Journal of medical ethics, 1986, 12, 123-126, 135
Ethical dilemmas in nursing
Jenifer Wilson-Barnett Kings College, London
Author's abstract
Nurses are increasingly realising that they can offer relevant information and participate in decision-making involving ethical issues. However, inter-projessional communications are frequently inadequate, and do not permit exchange of opinions. The consequences are often frustrating and upsetting for nurses whose care is affected by others' policies. This paper explores these issues using some clinical examples.
Fundamentaf values of preserving life and alleviating suffering are shared by members of the medical and nursing professions. Codes of confidentiality, honesty and colleagueship are also expected within these groups. However, the spirit of servitude and obedience questioned by Nightingale (1), but perpetuated by many nurses since, has created differences in the way dilemmas are faced and the context in which nurses and doctors consider their professional ethics. This article will explore some of these differences.
Traditionally nurses have taken orders from senior members of both professions and initiated only routine procedures. Their reasoning and intellectual skills were not fostered or valued. It therefore followed that decisions on medical as well as ethical issues were made by doctors (2). Increasingly now however, nurses are realising their therapeutic potential, and patients too require more involvement in their care and treatment decisions. Changes in nursing reflect a desire to become more responsible and contributory to the welfare of those who need care. Thus policies of unilateral decision-making are resented by those who are affected by the decisions, especially when they have good reasons to disagree and are faced with treatment consequences continually during their daily work (3).
Ethical issues in nursing must therefore