Library resources on a range of ethical issues: the NZNO library has many resources available to members on a range of ethical dilemmas. A selection of these items is listed on these pages.
Nursing codes of ethics bind nurses to the role of patient advocate and compel them to take action when patients' rights or safety are jeopardised. Reporting misconduct is known as whistleblowing and studies indicate there are personal and professional risks involved in blowing the whistle.
Nurses and whistleblowing: The ethical issues. Wilmot, S. (2000) Journal of Advanced Nursing; 32: 5, 1051-7.
Whistleblowing presents practical and ethical dilemmas for nurses, and needs to be seen as part of a spectrum of increasingly confrontational actions against miscreant organisations by their employees. The ethics of whistleblowing can only be understood in relation to its moral purpose, whether that is to achieve a good outcome (a consequentialist view) or fulfil a duty (a deontologicai view).
A strong argument can be made for the precedence of the nurse's duty to the patient over her duty to the employer. Although both duties are based on an implicit or an explicit promise, the promise to a person (the patient) must take precedence over the promise to an organisation. It can even be argued that duty to the employer may in fact justify whistleblowing by nurses in some circumstances. However, the consequences of whistleblowing are forced upon nurses in a different way, by the fact the danger of reprisals acts as a deterrent to whistleblowers, however justified their actions may be. A more robust approach to the protection of whistleblowers is needed on the part of the government and the National Health Service to remedy this situation.
The vegetative state: medical facts, ethical and legal dilemmas. Jennett, B. (2001) Cambridge: Cambridge University Press
The strange and harrowing sight of a person being awake but unaware with no evidence of a working mind--characteristics of the vegetative state--provokes intense debate and raises profound questions for health professionals, ethicists, philosophers and Lawyers. This unique account by an unrivalled expert in the field, who himself collaborated in coining the term "persistent vegetative state", surveys the medical, ethical and legal issues that surround this controversial topic.
Ethical arguments discussed include the conflict between sanctity of life and respect for the autonomy and best interests of the victim, between killing and letting die.
Do not resuscitate orders: The issues. Jevon, P. (1999) Nursing Standard; 13: 40, 45-46.
The decision whether or not to attempt resuscitation of certain patients can be difficult and complex. This article discusses the ethical, Legal and professional issues in do not resuscitate orders, with particular reference to the nurse's role and professional accountability. http://www.nursing-standard.co.uk/archives/ ns/vol13-40/v13w40p4546.pdf
Euthanasia, ethics and public policy: an argument against legalisation. Keown, J. (c2002) Cambridge: Cambridge University Press.
Whether the law should permit voluntary euthanasia or physician-assisted suicide is one of the most vital questions facing all modern societies. Internationally, the main obstacle to legalisation has proved to be the objection that, even if they were morally acceptable in certain "hard cases", voluntary euthanasia and physician-assisted suicide could not be effectively controlled, society would slide down a "slippery slope" to the killing of patients who did not make a free and informed request, or for whom palliative care would have offered an alternative. How cogent is this objection? This book provides the general reader (who need have no expertise in philosophy, Law or medicine) with a Lucid introduction to this central question in the debate, not Least by reviewing the Dutch euthanasia experience.
Quality of life and the right to die: An ethical dilemma. McCormack, P. (1998) Journal of Advanced Nursing; 28: 1, 63-69.
In an increasingly "patient-centred" health service, individuals are demanding to make independent judgements about their own fate. In keeping with this trend, there is now a growing drive to review the current laws on euthanasia and assisted suicide. The issues in the euthanasia debate usually revolve around patients who are terminally ill and/or suffering intractable pain. The paper uses a case study approach to examine the ethical and Legal issues surrounding euthanasia. The discussion centres around the principles of beneficence, non-maleficence and autonomy, in relation to whether it was morally or legally appropriate to intervene with the patient's wishes by artificial feeding.
The introduction and auditing of a formal do not resuscitate policy. Taylor, E. (1996) New Zealand Medical Journal; 109, 424-248. Aims: To introduce, to assess the use of and the staff understanding of a "do not resuscitate" policy.
Is caring the ethical ideal? Warelow, P. (1996) Journal of Advanced Nursing; 24, 655-661.
This paper examines the claim that caring is an appropriate ethical ideal for nursing. Initially it examines nursing's philosophy of care and caring, highlighting some areas of difficulty and dissatisfaction articulated by many of its contemporary theorists. Evaluation of the notion of caring as an appropriate ethical ideal for nursing is balanced against those in opposition, and in this process their critique is discussed. This discussion focuses on areas such as virtue ethics, moral responsibility, feminine values, mothering and the debate between male and female caring. Different forms of caring are evaluated and balanced against different forms of nursing. The paper suggests that current views which hold aloft nursing as a bedmate of caring may be detrimental to both the cared-for and the caret, advocating in the process a move toward change.
Comfort and nurses' moral choices. Wurzbach, N. (1996) Journal of Advanced Nursing; 24, 260-264.
Caring has been advocated as integral to nursing ethics, and much theorising has suggested it may be a partial or the entire foundation for nursing's ethic. Yet few research studies have examined the practical expression of caring in the clinical setting. In this study, the author examines the providing and feeling of comfort as related to 15 long-term care nurses' moral choices.
The following books are for REFERENCE ONLY:
* Ethics in nursing practice : a guide to ethical decision making. Fry, S.T. and Johnstone, M.J. (2nd ed) (c2002) Oxford: Blackwell Science. The International Council of Nurses (ICN) has revised and updated the classic Ethics in Nursing Practice to address the increasingly diverse social, cultural, political and religious situations in which nurses practise. Comprehensive in its scope and addressing a broad range of ethical issues, this new edition continues to serve the global nursing community. In harmony with the universally accepted ICN Code of Ethics for Nurses, this book presents complex ethical issues and systematically guides the reader to ethical decision making. Offering an expanded view of ethics, it now also includes Islamic and Hindu perspectives.
* Ethics: a guide for New Zealand nurses. Rogers, J. and Niven, E. (1996) Auckland: Longman.
* Health Care and the Law. Johnson, S. (ed) (3rd ed) (2004) Wellington: NZ Brookers Ltd.
Health Care and the Law is recognised as one of the leading texts setting out the basic principles of the Law relating to health care. This third New Zealand edition is a practical, uncomplicated account of the law, making it an ideal reference for all health practitioners, as well as risk managers, Lawyers, educators and students.
Other articles of interest:
Maintaining professional boundaries. Cain, M. (2000) Kai Tiaki Nursing New Zealand, 6: 4, 22.
Nurses and midwives need to be very clear about their professional boundaries, what they mean and how to maintain them.
Ensuring consent is informed. Carr, J. (2000) Kai Tiaki Nursing New Zealand, 6: 7, 22-3.
Nurses have a crucial role in ensuring patients' consent is informed. As their scope of practice expands so, too, will their need to fully understand the ethical underpinnings of informed consent. But traditional ethical prcinciples may not be the most appropriate.
Caring to confront in the workplace: An ethical perspective ,for nurses. DeMarco, R.F. (1998) Nursing Outlook; 46: 3,130-135.
Constructive confrontation of nurse colleagues is an intraprofessional ethical dilemma.
Guidelines for making end-of-life decisions. Fry, S. (1998) International Nursing Review; 45: 5, 143-144.
The author provides four guidelines to follow in helping patients and their families make end-of-life decisions.
Ethical dilemmas in neonatal care. Ho, T. (2000) Kai Tiaki Nursing New Zealand; 6: 7, 17-9.
Neonatal intensive care is fraught with complex ethical questions. How does the health care team, in partnership with family/whanau, make hard decisions about the care of extremely premature infants?
I see and am silent/I see and speak out: The ethical dilemma of whistleblowing. Canadian Nurse; 95: :10, 5-8.
Whistleblowers are people who expose negligence, abuses or dangers, such as professional misconduct or incompetence, which exist in the organisation in which they work. The decision to blow the whistle on a colleague, associate or employer is never an easy one; unless there is a Legal obligation to report, it should be a step one takes when all else has failed.
Reaching principled decisions. Niven, E. (2000) Kai Tiaki Nursing New Zealand; 6: 1, 13.
Nurses must be able to articulate and defend the decisions they make when facing ethical dilemmas.
Pondering on ethical dilemma. Rhodes, D. (2000) Kai Tiaki Nursing New Zealand; 6: 1, 12-3.
Doing your best for your patient can sometimes mean facing up to difficult ethical questions. Here one nurse poses some questions about a situation he faced in his practice. And on the facing page a nurse ethicist examines the situation and offers some guidelines.
Seen but not heard ... whistleblowing. Ryan, C. (2000) Nursing Times; 96: 47, 11.
Nurses and students raised the alarm about abuse and poor practice in two scandal-hit trusts but managers ignored them.
Dealing with life and death decisions. Paterson, M. (2000) Kai Tiaki: Nursing New Zealand; 6: 7, 14-6.
Nurses need to be aware of all the legal and ethical implications of "not-for-resuscitation" orders and the withdrawal of treatment. Only then can they practise in the best interests of their patients.
Casualisation of nurses and unregulated workers impairs ethical practice. Starch, J.L. (1998) International Nursing Review; 45: 5, issue 341, 140-141.
Starch paints a disturbing picture of health care restructuring and provides guidance for ethical practice.
Professional boundaries: guidelines for registered nurses in Victoria. (2001) Melbourne: Nurses Board of Victoria. Can be downloaded from: http://www.nbv.org.au 6pp.
Websites: Nursing Ethics: an international journal for health care professionals. Articles can be provided on request.
Home page: www.nursing-ethics.com Only abstracts available.
International Centre for Nursing Ethics http://www.freedomtocare.org/
This provides links to a range of public occupations and information about ethical issues facing those occupations. Of particular interest to readers will be the health care professionals and the nursing sections.
Nursing Ethics.ca http://www.nursingethics.ca/
A Canadian site offering specially selected nursing ethics resources. Includes sections on international resources, codes of ethics, articles and nursing ethics in the news.
NZNO members are able to borrow these books/articles, except those marked with an asterisk *. Email firstname.lastname@example.org or telephone 04-931-6736. Other resouces can be found on the library pages of the NZNO website: www.nzno.org.nz.
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|Title Annotation:||list of papers about ethics|
|Publication:||Kai Tiaki: Nursing New Zealand|
|Article Type:||Author Abstract|
|Date:||May 1, 2005|
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