Nursing ethics

Nursing ethics is the discipline of evaluating the merits, risks, and social concerns of activities in the field of nursing. There are many defined codes of ethics for nurses.

Nursing ethics shares many principles with other branches of health care ethics, such as beneficence and non-maleficence, but also has a number of distinctions.

Human rights and nursing practice
Ethics has been an integral part of nursing practice from the earliest foundations of modern nursing in the late nineteenth century. This has always entailed a respect for human rights of the persons in their care. However, early attempts to define ethics in nursing were focused more on the virtues of the nurses themselves, rather than looking at how the rights of the patient or client might be promoted in particular. In the modern era, the ethics of nursing has shifted more toward the promotion of these rights and the duties of the nurse (McHale & Gallagher 2003).

The importance of human rights in nursing was made explicit in a statement adopted by the International Council of Nurses in 1983.

Distinctive nature
Although historically much of nursing ethics has been derived from medical ethics, there are some factors that differentiate it from this. The key difference is that paternalism, which is often a key feature in theories of medical ethics, is generally not compatible with nursing ethics (Rumbold 1999). This is because nursing theory seeks a collaborative relationship with the person in their care. It therefore emphasises autonomy of the person being nursed over paternalistic practice where the health professional seeks to do what they believe to be in the person's or society's best interests. Codes of conduct for nurses tend to be written in the ethical framework of deontology and are therefore based on the rights of the patient and the duties of the nurse rather than on utilitarian concerns of the consequences justifying the action.

Common themes in nursing ethics
More so, the nurse's role is one of advocate for the interests of the people in their care. In terms of ethical theory, this means having a respect for the autonomy of the person to make decisions about their own treatment and be provided with information available in order to do this. So the principle of informed consent, where a person understands fully the implications of having or refusing a treatment, is one which is held in the nurse's mind when suggesting treatment options. (Rumbold 1999) This principle is not absolute as people are sometimes unable to make choices about their own treatment due to being incapacitated or having a mental illness that affects their judgement. This means that the nurse has to weigh their duty of care against the autonomy of the person in care.

Other common themes are that of truth telling in interactions with the person in care. This, however, also has to be weighed against any unnecessary harm that may be caused by divulging the information. Confidentiality is also an important principle in many nursing ethical codes. This is where information about the person is only shared with others after permission of the person, unless it is felt that the information must be shared to comply with a higher duty such as preserving life. (Rumbold 1999)

Nurses are interested in the quality of life of the people in their care. In medical ethics theories, this can be measured by QALYs. However, this is highly controversial as it is very difficult to measure the quality of someone else's life objectively and this can be particularly difficult if the person in care is unable to communicate their need, such as when they are unconscious or in a vegetative state

Currently the job of regulation of nursing personnel in relation to nursing ethics is left up to state, provincial, and national regulatory bodies. However there remains gaps in regulation in many countries (Please see the University of Minnesota Center for Bioethics for documentation about violations in health ethics by the American Military; http://www1.umn.edu/humanrts/OathBetrayed/index.html)

On the international nursing regulation front the International Council of Nurses has created a network of nursing regulatory agencies. It is primarily focused as a forum for the exchange of ideas and as a resource bank rather than achieving the ability to regulate.(ICN) ICN believes in “self regulation” and “self governance” by authorities in each country within the specific profession ((personal communication with Dr. Tesfa Ghebrehiwet. ICN)).

To correct the gap in regulation the Victoria Coalition for the Survivors of Torture (VCST)has developed a proposal that would establish an International Health Professions’ Ethics Committee. A draft of the Ethics Committee has been posted on the VCST web-site: http://vcst.ca/proposal.htm

Codes of ethics

 * Australian Nursing and Midwifery Council Code of Ethics
 * Nursing and Midwifery Council code of professional conduct (UK)
 * American Nurses Association code of ethics for nurses