Nursing focuses on aspects such as caring, preventing harm, and safeguarding the dignity of the client, as well as advocating the role of nurses that call for defending of the rights of clients. There are eight principles that nurses encounter and should abide within clinical settings, namely: autonomy (personal freedom and right of self-determination); veracity (truth-telling); beneficence (duty to safeguard good actions); justice (fairness and treating all equally); nonmaleficence (duty to prevent harm from happening); paternalism (allowing the nurses to make decisions for individual patients); fidelity (duty to abide by one’s promises and commitments; and, respect for others, anonymity and confidentiality. Nurses should abide to administrative law and statutory law regulating the nursing practice. The paper explores instances in which laws and ethics may be antagonism and how nurses can negotiate such conflicts.
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Nurses at all levels and in all facets of specialization should comply with strict ethical guidelines and operates as per various governmental and regulatory statutes. Frequently, the interaction between ethics and law is complex; however, professional nursing ethics mainly followed within the confines of the law are highly likely to be legally defensible. Nurses may come across diverse dilemmas, legal or ethical in nature amid their practice; nevertheless, some of the nurses may not be prepared to respond to such issue and may end up helpless in the event that questions regarding their ethics or conduct are raised (Robley, 2009).
A law represents a rule concisely laid down whereby any deviation from the set rule attracts punishment; however, ethics are not measurable and cannot be concisely defined like law. Ethics mainly depend on personal perception of issues and are complex to be outlined into right or wrong. A nurse most frequently comes into contact with the law via potential or imminent litigation in which the nurse may have engaged in, or observed in some action that led to the legal action (Timby, 2009). The nurse also encounters legal issues in the event that a disallowed act is perpetrated in the case of negligence and misconduct, which predisposes the nurse to criminal liability.
Nurses encounter diverse situations on a day-to-day basis that may be classified as either ethically correct yet legally objectionable, or vice versa. Situations such as abortion, death, and euthanasia by their pure nature may place the nurse into a dilemma. Examples of situations that can be outlined as relating to nursing laws and ethics are numerous and diverse (Timby, 2009). One of the situations that could be arise details a nurse giving a patient the wrong medication, and subsequently failing report the incident or concealing the situation to safeguard himself from legal action. This situation raises pertinent questions centring on both ethical and legal issues (Robley, 2009). The second situation that could be ethical rather than legal may entail permitting a client to smoke marijuana for medicinal reasons. Another situation that could emerge bordering legal and ethical boundary centres on forcing a patient to assume something not in favour of his or her wishes or devoid of informed consent.
Conflicts that may exist between Ethics and the law in Nursing Practice
In arriving at professional decisions, nurses may be caught up between two conflicting sets of demands, one deriving from the mission of the profession and the other emanating from legal provisions. Nurses and other healthcare professional may become entangled in either civil or criminal justice systems such as when nurses incur criminal action by failing to renew nursing license in a timely manner (Timby, 2009). Other actions revolving around criminal law may encompass substance abuse, especially in cases where the nurse acquires medications un procedurally within clinical settings.
Nurses should distinguish between law and morality since an action can be legal but immoral. For instance, an order to undertake resuscitation for a dying client may be legal, but questions could still linger on whether the act if moral. Similarly, an action may be moral but illegal. One of the conflict that may arise between ethics and law details instances in which the nurse determines that there are no active goals that can be attained with certain services such as therapy services, then in line with the profession code of ethics it would be unethical for the practitioner to charge services rendered (Robley, 2009). At the same time, nurses remain legally required to avail services to their clients indiscriminately. Similarly, conflict within the practice of nursing may stem from consumer expectations and beliefs such as a client’s refusal to blood transfusion.
In some cases, compliance with a legal or professional obligation may appear as harmful, unjust, or otherwise invalid. Sometimes nurses steer away from absolute compliance, especially when the law appears as contradicting ethics. In other times, nurses may not be ready to sacrifice personal values and/or client welfare to an imperfect system outlining rules and regulations. For instance, nurses may fail to abide by professional accountability in divulging confidential information (Kjervik & Brous, 2010). Similarly, conflicts between law and ethics may arise in decision making for the incompetent and dying, as well as issues regarding individuals with disability and right to life issues.
How Nurses should Negotiate Conflicts that Exist between Ethics and the Law
Some of instances in which conflict between ethics and law may manifest may revolve around values such as truthfulness, fairness, client well-being, client choice, privacy and confidentiality, respect for life, and maintaining commitments to oneself, clients, nursing colleagues, nursing profession, and practice settings. These values remain essentially shared by the society; however, when two of the values are applicable to a situation, but supporting diverging courses of action, a conflict may arise (Westrick & Dempski, 2009).
The code of ethics describes nursing practice mission of meeting client needs and responding to environmental forces that may generate conflicts between ethics and law. The possibility of conflict between a nurse’s ethical duty to her patient, and her legal duty on her employer/physician may place the nurse to considerable professional risk (Kjervik & Brous, 2010). There are insufficient guidelines in resolving the dilemmas prominent in nursing practice. Codes of ethics sometimes fail to avail legal protection for nurses acting as a patient advocate and may be too abstract to apply with consistency (Cady, 2012). Conversely, in some instances, the government may disallow nurses from attending to certain people or practicing in a certain way. This contradicts nursing practice, especially on the premises of duty to care for clients. The Code of practice expects nurses to respect the decisions arrived at by the client, as long as it is informed consent (Westrick & Dempski, 2009). When patients or their families turn down provider recommendations or treatments, this can herald conflict and possible moral dilemma for the nurse. A moral dilemma stems from cases where two or more concise moral principles apply, but they support mutually inconsistent sources of action (Timby, 2009).
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How Nurses have historically Handled Conflicts between Ethics and the Law: Responding to prejudicial laws
Conflicts may arise when the nurse faces an unreasonable burden, a personal danger, conscientious objection, and, concerns regarding individual competence. Unreasonable burden manifests when the nurse’s capability to avail safe care and satisfy Standards of Practice is undermined by impractical expectations, inadequacy of resources, or threats on personal wellbeing (Mihyun, 2009). Nurses are not warranted to desert their clients, and are not obligated to place themselves in situations where the care delivery would visit unreasonable danger to their personal safety. This entails situations such as violence, communicable disease, physical, and sexual abuse. In terms of individual competence, nurses are expected to practice competently and constantly attain fresh knowledge and skills within the area of practice (Cady, 2012).
The nurse is not obligated to avail care beyond his/her level of competence. In remote circumstances, the nurse may confront cases where he/she is asked to avail care beyond his or her competence. In such case, the nurse should always avail care that he/she is competent to give. In terms of conscientious objection where a certain form of care conflicts with the nurse’s moral or religious beliefs, the nurses should consult his/her employer, and do the best to refrain from providing care (Kjervik & Brous, 2010). Personal biases or judgement that conflicts with the client’s lifestyle should not form the grounds for conscientious objection.
Nurses have historically utilized the professional code of practice to resolve the conflicts that may arise between ethics and law through respectful communication, and the guidance availed by nursing practice code of conduct (Timby, 2009). The code derive from the shared belief that nurses core roles entail the prevention of ailments, the easing of patient’s suffering, and the safeguarding, promotion, and restoration of client’s health within the caring of individuals, groups, families, and communities (Cady, 2012).
Healthcare institutions are expected to avail multidisciplinary ethics committees that avail education, counselling and support on ethical issues. This avails a platform on which varying views can be expressed, avail support for caregivers, and minimize the institutional legal risks (Kjervik & Brous, 2010). The standards of the profession can aid nurses comprehend professional nursing conduct by: availing a sign of the nursing practice commitment to the public; outlining the significant ethical standards for professional behaviour; guiding the professional in the quest for self-regulation; and, ensuring that nurses keep in track their unique responsibility of caring for the sick (Mihyun, 2009).
Nurses should apply the principles to practice in making ethical decisions by recognizing the client’s right to safe, competent, and ethical care. Nevertheless, in some instances, the nurse’s individual rights and values may contradict the client’s right to receive care. As such, nurses should: determine the facts and highlight the dilemma; clarify the dilemma; implement available options and develop a plan; and, implement the plan. The formal legal and ethical standards set within the nursing practice should not be contravened on the grounds of satisfying patient welfare. Based on the fact that a section of nurses may sometimes violate formal legal and/or ethical standards owing to conflict between deeply held values and the ethical or legal obligations, it is essential to guarantee that their actions are grounded in sound legal or legal judgement, instead of prejudice, self-interest, or rationalization.
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