Ethics is a philosophical branch that defines what is right and what is wrong concerning the actions of people, as well as the decisions they make. Being ethical ideally means doing good deeds and refraining from inflicting harm on other subjects. The question of ethics is largely dependent on the perceptions of an individual and the society. A breach of ethics is immorality. The law defines what is supposed to be done and what is not to be done; it is a rule that is explicitly laid down and breaching it is punishable (Chaloner, 2007). Many professions and societies have come up with official codes of conduct that define the values of relevant groups and how the members should behave. In the US, for instance, the American Nurses Code of Ethics (2001) is used to guide the practice of nurses. The code defines the duties and the obligations of those who practice the profession of nursing. Despite this difference, ethics and law are related very closely since both are instruments used to regulate and define how people should act when relating with one another.
In general, the law portrays the ethics that have been set by the society (Chaloner, 2007). Nevertheless, law and ethics can be in conflict; for instance, an action can be legal but unethical, like abortion. A clash can occur where something is illegal but ethically validated, like pro-euthanasia rationalizations (Ogata, 2005). Nurses encounter such dilemmas in everyday life in their practices, regardless of the roles they play and where they work. The dilemmas normally revolve around life quality versus quantity, pro-life against pro-choice, freedom against power, truth versus lying, and empirical knowledge against individual beliefs among other issues. To meet the requirements of good practices, it takes a well-reasoned evaluation of what nurses perform coupled with an appreciation of why, as well as how it ought to be done (Chaloner, 2007). Thus, law and ethics are very crucial in the professional practice of nurses.
It is very important to note that it is not easy to come up with laws that are neither too particular nor exclusive since each case involving a specific patient presents a unique circumstance. Owing to this fact, laws currently present a substantial degree of flexibility regarding decision-making by professionals, nurses included. According to the law, every health professionals should endeavor to provide maximum care for any patient (Ogata, 2005).
One of the conflicts between ethics and law in nursing has been the issue of pro-life versus pro-choice, particularly abortion. Abortion is a legal, political and social issue at the same time, dating back to the 1970s before the Roe Wade ruling by the Supreme Court in the US. Abortion was illegal within the US boundaries before then, but abortion was legalized in the Roe Wade decision (prochoiceamerica.org, 2012). Thus, the other laws against abortion that were in place before were rendered unconstitutional since they were considered as interfering with the mother’s right to privacy as per the constitution. The Roe Wade ruling stated that abortion would be done at any time in the first trimester, abortion would be regulated by the state in the second trimester only to protect the mother’s health, and the state would restrict abortion in the third trimester unless the mother’s health is in danger due to the pregnancy (Chaloner, 2008).
According to the views of many, the constitutional right of women to privacy disregarded the right of the fetus to life. Those who held that life began at conception consider abortion at any time as unethical. Nurses, therefore, require having a clear understanding of the issues that divide the society in order to make sound decisions concerning abortion. Nursing entails numerous responsibilities indispensable in the legal and ethical conflict regarding abortion (Chaloner, 2008). The knowledge on the abortion intricacy from both the legal and ethical perspectives, as well as the knowledge of the laws in each state is very crucial. Appreciating that this is a dilemma to many, while it is just a fundamental breach of personal/religious views to others is also pivotal.
Based on personal values, nurses have historically reacted to abortion in varied ways; some have objected to take part in it totally, others do not participate but they may care for women who have aborted, and others object later abortions but may aid in the first trimester. Others assist in abortion and can provide the care to these women, but they feel compelled by their conscience to first dissuade the mother from choosing to abort, while others only assist if the fetus has severe abnormalities and do not give assistance in any other situations (prochoiceamerica.org, 2012).
Nevertheless, based on the professional requirements, it is clearly defined that nurses are not obliged to support a stand that they do not agree with. Many practices of nurses in many states provide for nurses to reject to offer any assistance if a procedure contravenes ethical, moral and religious stands. However, it is an obligation that this information be communicated to institutions that performs abortions before they are employed there, thus it is considered unethical if nurses withhold this information only to object when assigned to assist a woman in aborting (Chaloner, 2008).
The other conflicting choice to make in nursing is on euthanasia. This issue has legal, as well as ethical implications. In virtually all states, euthanasia is considered illegal and this has spurred a lot of controversy in the public and media. Nurses will have a vital role in euthanasia if at all it will be made legal. Euthanasia can be classified into two; active euthanasia, which involves direct actions to cause death and is considered repugnant presently. The other form is passive euthanasia, which involves killing a person via omission. Passive euthanasia is acceptable in Oregon and Washington states. Other actions like ventilator support, nutrition and hydration withdrawal, and sedation for excessive pain may be legally and ethically acceptable, but morally unacceptable by certain people or groups (De Bal, Gastmans, & Dierckx de Casterle, 2008). To make it more complex, the words used, for example, assisted suicide, allowing dying or euthanasia, can have varied meanings to different people.
Nurses should, thus, ascertain that the meaning that the surrogate or patient attaches to the word used is consistent with the provider’s meaning. It is also crucial for nurses to acknowledge that whereas there is no legal or ethical difference between withholding and withdrawing therapy once started, members of the family may hold different feelings about it. The moral obligation of the nurse is to their patients during care in end-of-life. The family is frequently the center of the care, thus nurses will have moral responsibilities to the patient and their family too. A nurse is obliged to ensure that the patient is as comfortable as possible, while considering the legal implications of his/her actions (Niemira, & Townsend, 2009). Boundaries with patients ought to be maintained such that crop-up of ethical conflicts can be tackled by making decisions from a professional perspective, disregarding emotional attachment (De Bal, Gastmans, & Dierckx de Casterle, 2008).
Withholding resuscitation is another form used in end-of-life care. To the healthcare providers, it has been evident that cardiopulmonary resuscitation (CPR) after a cardiac arrest in most cases does not bear fruits; instead, it only prolongs suffering. While the practice of withholding resuscitation is of clinical significance to nurses, patients and family members may not welcome this decision. The logical starting point for nurses should involve a discussion between the provider and the patient. Nurses, the patient and the surrogate should all have an understanding that resuscitation in this case is limited so that they can be able to appreciate the fact that this is only in line with comfort measures and aggressive disease-fighting measures. Nurses should, thus, ensure that patients are well informed on this issue with sheer honest and sympathy as they seek to determine what the wishes of the patient or surrogate are. This will enable informed decision-making for the nurse (Niemira, & Townsend, 2009).
Management of pain also possesses legal, as well as ethical and moral implications, thus it poses a dilemma for nurses. Pain management involving medication entails policies of health, regulation, enforcement of law, and medical care standards. Thus, in the complexity of this issue, laws and policies and ethical considerations are crucial in decision-making. Moreover, assessment is made difficult because of the fact that only the sufferer is capable of truly evaluating the pain quality and intensity. Legally, patients have the right to efficient pain management; the federal government in the US states that the ethical responsibility to relieve and control pain is central to the role of nurses. The American Nurses Association (ANA) stipulates that nurses should provide effective doses in medications, and that nurses possess a moral right to advocate on the patient’s behalf when this medication is not managing pain sufficiently. Evidence from previous cases in court give pain relief a legal justification, in favor of patients and family members inefficiently relieved of pain (Hall & Mark, 2009).
In managing pain, nurses can rely on the tenet of autonomy to act as a guide. A breach of this principle amounts to violation of human rights. Nevertheless, at times it is easier and historically so. To yield to decisions by other parties, such as the primary nurse, it takes sincere and absolute respect for persons to meet this ethical principle. The other principle is veracity, which demands truthfulness, and this poses a big challenge to the use of placebos by nurses. Use of placebos in pain management has been prohibited, except in clinical trials. The principle of double effect is a great dilemma for the nurses too. This principle permits an act that has more than one outcome even when it is morally wrong, like in the use of analgesics to manage pain. This may spur different views from the patient, family members and even the provider (Taylor, 2008).
Based on sociocultural reasons and prejudice to drug addiction, some nurses deprive patients of sufficient patient medication and prefer pain. Nurses should be informed that the application of ethical principles including veracity, autonomy, beneficience, and justice in managing pain is a fulfillment of their most important functions. Equally, a consideration of laws on drugs and professional practice is a provision of safe and reliable care to patients. Therefore, these two perspectives must be reckoned in managing pain (Zalon, Constantino, & Andrews, 2008).
In conclusion, legal and ethical conflicts in nursing practice are inescapable, and best ways to resolve them are indispensable. Nurses should strive to stick to the right thing by strictly considering all the ethical principles that guide their practice, as well as the laws governing their practice in their states. A keen consideration and balance of these two considerations will enable nurses make sound decisions for the good of patients and the nursing profession.
References
Chaloner, C. (2007). An introduction to ethics in nursing. Nursing Standard, 21(32), 42-46.
Chaloner, J. K. (2008). Ethics of abortion: The arguments for and against. Nursing Standards, 21(37), 45-48.
De Bal, Gastmans, C., Dierckx de Casterle, B. (2008). Nurses’ involvement in the care of patients requesting euthanasia. International Junior Nursing Students, 45(4), 626-44.
Hall, J. K., & Mark, V. B. (2009). Ethics, law, and pain management as a patient right. Pain Physician, 12, 499-506.
Niemira, D., & Townsend, T. (2009). “Ethics conflicts in rural communities: End-of-life decision-making.” in Nelson, W.A. Handbook for rural health care ethics: A practical guide for professionals. Hanover, NH: Dartmouth College Press
Ogata, S. S. (2005). Legal, ethical, and political issues in nursing. Critical Care Nurse, 25(5), 572. Web.
Prochoiceamerica.org (2012). Refusal to provide medical services. NARAL Pro-choice America. Web.
Taylor, A. (2008). Addressing the global tragedy of needless pain: Rethinking the United Nations Single Convention on Narcotic Drugs. J Law Med Ethics, 35, 556-570.
Zalon, M. L., Constantino, R. E., Andrews, K. L. (2008). The right o pain management: A reminder for nurses. Dimensions of Critical Care Nursing, 27(3), 93-101.