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Nurses make legal and ethical decisions when caring for patients; decisions that need to be made carefully because the decisions could possibly change a patients’ life. There are theories to explain how to problem solve ethically and the theories are not based on emotion (Guido, 2006). This paper will discuss the relationship between legal and ethical issues and ethical theories, examples will be provided.
Ethics can be described as principles and standards that are a guide to conduct used to elevate the standard of compliance (Judson & Harrison, 2010). Ethics is derived from the Greek word “ethos” ethics explains actions as right or wrong in respect to cultural principles and values. Moral values are personal beliefs that are intertwined with ethical actions and behaviors (Guido, 2006). Ethics, similar to values, are individualistic and they come from our experiences, culture and actions. While one’s values or moral ethics may be different, the nurse’s ability to conform to a patient’s ethical behavior is important (The VA leads change toward Integrated Ethics approach, 2008).
The legal system was created to establish policies to protect the public (Judson & Harrison, 2010). The laws that are set can be changed when evidence suggests amendments are necessary. The relationship between law and ethics is apparent when discussing a patient’s healthcare decision that goes against the norms or beliefs of the healthcare provider. An example would be the patient exercising his or her right to refuse treatment for a disease process that will result in imminent death, such as a patient in renal failure refusing dialysis (Guido, 2008). Shannon (2008) discussed the differences of legal and ethical decisions as “morally ordinary” and “extraordinary” treatment related to the provision of assisted nutrition and hydration, particularly for patients in a “permanent vegetative state” (p.894).
Metaethics is a nonnormative ethic that attempts to describe the implication between moral concepts or statements and the justification of why something is regarded good or ethically correct. Normative ethics understand standards of behavior and application of these behaviors in life. Normative ethicsbranch out into two broad categories called deontological and teleogical theories (Guido, 2006).
Deontological theories focus on the intended action not the consequences of one’s actions (Guido, 2006). The theory focuses on the dignity and sense of duty of the individuals and finds the relationship between the person and the action. Deontological theories are divided into two subcategories; act deontology and rule deontology. Guido (2006) states that “act deontology is based on the personal moral values of the person making the ethical decision, whereas rule deontology is based on the belief that certain standards for ethical decisions transcend the individual’s moral values” (p. 4).
Teleological theories are based on the simple concept, right actions have good consequences and bad actions have bad consequences. This theory suggests the act of right or wrong is directly related to the consequence of the action. Utilitarianism stems off of teleogical theories, explains that consequences count and acts are determined by the consequence. Some utilitarian’s believe that the moral rightness of a consequence is determined by the greatest number of good or the least harm and suffering (Guido, 2006). Considering the moral rightness is based on greatest number to benefit from the greatest good, actions based on the utilitarianism theory can often be unethical and illegal.
Nurses in acute care settings are faced daily with ethical issues and concerns. Shannon (2008) examines the terms “morally ordinary” and “extraordinary” in respect to patients in a “permanent vegetative state” (p. 894). It is thought if we can keep the body alive we should, “capacity generated obligation” but there is a compromise in human dignity, making this both a legal and ethical dilemma (Shannon, 2008, p. 894).
Euthanasia and end of life care often cause a lot of animosity, as they have been distorted by general public. Shannon (2008) states, “Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expect outcome can be legitimate; it is the refusal of over-zealous treatment” (p. 898). This statement defines euthanasia in its most accepted form withdrawal of treatment. This makes the act legal, but is it ethical to withdraw treatment that was started to sustain life, knowing that the result ends in death?Another example of an ethical issue in an acute care setting is preserving organs for donation in a patient who is pronounced dead following a cardiac event. Organ donation is a personal choice that can be expressed though written consent by the donor. Although, if there is no documentation of the patients wishes, family members have to make the decision in the event of unexpected death.
Is it legal and ethical to maintain the body of a patient who has died in order to keep the organs viable while waiting for the family’s decision (Bonnie, Wright, & Dineen, 2008)?When a patient has been declared dead according to neurological criteria hospitals will maintain organ viability while awaiting family decision about donation. Procedures are started post-mortem by a transplant team to determine candidacy for donation. Medications are started and additional lines are inserted. All of which are done after the patient is declared dead. This is legal in many states, in fact there is a statute called the “immunity clause” to protect the health care workers from any liability, but is it ethical (Bonnie, Wright, & Dineen, 2008)?
According to Bonnie, Wright, and Dineen (2008), “Organ preservation in cases of uncontrolled cardiac death violates no legally protected interest of the family members. It does not constitute “mutilation of the body” and falls comfortably within the general principle that hospitals have no duty to deliver corpses to families in their exact condition of death” (p.744). Consider this statement and place an ethical emphasis on your thought process. Healthcare workers are not legally bound to deliver the bodies of their loved ones in the exact condition of their death.
In conclusion, through cultural norms, behaviors, beliefs, and attitudes the ethical behaviors of healthcare workers are analyzed. The governing bodies of healthcare such as the American Nurses Association and the American Medical Association mandate healthcare workers to uphold ethical values in his or her practice. The legal system maintains the right to investigate and examine decisions made by healthcare practitioners when decisions appear unethical or perhaps unlawful. The various ethical theories provide direction for healthcare practitioners and ethics review boards with decision-making processes.
Bonnie, R., Wright, S. & Dineen, K. (2008). Legal authority to preserve organs in cases of uncontrolled cardiac death: preserving family choice. Retrieved April 29, 2009, from EbscoHost Database.
Guido, G. W. (2006). Legal and ethical issues in nursing (4 ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
Judson, K. & Harrison, C. (2010). Law and ethics for medical careers (5th ed). New York,NY: McGraw-Hill.
Shannon, T. (2008). Unbind him and let him go: Ethical issues in the determination of proportionate and disproportionate treatment. Theological Studies, 69, 894-917. Retrieved April 29, 2009, from MasterFILE Premier database.
The VA leads change toward Integrated Ethics approach. (Cover story). (2008, December). Medical Ethics Advisor, Retrieved May 1, 2009, from Academic Search Complete database.