Fundamentals of Nursing and Midwifery 2e

Unit II Foundations of nursing and midwifery practice

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(Table 11-1). Many nurses and midwives add fidelity , verac- ity, accountability, privacy and confidentiality to this list, because they play a central role in the tradition of nursing (and medical) ethics, and guide the behaviour of healthcare professionals towards patients and their families. Principles offer general guides to action. All things being equal, we ought to act at all times in a manner that respects the autonomy of others, does not harm, does benefit others, treats others fairly and is faithful to the promises we make to others. Rarely is this as simple as it sounds. Be sensitive to the fact that each individual (patients, family members and professional carers) may identify benefits and harms differently. A benefit to one may be a burden to another. Ethical dilemmas arise when attempted adherence to basic ethical principles results in two conflicting courses of action. There is no foolproof method for identifying which principle is most important when there is conflict between competing principles. Moral principles are most beneficial to ethical decision in situations when there is disagreement on a course of action. This is the very time that principles can be relied on to find the best approach for the situation. However, it is important to understand that nurses rarely rely on a single principle to address an ethical dilemma. Principles can be used in combination and ethical frame- works or decision-making models are often utilised to guide nursing practice in daily clinical situations. Care-based approach Dissatisfaction with the principle-based approach to bioethics led many nurses to look to the provision of care and caring as the foundation for nursing’s ethical obligations. Provide the information and support patient and families need to make the decision that is right for them; at times, this may mean collaborating with other members of the health- care team to advocate for the person. Seek not to inflict harm; seek to prevent harm or risk of harm whenever possible. (patients, family members and professional carers) may identify benefits and harms differently. A benefit to one may be a burden to another. Always seek to distribute the benefits, risks and costs of nursing care justly. This may involve recognising subtle instances of bias and discrimination. Be faithful to the promise you made to the public to be com- petent and to be willing to use your competence to benefit the people entrusted to your care. Never abandon a person entrusted to your care without first providing for their needs. Implications for practice

Jimmy Banda, a 62-year-old homeless Indigenous man, is being discharged into the community, but requires supervision and support as well as ongoing healthcare. In Chapter 5 the ethical dimension related to continuity of care in the healthcare system was introduced. Consider Jimmy Banda’s situation and reflect on the following questions. Is healthcare a market commodity to which Mr Banda has limited access due to lack of financial resources? Is health- care a social right that should be freely available to all? Now that you have reflected on the broad ethical dimension, reflect further on your own and the profes- sions values. Consider the situation from a nursing ethics perspective. What are the moral obligations of the case manager caring for Mr Banda? Nurse ethicists frequently use two popular theoretical and practical approaches to ‘doing ethics’—the principle-based approach and the care-based approach . The principle-based approach concentrates on the abstract concepts of ethical principles from a more detached perspective, while the care- based approach favours emotional involvement in a moral or ethical dilemma in order to highlight the consequences of nursing actions. Midwives who practise woman-centred care may also use a feminist approach . Principle-based approach Beauchamp and Childress’ (2009) influential principle-based approach to bioethics is based on a common morality. The common morality is a set of norms shared by all persons committed to morality. The authors identify four key princi- ples: autonomy , non-maleficence , beneficence and justice

TABLE 11-1 Principles of bioethics

Principle

Moral rule

Autonomy

Respect the rights of people

(self-determination) or their surrogates to make

healthcare decisions.

Non-maleficence Avoid causing harm.

Beneficence

Benefit the person, and balance Commit yourself to actively promoting the person’s benefit benefits against risks and harms. (health and well-being). Be sensitive to the fact that individuals

Justice

Give each their due; act fairly.

Fidelity

Keep promises.