Medical professionals have a responsibility to their clients to deliver safe, quality care with regard for patients’ individuality, needs, and desires. Patients seek out professional health care with their own goals in mind. Their goals may not match ours, but we as health care providers have a duty to inform and treat our clients with competence and afford them the utmost dignity and respect. In short, we must be ethical in our practice. We have an equal obligation to uphold the law. But law and ethics are not always synchronous. What may be legal in practice may be unethical; and what may seem the ethical choice may not be legal.
We must strive to uphold both the law and code of ethics of our profession. The Relationship between Legal and Ethical Issues Law is concerned with how we live; what we can and cannot do. Laws are rules governing conduct and offenses to these laws at times are punishable. Ethics is a system of values-based conduct. Ethics provides a framework from which to decide a course of action based on what is morally acceptable to an individual. Some actions can be legal, but deemed unethical. In health care, a patient is afforded certain rights, such as the right to refuse treatment, even if the potential outcome results in the loss of his or her life.
In such cases, health care providers may find themselves conflicted in their duties because of their own ethical values. However, we as health care providers must allow our patients to decide for themselves their course of treatment. This respect for a patient’s autonomy, or determination, is considered one of the foundational ethical principles in health care (Perry, Churchill, & Kirshner, 2005). Personal Values and Professional Ethics Values are that which is believed to be important to an individual or an organization. Something considered valuable has worth.
Values are closely linked with morals, which are concerned with judging right from wrong. Values are formed early on in our lives and come from family, societal norms, religious indoctrination, and cultural views. Though values vary from person to person, they inform a one’s sense of what is right and wrong. They provide standards for living based on what is considered important to the individual or organization. Values are the basis by which we judge the rightness or wrongness of an action. Values may change as we move away from our families and adopt different sets of values and norms gleaned from the society in which we exist.
Values inform ethics. Ethics is a philosophy used in determining the right or moral behavior in a given situation. Ethics is concerned with behaving as we should and is based on individual or corporate values. Personal ethics, like values can change over time based on changing societal influences. Professional ethics is a framework for the way we should act in a professional setting. Professional ethics use reasoning and professional values to guide our behavior. Codes of ethics guide health care professionals by addressing ethical behaviors in a variety of clinical situations.
Cohen and Erickson (2006) add that “Ethical codes of professional practice outline principles that demonstrate the responsibility of the profession’s members to society” (p. 776). Ethical Theories Although many ethical theories exist, the two main ethical theories that apply to clinical practice are deontological and teleological. Deontological Deontological theory states that when facing ethical dilemmas we should adhere to our commitments and duties. It means keeping ones promises and following the laws, rules, and policies to which all medical professionals are held accountable.
Deontological theory is classified as non-consequential because outcomes are less important than honoring one’s duties and commitments (Guido, 2010). Teleological Teleological theory states that an action is determined ethical by the outcome it produces. This is also known as a consequentialist theory because an action is judged ethical based on its consequences. However, teleologists disagree on which actions are deemed right and which are wrong (Guido, 2010). Utilitarianism, a common type of consequential theory, states that the ethical action is one that does the most good for the most people (Hughs, 2002).
Hughs (2002) states ethical theories are only useful when applied in conjunction with the four primary ethical principles of health care: Respect for autonomy, beneficence, non-maleficence, and justice. Ethical Principles These ethical principles are useful in health care when applied to the clinical decision-making process. Respect for autonomy Autonomy speaks to personal freedom and self-determination. Essentially, it is affording patients the right to make their own decision regarding treatments affecting their body, health, and life, even if the health care providers do not agree with those decisions.
Respecting patients’ right to autonomy communicates that we as health care professionals give them the freedom to choose a course of treatment that best serves their chosen lifestyle. Informed consent exemplifies this principle. The medical team gives patients the facts concerning treatment options and allows them to decide for themselves whether or not to proceed, not based on what is ‘best’ for them as deemed by the medical staff but what they feel is best for themselves. Beneficence and Non-maleficence Beneficence is the ethical act of preventing harm or doing what is good for another (Guido, 2010).
Often in health care, however, defining precisely what actions are ‘good’ can be problematic. Non-maleficence is the corollary of beneficence and essentially means to do no harm. A part of the principle of non-maleficence is the double-effect, which states that an action may have both harmful and good effects with the good overriding the bad. We tell our patients to take their medicine because it is good for them, even if administering such medication may involve miserable side effects, as is often the case with chemotherapy.
Though chemotherapy can be difficult to tolerate, the overarching goal in administering it is beneficence by halting tumor growth; thus, prolonging or improving a patient’s life. Justice The principle of justice speaks to the fairness of an action, particularly, treating people fairly. Justice delivers to people what they deserve; what is right. Justice involves treating people equally and without bias. Veracity Veracity means always telling the truth and telling the entire truth. The bedrock of veracity is respect for a person’s autonomy.
It means leaving nothing out and communicating the truth simply and clearly with the goal of being understood. Fidelity In ethics, fidelity means keeping one’s promises. It also means not making promises one cannot keep. Fidelity is grounded in a sense of duty and commitment. It means being faithful. Application to Current Practice I find it interesting that the two ethical theories which apply to the clinical setting, deontological and teleological, are seemingly in conflict with one another. Deontological theory is concerned with fulfilling our obligations.
Teleological theory looks at the consequences of our actions and whether or not the outcomes are deemed ‘good. ’ I will be the first to admit I struggle, sometimes mightily in my practice trying to determine the ‘goodness’ of an outcome; precisely when I am fulfilling my obligations. For instance, I worked with a physician. His patient Jean was in the end-stages of COPD. This patient was gasping for breath and had an advanced directive. She does not wish to be put on artificial mechanical ventilation but was suffering from a lack of oxygen. The physician believed strongly in the sanctity of life.
He was uncomfortable prescribing morphine because he knew of its ability to repress the respiratory system; precisely the reason I asked for the morphine order. I wished to ease my patient’s suffering. I believed in my patient’s right to autonomy and also sought to preserve her dignity. The physician told me, “Alright. You can give her morphine, but you also need to inform her that it may kill her. ” My hands were tied. I could not tell a patient that! For one, I did not agree. I would not state something without veracity. Medicating this patient with a small amount of morphine for respiratory distress would not kill her.
Instead, it would provide a small measure of relief of her symptoms and afford her the dignity to which she was entitled. Those are my ethical beliefs; my professional values. The conflict in ethical principles with the physician created an ethical dilemma for me. Such is often the case when working in the field of oncology. I cared for another patient. Maria was Hispanic and had the usual large extended family present in her private room. Maria was newly diagnosed with end-stage breast cancer. She had several serious underlying complications that made her prognosis grave.
She was in pain. She was afraid. She spoke no English, and I spoke no Spanish. I asked her oldest son, the spokesperson of the family, if Maria knew of her diagnosis and prognosis. He said no. I explained with some urgency that Maria had the right to know; that knowing would aid her in making final choices about her life, while she was still decisional. Her son patiently explained to me that according to his culture, he was protecting his mother by keeping this grave information from her; that it was in fact his duty as a good son to do so. I struggled with this new knowledge.
I spoke to Maria’s physician asking him if she was aware of her prognosis. He said he was not sure if she knew. None of the physicians seemed intent on telling her, either. I was upset. My personal ethics were clearly getting in the way of my professional ethics. I had a duty to respect differing cultural values in the interest of the ethical treatment of my patient and her family as well. To do otherwise would be to transfer my moral dilemma onto their shoulders, and that would go against my professional ethics. I had to leave that one alone, but I learned the difference between personal and professional ethics.
Conclusion Medical professionals work from their own sets of personal values and ethical principles. We are also expected to adhere to professional codes of ethics and the values of our professions. Whereas our beliefs and values form our own personal morals and ethics, professional ethics is a study that describes the understanding of morals from a larger perspective (Cohen & Erickson, 2006). Working in the health care profession, we have an ethical duty to the clients we serve. By adhering to professional standards of care and codes of ethics, we demonstrate the responsibility to serve our community ethically and with excellence.