Nursing ethics on Harm may not only be incidental and intended but also intrinsic
Non-maleficence means inducing the least possible harm to a beneficial outcome. The relationship between physician and patient should be fiduciary. Patients always have trust that physicians would apply their professional expertise in the patients’ interest and benefit and the physician would do nothing to harm them. As per the international code of medical ethics, “A doctor must always bear in mind the obligation of preserving life”. The non-maleficence principle entails the concept of no harm. (Banks et al.,2016) Harm results in pain, which will lead to distress. Harm may not only be incidental and intended but also intrinsic.
Incidental harm comes about because of carelessness and negligence, intended harm on the other side is measured and inflicted pain. Intrinsic harm is deliberately harming a person and hence violates the negative duty not to harm. In medical non-maleficence recommends not to harm. The four categories of medical non-maleficence include dedication oneself to the wee-being of the patients, provision of adequate care, proper analysis of the situation and finally making proper beneficial assessments.
Medical non-maleficence is the act of imposing no risks as well as inflicting no actual harm. Based on the fiduciary relationship between them it is the role of the patient to prevent patients from any form of harm. (Winkler et al.,2018) Physicians inflict harm to patients in real life but aim at achieving good and no harm. A moral dilemma comes about when the physician inflicts pain to produce no harm and this is because negligible harm is because of detriment-benefit analysis in the patient’s favor.
Most of the time, physicians inflict fatal harm using double effect which is to the benefit and interest of the patient. The dilemma is if the infliction of fatal harm that violates the obligation of non-maleficence is in the patients’ interests, benefits. (Ye et al,2018) The intended and non-intended actions are differentiated by this effect. Both actions are associated and the intended effect is good and primary.
The double effect principle must always fulfill the following conditions:
- The actions itself must be morally good and neutral.
- The agent’s intentions must be good and not bad. The bad effect might either be foreseen, tolerated, and permitted but not be intended.
- The bad effect must not be a means of bringing an end to a good effect.
- The outcome must outweigh the evil permitted.
According to Emily’s scenario, the non-maleficence aims at not harm. However, Emily is refusing nasogastric feeding the care team at promoting good and that is improving her lost weight and body mass index (BMI). The care team should therefore forcefully induce the nasogastric feeding method in the benefit of Emily despite going against her interests.
Justice means fairness and in healthcare it is the distribution of resources equally. There are different forms of justice including distributive justice and rights-based justice. Respect for peoples’ rights that is applied in healthcare is the right based justice. (Mohtashami et al.,2019) Every person has a right to seek healthcare and participate in his or her care plan. According to Emily’s scenario, though the care team does not consider fairness in decision making since Emily does not agree with their decision, the care team is in a dilemma on whether to follow the patient’s wish or make a decision on their own but for the benefit and good of the patient. The care team is being forced to violate the justice rule and hence save Emily’s life by giving her a nasogastric feeding tube.
Professional standards describe the competency levels. These standards always reflect a desired and achievable performance level against which the nurse’s performance level can be compared. Professional standards’ purpose is to direct and maintain a safe and clinically most competent nursing practice. The importance of these standards to our profession is to promote and guide clinical practice. These standards provide a framework for clinical competency checklists and sometimes used as a comparison tool to evaluate a nurse’s care if he/she is suspected of unsafe working habits or doesn’t adhere to organizational policies.
Professional standards assist us, the management team in the development of safe staff practices, allocation of tasks. They are majorly patient-centered, promote the most favorable outcomes, and minimize risk exposure. (Van between et al.,2018) These standards persistently encourage us to enhance our knowledge through experience, education, and updated guidelines. Any clinical officer is accountable for their clinical decisions and actions
The code of ethics for nurses has seven provisions that guide the nurses in their professional practices. The first provision is that nurses should practice with compassion and respect for the inherent dignity, worth, and unique attributes of each person. Any person should be respected by the nurses and allow dignity regarding care and communication. Families to the patients should be respected concerning their relationship with the patient. Nurses must work with colleagues and the patient’s families in the exercise of their professional guidelines in communication and work. (Shaw et al.,2017) According to Emily’s case, the care team is supposed to involve her family in the decision they make even if Emily does not agree to it. Professionally, the care team would have exercised their profession appropriately.
The second provision is that the patient is the nurses’ primary commitment whether as an individual. In the healthcare setting, the patient should always be the priority. The nurse must recognize the importance of patient inclusion in care practices. The nurse’s actions have to always be shared with the patient and must promote the good always. (Ramos et al.,2018) It is necessary to collaborate with any teams internally and externally to enhance the betterment of the patient. Nurses should also understand professional boundaries and their relation to the outcome.
The third provision the patient’s rights, health, and safety should be protected, promoted, and advocated for. All privacy guidelines with regards to the patient should be well understood by the nurses. The aspect of participation including informed consent and disclosure to the patient by nurses doing research should be understood. Institutional standards should be understood in case the nurses’ performance needs to be reviewed. The nurses should demonstrate competence in clinical and documentation skills.
The fourth provision is a nurse has authority, accountability, and responsibility for nursing practices, decisions, and actions taken with the obligation for optimal patient care. A nurse should make decisions that she will be accountable for. The authority must be applied professionally in all aspects of individualism and patient, ethical concerns. Decisions in nursing must be well thought, planned, and implemented responsibly.
The fifth provision states that the nurse owes the same duties to themselves as to others including the promotion of health and safety, character preservation and integrity, competence maintenance, and enhance personal and professional growth. Nurses should take care of themselves as well as others. (Rees et al.,2017) An ideal nurse upholds safe healthcare practices within the healthcare setting and at home. Nurses should always uphold integrity as well as concern for personal growth regarding continue learning of the profession.
The sixth provision states that the nurse through individual or collective effort establishes, maintains, and improves. An ethical environment of the work setting and conditions of employment that are safe and of quality. In the nursing profession, standards should be stipulated within and external to institutions of work dictating the ethical obligations of care and any deviations from appropriateness reported.
The seventh provision states that in collaboration with other health professions and public the nurse should protect human rights, promote health diplomacy, and reduce health disparities. Collaboration between members of a discipline enhances the maintenance of the concept that health is a right for any individual and channels best practice possible.
According to Emily’s case, the care team must professionally think critically and make a decision that will benefit the patient and do good by improving her health and later improving her general health.
CONCLUSION
In conclusion, there seems no perfect answer to any ethical dilemma. In most circumstances it is difficult to choose one principal over the other and the ethical decision tells us to choose the perfect principle possible. However, the choice made might not be as perfect but maybe of more good than harm. While making a perfect decision and choice of principle, the framework that guides nursing practice and the patients’ bill of rights should be considered. In any situation, advantages and disadvantages, as well as risk and benefits, should be weighed
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