Health care providers can be held legally and mentally responsible if there is a fatal outcome to their treatment decisions, so each option must be weighed. Many nurses are expected to value equality, freedom, justice and truth, but treatment decisions cannot be made solely by nurses. Ethical codes in conjunction with other health care providers and laws protecting patients rights and confidentiality aim to create the perfect balance of technology and human life. "I've seen miracles, and a lot of bad, but as a nurse you can't change what's happening; [you] just take the best care you can of every patient," says Hruska.