Ethics and ethical norms have developed in different cultures that dictate the notions and meanings of good and evil. These culturally and ethically determined concepts have touched upon different spheres of life. In this regard, the healthcare system is a sophisticated combination of medical practice with legal issues, cultural stereotypes, and social values. Many countries and the USA, in particular, have devised correspondent ethical norms for the healthcare professionals as well as specific laws to properly serve both the medical personnel and the patients. Therefore, it is vital for the medical professions to take legal and ethical responsibilities for their patients and to meet standards of specific ethical codes. However, there are frequent cases when ethics does not coincide with legal justifications since healthcare is the field where priority is given to a human factor. It means certain moral actions cannot be legally justified and vice versa, some laws are just impossible to correlate with ethical norms. So, it is necessary to define the role of law and professional ethics in the healthcare sphere.
Relation between Ethical and Legal Issues
It is impossible to fully distinguish the notions of law and ethics in general since each legal principle is always accompanied by the necessity to take an ethically bound decision. A close interaction between legal and ethical issues is also explained by their similar perception of human actions as both aspects regard the action from the angle of what is right and what is wrong. However, the difference is that legal issues are based on generally established norms within a particular society. Hence, the law is an officially recognized principle that must be observed by each person whereas ethics involves an individual recognition of the problem thus proposing a subjective judgment of a situation.
Based on the above, medical practice witnesses many cases where a combination of law and ethics creates great biases and disputable situations. For instance, in the article called Law and Ethics, Arthur Zucker (1999) presents the law case about the overdose of chemotherapy causing the deaths at Dana Farber Cancer Institute. In this case, sixteen nurses have been accused of improper following of nursing standards and of negligence in administering the doses, which considerably exceed the acceptable norm. The point is that nurses’ actions can be justified since they strictly follow the written instructions issued by Dr. James Foran who admits his guilt of being negligent. Judging this case from a legal point of view, the nurses can be fully approved as well, since they followed the protocol that was not written in the appropriate way. However, ethically viewing the problem, the nurses should not neglect the ambiguous orders and instead of following them, they should have contacted the physician for more accurate information. Apart from this problem, the case also reveals the biases connected with improper organization and leadership as the basis of a well-organized and legally competent healthcare system.
While interpreting the article from the patient’s point of view, the case provoked a number of disputable questions that can be discussed in ethical and legal terms. The above case has proved that ignorance of professional standards of nursing practice can lead to serious consequences. The decision to follow the ambiguous instructions was exclusively the nurses’ decision since they considered it unnecessary to clarify the steps of treatment.
The nursing practice has also witnessed incidents when ethical notions are closely intertwined with the law. This particularly concerns the principles of patients’ privacy and documentation securities. However, the ambiguity can be eliminated if considering that a patient’s privacy covers only the information about his/her physical and mental state (Judson et al., 2006, p. 172). Other data like name and address can be available for the inquirers. Such an approach can ensure the person with a secure treatment and simplify the work of the medical personnel. The same concerns the security issues where the medical information only should be carefully concealed.
On whole, the only difference between ethics and law lies in the idea that law presupposes an external imposition of constraints on human behavior whereas ethics serves as self-imposed limitations for people. In healthcare practice, there are a great number of laws regulating and controlling the work of healthcare professionals. The basic comprehension of laws applied to nursing is crucial since the medical staff should report on their pivotal decisions. More importantly, some common healthcare activities cover both legal and ethical implications (Rosdahl and Kowalski, 2007, p. 35). This is why a healthcare professional must take into consideration the peculiarities of ethical behavior complying with legal principles and notions.
Consideration of Ethical Theories and Principles
Nature of Moral Judgments and Ethical Decisions. Before analyzing the ethical standards in the healthcare profession, it is first necessary to define the existing ethical theories, biases, and practical applications in the sphere of medical care. Additionally, a careful examination of researches should be conducted to identify the most effective ethical principles that can be applied to nursing, specifically to the process of ethical decision-making.
Basically, each ethical action is guided by the concept ‘the right’ and ‘the wrong’ behavior, which are different for each person. This is explained by the idea that each ethical dilemma can be justified by different ethical theories. It is acknowledged that all known theories present an altruistic orientation towards humankind rather than an egoistic one. But with regard to the nurse practice, a brief overview of major ethical theories can contribute to clarifying the ethical problems experienced by healthcare professionals. These ethical principles can help to determine whether human actions are morally justified and to make a decision-making process easier in terms of analysis of moral dilemmas and conflicts that occurred in everyday professional healthcare practice.
The consideration of ethical theories argues the necessity to analyze the underpinnings of moral judgments. In this respect, the main question that should be raised here is the subjectivity of moral actions and judgment. The theory of subjectivism suggests that “human judgments create morality and that there is no set of objective moral truths” (Pera and Tonder, 2005, p. 29). As proof, Sparks and Merenski (2000) state that the ethical decision process starts with the acknowledgment of an ethical dilemma. In order to solve this dilemma, one should enable the individual’s cognitive process. As a result, each ethically bound decision is guided by two main principles – ethical awareness and cognitive perception of the problem. In other words, problem-solution always begins with a personal evaluation of ethical content but not with reference to generally accepted standards.
Despite the above, healthcare practice approves more of an objective approach in moral judging. Unlike subjectivism, the objectivist approach deprives moral judgments of irrationality and inconsistency. Furthermore, there are frequent cases when people experience moral hesitation concerning the decision made, which means that subjectivism fails to be rationally justified, particularly in nursing practice (Pera and Tonder, 2005, p. 29).
Appropriateness of Consequentialism. Consequentialism, which is also known as teleological theory, stands for the idea that the action can be considered either right or wrong if its outcome is positive, or morally appropriate. Teleology suggests three streams of that theory, namely utilitarianism, egoism, and limited consequentialism. The first one puts forward the importance of self-interest. Being a theory of morality, egoism is irrelevant for healthcare and nursing in particular, since it excludes the consideration of personal comfort and pleasure. Further, utilitarianism measures the values in compliance with their consequences despite the means of achievement. Finally, limited consequentialism embodies the balance between egoistic actions and the ones which are justified by moral outcomes. In general, the theory presents no practical values for medical practice since it fails to consider the patients’ interests.
Appropriateness of Non-Consequentialism. The theory of non-consequentialism, or deontology, “is based on unconditional respect for persons (or other forms of life) and may require doing what is right regardless of the consequences” (Tschudin, 2003, p. 49). What is more important is that this theory considers duty and obligation as fundamental guidelines for a person. Additionally, an emphasis is made not on the action but on the person accomplishing this action. Therefore, deontological ethics is more relevant for a medical person since the action is always accomplished from an internal sense of obligation.
So, if consider that all moral judgments are objective, then moral decisions are guided by the principles of rightness and wrongness. In this respect, the theory of deontology gives the priority to good intentions as the main determinants of morally right action (Pera and Tonder, 2005, p. 30).
Personal Values and Professional Ethics in Nursery
Personal values, as well as professional ones, should be guided differently since the professional code of ethics involves some important constraints for self-interest. This is explained by the fact that the code of ethics provided a sort of protection for the patients and for the healthcare professionals. One of the best-known examples of ethical codes is the Hippocratic Oath which is still enforced in certain medical schools. Professional ethics, hence, constitutes one of the inherent components of medical practice since it ensures the quality of patients’ care. Apart from ethical code, there is a tendency of using ethical principles consisting of “autonomy, non-maleficence, beneficence, and justice” (Limentani, 1999, p. 395).
The implementation of ethical principles in medicine provokes biases and disputable situations due to many reasons. Hence, ethics often implies the use of subjectively justified decisions, since each person has his/her unique vision of an ethical problem and, therefore, ethics as itself acquires secondary value. However, the reality is based on external and independent values. Still, the presence of ethical decisions is urgent due to the uniqueness of each situation in healthcare practice. Despite its subjectivity, professional ethics represent important concepts and values which establish general ethical standards and approaches for the health care system (Limentani, 1999, p. 397).
Examples of Student Current Practice of Ethical and Legal Principles
The above consideration of professional ethics and legal issues shows that student practice involves the implementation of ethical codes and principles towards different cases and situations. The point is that each nursery school provides a different set of ethical notions and principles tackling the particular situation differently. Therefore, students experience a lot of difficulties in handling ethically bound cases.
In the research conducted by Liaschenko et al (2006), an alternative method has been proposed for defining the problems in student practice of ethical and legal issues and for outlining the solutions to facilitate students’ awareness of generally accepted standards in ethics. In order to improve the situation and to help students cope with ethical dilemmas, the researchers have resorted to the so-called “tragic case”. This means that students from four different schools have been introduced to a certain case involving a lot of ethically predetermined issues to find viable solutions and to invite them to the process of decision-making. The article, therefore, proves that ethical education of future nurses is actively applied and practiced and that professional ethics, in general, is considered as an inherent part of the nursing and health care profession.
The consideration of legal and ethical issues in the nursery and health care profession has revealed many biases and problems. In particular, it has been proved that legal matters in the medical sphere should be guided by generally established laws and issued by specific medical associations. Otherwise, it may lead to lawsuits and legally bound situations. Further, the analysis of ethical theories has revealed that the deontological approach is more acceptable for medical practice as it gives priority to the sense of duty and respect for other people. More importantly, the deontological approach has identified the necessity to apply objective moral judgments rather than subjective ones to the ethical code of nursing. Finally, medical practice has approved the use of ethical principles as inherent components of successful work of nurses, which is also actively applied in student current practice.
Judson, K., Harrison, C., and Hicks, S. (2006). Law and ethics for medical careers. NJ: Prentice Hall.
Liaschenko, J., Oguz, N. Y., and Brunnquell, D. (2006). Critique of the “tragic case” method in ethics. Journal of Medical Ethics. 32, 672-677.
Limentani, A. E. (1999). The Role of Ethical Principles in Health Care and the Implications for Ethical Codes. Journal of Medical Ethics. 25(5), 394-398.
Pera, S. A., and Tonder, S. V. (2005). Ethics in Health Care. South Africa: Juta and Company Ltd.
Rosdahl, C. B., and Kowalski, M. T. (2007). Textbook of basic nursing. Philadelphia, PA: Lippincott Williams & Wilkins.
Sparks, J. R., and Merenski, J. P. (2000). Recognition-Based Measures of Ethical Sensitivity and Reformulated Cognitive Moral Development: an Examination and Evidence of Nomological Validity. Teaching Business Ethics. 4, 359-377.
Tschudin, V. (2003). Ethics in nursing: the caring relationship. China: Elsevier Limited.
Zucker, A. (1999). Law and ethics. Death studies. 23, pp.281-383.