Ethics is defined as moral principles that govern a person's or group's behavior. Sensitivity to ethical issues should be necessary for any profession that holds public trust. Nursing holds a public trust and therefore we must be aware of ethical concerns when dealing with patients (Barry, 2002). Ethical dilemmas such as consent force nurses to decide on possible actions to take. By discussing the ethical principles of autonomy, beneficence and non-maleficence and applying the ethical theories I hope to make it clear how nurses justify their actions.
My understanding of ethical accountability is that I am answerable to myself; I must always be truthful, fair and respectful and I believe I must treat others as I would like to be treated. Nurses faced with an ethical dilemma have to decide which possible action is the right action to take and how choice of this action over others is justified (Singleton and McLaren, 1995). During the module we have looked at various ethical models including Seedhouse’s Ethical Grid (1998) and Curtin’s Ethical Decision Making Model (1982) which provide guidance toward the resolution of clinical dilemmas; some of the aspects of these models will be evolved in the next section of this assignment.
Rumbold (1999) insists that respect for a person’s autonomy is one of the crucial principles in nursing ethics and ethical models. Gillon (1986, pp.56) defines autonomy as “the capacity to think, decide, and act on the basis of such thought and decision, freely and independently and without let or hindrance”. Therefore, it can be said that patients can expect to be fully informed of any methods of treatment available to them, in order to exercise their rights to consent to or refuse such treatment. In order for a nurse to fully respect patients autonomy, she must respect whatever decision the patient makes, and to act otherwise is to disregard the patient as an autonomous being (Fletcher et al., 1995). Fletcher, Holt, Brazier et al. (1995) discuss that when considering patient well-being, nurses may demonstrate paternalism towards their patients. Paternalism is to believe that it is right to make a decision for someone without taking into consideration those persons wishes, or even to override their wishes; therefore overriding autonomy. This happens all the more in Mental Health and Learning Disability services because people assume that they may not have capacity to make decisions for themselves.
Singleton and Mclaren (1995) suggest that justification for nursing interventions rest on the concept that the principle of beneficence and non-maleficence takes precedence over considerations of respect for the patient’s autonomy.
Beneficence means that you must act in ways that benefit others; often summed up as the duty to care. As professionals we have both a moral and legal duty to ‘do good’ (Hendrick, 2004). But the problem is working out precisely how you are supposed to positively benefit others in practice. Rumbold (1996) says that in terms of healthcare beneficence is the idea that one should always do what is best for the patient, and that the good of the patient should be put before ones own needs.
Non-maleficence means that nurses have a duty not to harm patients or subject them to risk of harm (Rumbold, 1999). Hendrick (2004) expresses that harm can be physical and include pain, discomfort and death; but can also be psychological including: mental distress, humiliation and exploitation. Harm can be caused deliberately or without malicious or harmful intent. In healthcare, unintentional harm is likely to be caused by careless or negligent care or treatment (Hendrick, 2004).