Compare and Contrast Ethical Framework
Introduction
Nurses constantly confront a range of ethical issues in their day to day clinical practice. The ability to confront complex situations resulting from ethical dilemmas results from the application of the Canadian nursing code of ethics, ethical principles, and values. Nursing is a profession that demands moral responsibility hence, nurses must carry out their role while respecting patients’ rights. The use of the Canadian nurses’ codes of ethics and ethical frameworks such as deontology helps in guiding nurses towards making ethical choices. The Canadian code of ethics and deontology ethical framework involve the active use of moral elements in making decisions in clinical practice such as autonomy and beneficence in resolving conflicts that are likely to affect patients’ health outcomes. Nursing has an obligation to maintain optimal health and quality of life for their patients. The commitment lies in providing care to the patients, along with their respective families and communities. This report encompasses an ethical dilemma of Jane, an 80-year-old African Canadian, who was recently diagnosed with bladder cancer stage 3A but her family decided not to inform her about the diagnosis. Thus, the objective of this report is to compare and contrast the nursing code of ethics and deontology ethical frameworks from a nursing practice perspective to determine their strengths and weaknesses in resolving the ethical dilemma.
Compare and Contrast the Code of Ethics and Deontology Ethical Frameworks
The code of ethics serves as the basis for nursing ethical practice. It provides guidance to nurses with respect to ethical relationships, behaviors, responsibilities, and decision making. The ethical clinical practice involves trying to address a wide range of social justice issues that are associated with the well-being and health of the patients. According to Kangasniemi, Pakkanen, & Korhonen (2015), nurses have a responsibility to build and maintain trustworthy relationships as a foundation of effective communication while recognizing that this requires making conscious efforts to understand the health needs and concerns held by people that they owe care. Therefore, from an ethical nursing practice perspective following the principle of beneficence nurses are required to question as well as intervene to resolve unsafe, incompetent, non-compassionate, and unethical conditions that affect their ability to provide ethical, safe, and competent care to their patients while providing them with the needed clinical support (Butts & Rich, 2019). Hence the code of ethics asserts the need for nurses to provide care that is mainly directed towards the well-being and health of the patients, family, or communities to whom they provide care services.
The ethical framework, therefore, emphasizes the need for nurses to collaborate with patients, other health care providers, family, and communities in maximizing positive health outcomes of the persons receiving care as well as those with care needs. In addition, they must respect the role of each party in the management and delivery of care. The objective is to ensure that they build positive relationships that allow effective, compassionate, and safe care delivery to their patients (Butts & Rich, 2019). Ethical practice requires that nurses to the highest possible degree should provide information to persons in their care that they need to make an informed decision that is related to their health and well-being. In this context, nurses should ensure that the health information is delivered to the persons, groups, families, communities, and populations in their care in an accurate, transparent, open, and reliable way.
Autonomy as a nursing principle holds that individuals have the right to making independent decisions about their life particularly when it comes to clinical decisions about treatment, health, and well-being without any form of interference from other parties. Doody & Noonan (2016) posits that nurses should ensure that their patients have all the information that is needed to make decisions regarding their medical care and the details should be elaborated in a way that those under their care understand. For instance, the information should involve providing details about a diagnosis, potential health outcomes, available treatment options, and management. The nurse should not therefore influence the decisions of their patients rather allow them to make independent decisions (Burkhardt, Nathaniel & Walton, 2018). Also, responsibility involves respecting the decisions of competent or capable individuals to refuse to receive information about their health condition. Competent persons have the right to exercise individualism in decision making when it comes to their health and well-being.
Hence, based on the ethical principle of non-maleficence, nurses have a non-negotiable obligation to advocate for individuals in their care in the case that they believe that the health of these people is being interfered with by factors that they cannot control, such as decision making by their caregivers. However, while the principle gives nurses the responsibility to advocate for the rights of their patients, the main limitation is that it also requires them to respect the informed choices of competent persons such as treatment and lifestyle choices even though that is likely to jeopardize the health of those receiving care (Butts & Rich, 2019). While an illness and additional factors might diminish an individual’s ability to make decisions, it is the responsibility of nurses to assist and support the individuals in making decisions that are applicable to their health capacity.
In clinical decision-making, nurses should work with those that are receiving care including families and communities by taking into account their customs, values, spiritual beliefs, and socio-economic situations (Doody & Noonan, 2016). The values that are reflected by these individuals are reflective of the unique beliefs acquired socially, culturally, and as a result of religion. Therefore, in all their professional capacities, nurses are required to acknowledge that these values influence the health and well-being decisions that they make. They should intervene as well as report instances in which others fail to be respectful of the dignity and welfare of the individual receiving care by recognizing that choosing to be silent and passive is the same as condoning the behaviour that violates the patients’ rights to safe and ethical care.
On the other hand, deontological ethics places specific focus on the link between obligation and standards of nursing practises. More so, deontological approach is a patient-centered ethical model hence enables the management of a nurse’s medical practises. According to Silva et al. (2018), deontological ethics mainly focused on the suitability or wrongness of actions rather than the rightfulness or wrongness of the consequences. In its nature, the relationship between nurses and patients is deontological given that clinical teaching practices emphasize the tradition of choosing moral actions and when deontological ethics are violated, these results in medical negligence. Therefore, deontological ideologists in a clinical setting including nurses, physicians, and other healthcare workers are normally guided by the need to make ethical decisions. Rather, than adopting the assumption that health resources should be used to achieve greater health outcomes, where minimal harm is accepted deontology rejects this notion in clinical practice (Dimitrios & Antigoni, 2018). For example, nurse are supposed to be non judgemental while delivering their services to patients. Setting up a medical environment where nursing practise is guided through the application of moral virtues and medical outlines streamlines the medical outcome of the patients.
Deontological ethics provides nurses with a foundation for clinical conduct. Similar to the nursing code of ethics, the model requires nurses to treat others with respect despite the existing cultural, religious, or socio-economic differences. In simpler terms, the nurses are to act fairly and respectfully. The theory can be applied to individual’s thoughts as well, as one must act and conduct themselves in ways that are respectful and ethical. In clinical practice, deontology is advantageous since it creates and emphasizes the personal and professional responsibility of healthcare workers. Deontological ethics requires individuals to act as though they were the ones responsible for designing the standards and expectations that society follows (Silva et al., 2018). Thus, all the actions by the individual should result in harmonic outcomes without creating further conflicts to be considered as morally right.
Deontological ethics defines wrong from right and gives nurses standardizing guidelines under which they can work on to produce quality medical outcomes. Nursing practises are informed on governmental and medical bodies. The nurse has to carry out his or her duties based on written guidelines. The outcome is tied to the underlying action (Silva et al., 2018). Therefore the nursing is holistic and has to capture every single need of the patients. One way of ensuring a holistic approach is through the application of deontological notions of medicine that considers the suitability of every action and defines each single step. This way, nurses remain relevant and accountable to each and every action they take. In the end the practise shapes the personality of the patient and the skilled nurse gets a platform to perform all the right procedures and certified medical practises.
However, the application of deontological ethics in clinical practice is characterized by several limitations. Deontological ethics creates inconsistency since there are times where the well-being of the general society is prohibited. In that, any individual cannot take action that promotes greater good for the society and at the same time failed to take action is considered unethical. Deontological ethics insists that one should always do the right thing regardless of the situation without providing any exception unlike the code of ethics (Dimitrios & Antigoni, 2018). In that, the code of ethics suggests that nurses should intervene in the case that the well-being of the patient is threatened. On the other hand, deontology asserts the morality of decisions without any deviation which might be impossible in the healthcare setting where ethical issues emerge on a daily basis. Also, contrary to clinical practice principles that assert the need to make decisions based on objective reasoning, deontological ethics encourages subjective opinions. Even the act which involves making a decision that promotes better health outcomes for a patient might be considered as morally wrong irrespective of the outcome simply because the action is one that is not presumed to be right.
Deontological ethics differs from the nursing code of ethics which asserts the greater good of care receivers including patients, their families, and respective communities. Following the deontological approach, it becomes rather challenging to focus on the health needs and well-being of the patients while at the same time accounting for the well-being of society (Silva et al., 2018). This is because such actions might create conflicts and cause harm to one party which cannot be accepted under the framework. Code of ethics as an ethical framework allows nurses and other healthcare workers to focus on the needs of every party by building a meaningful relationship where it does not create obsolete choices as each party is allowed to exercise autonomy in decision making. Deontological ethics is limited for use in clinical decision making as it creates inconsistency on clinicians’ responsibility in protecting the health and well-being of their patients.
Ethical Framework Best suited for Resolving the Ethical Dilemma
With respect to Jane’s ethical scenario, it is evident that the ethical framework that is best suited to resolving the dilemma is the Canadian nursing code of ethics. The ethical conflict from the case lies in the inability of the patient to exercise autonomy in making a decision about her health, treatment, and well-being due to her family’s beliefs to protect her from emotional adversities through non-disclosure of crucial medical information. Hence, this calls for an ethical action, which aligns with the ethical principle of non-maleficence as it guides nurses in their professional capacities to avoid causing harm and also exercise cultural sensitivity to respect the family’s beliefs (Chittem & Butow, 2015). While the patient’s health has been declining in the last six years after losing her husband of fifty years, from the interview it was determined that she is competent to understand the diagnosis and make an independent decision about her health and treatment. For instance, the fact that she inquired about the blood in her urine illustrates that she understands that something is wrong but her family believes that keeping the information away will protect her while denying her the opportunity to exercise autonomy.
From an ethical code perspective, therefore, it is my responsibility as a nurse to intervene given that the well-being of the patient is being threatened by the decisions made by her family. As a nurse, it is my responsibility to ensure that I provide adequate information to the patient about her diagnosis, treatment option, symptoms, and potential effects on her health. The information is needed to enable the patient to make informed decisions while collaborating with her family as the primary caregiver. There is a need to inform the family as to why their decision violates the rights and well-being of the patient. The intervention involves ensuring that the well-being of the patient is a priority while also building and maintaining meaningful relationships with the family as well.
The code of ethics is a more suited theory in resolving the conflict because it highlights the responsibility of a nurse in addressing the ethical dilemma. The ethical framework recognizes the responsibility and role of every party in promoting the well-being of those receiving care and the greater good for the respective communities (Doody & Noonan, 2016). The principles assert that a nurse should always act in a way that shows respect to the values and beliefs that are held by the patient and the families by recognizing that they stem from cultural, religious, and socio-economic factors that makes them unique but also acceptable. On the contrary, deontology asserts on making absolute decisions that should not change irrespective of the likely outcome which makes it effective in resolving the conflict which is complex as not considering the needs of one party might create further issues.
Conclusion
To sum up, nursing is a profession that demands the use of ethical principles and nursing values in making professional decisions while interacting with patients, families, communities, and other healthcare professionals. Nurses are expected to make a decision that promotes the well-being and health of those receiving care and therefore the outcomes of their decisions and actions matter. Hence, this makes the application of deontological ethics in clinical decision-making is less suitable compared to the code of ethics which emphasizes the responsibility of nurses in building and maintaining meaningful relationships with patients and their families as well as enhancing the health outcomes of the care receivers. Hence, from an ethical nursing practice perspective, the code of ethics is more effective in addressing the ethical dilemma in Jane’s case as it allows me as a nurse to intervene in ensuring that the patient is well informed of her diagnosis and existing medical options for decision making without interfering with the family’s beliefs and values.
References
Burkhardt, M. A, Nathaniel, A. K, & Walton, N. (2018). Developing principled behaviour. Ethics and Issues in Contemporary Nursing (3rd ed., p. 90). Nelson Education.
Butts, J. B., & Rich, K. L. (2019). Nursing ethics. Jones & Bartlett Learning.
Chittem, M. & Butow, P. (2015). Responding to family requests for nondisclosure: the impact on oncologists’ cultural background. Journal of Cancer Research and Therapeutics, 11(1), 174-180. https://doi-org.ezproxy.uleth.ca/10.4103/0973-1482.140836
Dimitrios, T., & Antigoni, F. (2018). Ethics and deontology in nursing research: A discussion paper. International Journal of Caring Sciences, 11(3), 1982-1989.
Doody, O., & Noonan, M. (2016). Nursing research ethics, guidance and application in practice. British Journal of Nursing, 25(14), 803-807.
Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an integrative review. Journal of advanced nursing, 71(8), 1744-1757.
Silva, T. N. D., Freire, M. E. M., Vasconcelos, M. F. D., Silva Junior, S. V. D., Silva, W. J. D. C., Araújo, P. D. S., & Eloy, A. V. A. (2018). Deontological aspects of the nursing profession: understanding the code of ethics. Revista brasileira de enfermagem, 71(1), 3-10.
