Health Care Ethics and Medical Law

Introduction

In every nurse’s career, the nurse is faced with many legal or ethical dilemmas. One of the professional competencies for nursing states that nurses should ” integrate knowledge of ethical and legal aspects of health care and professional values into nursing practice”. It is important to know what types of dilemmas nurses may face during their careers and how they may have been dealt with in the past. It is also important for nurses to understand what malpractice is and how they may protect themselves from a malpractice suit.Nurses are subject to a plethora of ethical, legal and professional duties which are too numerous to discuss within this thesis. Therefore the main professional, ethical and legal duties will be discussed. These three main duties are generally considered to be to respect a patient’s confidentiality and autonomy and to recognise the duty of care that is owed to all patients. These three main duties are professional duties, however there are legal implications if they are breached, therefore they are also legal duties; ethical considerations arise in contemplation of these duties, such as consideration of when they can be breached and they are therefore ethical duties as well. Before considering the main duties, consideration will be given to the regulatory body of nursing, the GMC.

LAW VS. ETHICSIt is important to first understand the difference between law and ethics. Ethics examines the values and actions of people. Often times there is no one right course of action when one is faced with an ethical dilemma. On the other hand, laws are binding rules of conduct. When laws are broken, it is punishable by an authority figure. There are four types of situations that pertain to law vs. ethics. The first would be an action that is both legal and ethical. An example of this would be a nurse carrying out appropriate doctor’s orders as ordered. A nurse may also be faced with an action that may be ethical but not legal, such as allowing a cancer patient to smoke marijuana for medicinal purposes. The opposite may arise where an action may be legal but not ethical. Finally, an action may be neither legal or ethical. Ethics is the study of right and wrong. Most cases of ethical decision making are simple, because it is obvious what is right. This does not mean that we always do what is right. We are more interested in cases where the answers are not obvious. These cases happen when there is public controversy over what is right, or when there are pros and cons on both sides. There are many elements to ethical decision making. Be clear about what the problem is. Consider what options are available. This requires creative thinking. Weigh the consequences of each option. Consult your conscience, Pray, Consult others, friends, family, clergy, ethicists , and your horoscope. Think it through: what ethical principles are involved? can we decide which principles are most important? Come to a decision. Reflect on your decision. Note that even if we are all rational, we might still disagree with each other about what to do. Then we need to consider who has the right to make the decision. Physician-assisted suicide refers to the physician acting indirectly in the death of the patient — providing the means for death. The ethics of PAS is a continually debated topic. The range of arguments in support and opposition of PAS are vast. Justice, compassion, the moral irrelevance of the difference between killing and letting die, individual liberty are many arguments for PAS. The distinction between killing and letting die, sanctity of life, “do no harm” principle of medicine, and the potential for abuse are some of the arguments in favor of making PAS illegal. However, self-determination, and ultimately respect for autonomy are relied on heavily as principle arguments in the PAS issue. Daniel Callahan, author of When Self-Determination Runs Amok, is against any social policy that would allow for PAS to be practiced. Callahan believes that the argument for PAS does not have a firm foundation, because self-determination and mercy, the two principles that are in support of PAS, may become separated 711. If mercy is seen as a core element in support of PAS, why restrict PAS only to those who can ask for it — don’t the unconscious or incompetent deserve mercy also? Callahan is in opposition to the belief that the essence of human dignity is the notion that a person should be free to choose how and when they want to die. Callahan questions the absolute nature of autonomy and self-determination and the extent to which these values can be applied. Self-determination by definition entails human freedom of action and respect for persons but those in support of PAS want it to be restricted to those who are terminally ill. Human suffering and an individual‘s outlook on the quality of their life, are, in Callahan’s opinion, subjective and there is no one standard to compare individual suffering. If we just focus on autonomy/self-determination, why restrict PAS only to those who are terminally ill and competent? Are the incompetent less deserving of relief from suffering than the those competent individuals? If physician-assisted suicide is legally permitted yet restricted to the terminally ill adult with full decision-making capacity, it will certainly raise legal concerns about discrimination. PAS will probably broaden to include incompetent, non-consenting, and non–terminally ill persons. The final extreme of the slippery slope argument is that PAS will be abused, run amok and ultimately become involuntary euthanasia. Physician-assisted suicide refers to the physician acting indirectly in the death of the patient — providing the means for death. The ethics of PAS is a continually debated topic. The range of arguments in support and opposition of PAS are vast. Justice, compassion, the moral irrelevance of the difference between killing and letting die, individual liberty are many arguments for PAS. The distinction between killing and letting die, sanctity of life, “do no harm” principle of medicine, and the potential for abuse are some of the arguments in favor of making PAS illegal. However, self-determination, and ultimately respect for autonomy are relied on heavily as principle arguments in the PAS issue. Daniel Callahan, author of When Self-Determination Runs Amok, is against any social policy that would allow for PAS to be practiced. Callahan believes that the argument for PAS does not have a firm foundation, because self-determination and mercy, the two principles that are in support of PAS, may become separated 711. If mercy is seen as a core element in support of PAS, why restrict PAS only to those who can ask for it — don’t the unconscious or incompetent deserve mercy also? Callahan is in opposition to the belief that the essence of human dignity is the notion that a person should be free to choose how and when they want to die. Callahan questions the absolute nature of autonomy and self-determination and the extent to which these values can be applied. Self-determination by definition entails human freedom of action and respect for persons but those in support of PAS want it to be restricted to those who are terminally ill. Human suffering and an individual‘s outlook on the quality of their life, are, in Callahan’s opinion, subjective and there is no one standard to compare individual suffering. If we just focus on autonomy/self-determination, why restrict PAS only to those who are terminally ill and competent? Are the incompetent less deserving of relief from suffering than the those competent individuals If physician-assisted suicide is legally permitted yet restricted to the terminally ill adult with full decisionxs-making capacity, it will certainly raise legal concerns about discrimination. PAS will probably broaden to include incompetent, non-consenting, and non–terminally ill persons. The final extreme of the slippery slope argument is that PAS will be abused, run amok and ultimately become involuntary euthanasia. The definition of a profession is “a calling requiring specialized knowledge and often long and intensive academic preparation” (Webster Dictionary, 2008). By definition, I would consider nursing to be a profession, without a doubt. Nurses have spent too much time and effort in academic settings not to use the word profession. Nurses are taught and academically prepared by leaders in the nursing field who have the specialized knowledge that will specifically train nurses to meet the challenges of the profession. Nursing theorists, who are experts in nursing, have contributed great amounts of work to promoting nursing as a profession. According to Alligood and Tomey, “Nursing theory has been a prevalent theme in the nursing literature for the past 35 years and has stimulated phenomenal growth in the nursing profession” (Alligood & Tomey, 2006, p.3). I see the profession of nursing as something special, something different than just a job. I think most nurses feel that they have been called in some way to the profession. The future of nursing is in the hands of nurses.