Page 101 - ACCCN's Critical Care Nursing

5 Ethical Issues in Critical Care

Amanda Rischbieth
Julie Benbenishty

paramount to critical care nurses (as part of the
Learning objectives critical care team), whose patient cohort is a particularly
vulnerable one. Critical care nurses are encouraged to
After reading this chapter, you should be able to: participate in discussion and educational opportunities
● understand the diversity and complexities of ethical issues regarding ethics in order to provide clarity in relation to
involving critical care practice fulfilment of their moral obligations. The need to support
● understand key ethical principles and how to apply them in critical care nurses, by mentoring for example, is very
everyday practice as a critical care registered nurse important in terms of developing moral knowledge and
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● be aware of the availability and access to additional competence in the critical care context.
resource material that may inform and support complex Common ethical principles that relate to critical care
ethical decisions in clinical practice nursing practice are outlined in this chapter, with a
● discuss the ethical implications of the organ donation for description of how they may be applied to practical
transplantation decision-making process situations such as clinical decision making, obtaining
● understand consent and guardianship issues in critical care informed consent and applied research. Ethical implica-
● describe the ethical conduct of human research, in tions of brain death and organ donation that particularly
particular issues of patient risk, protection and privacy, and relate to nursing practice are also reviewed.
how to apply ethical principles within research practice.
PRINCIPLES, RIGHTS AND
THE LINK WITH LAW
Key words THE DISTINCTION BETWEEN
ETHICS AND MORALITY
futility
consent Ethics deal with all aspects of human behaviour and are
ethical decision making often complex and contentious. Many clinical scenarios
invite ethical reflection and raise questions about
organ donation health professionals’ decision making and behaviour, as
ethical principles distinct from specific diagnostic or technical questions.
patient advocacy In it simplest form, ethics refer to standards that govern
end-of-life behaviours.
Ethics involve principles and rules that guide and justify
conduct. Personal ethics may be described as a personal
INTRODUCTION set of moral values that an individual chooses to live by,
whereas professional ethics refer to agreed standards and
Nurses are expected to practise in an ethical manner,
through the demonstration of a range of ethical compe- behaviours expected of members of a particular profes-
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tencies articulated by registering bodies and the relevant sional group. Bioethics is a broad subject that is con-
codes of ethics (see Boxes 5.1 and 5.2). It is important cerned with the moral issues raised by biological science
that nurses develop a ‘moral competence’ so that they are developments, including clinical practice.
able to contribute to discussion and implementation of Although some nurses draw a distinction between ethics
issues concerning ethics and human rights in the work- and morality, there is no philosophical difference between
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place. Moral competence and ethical action is the ability the two terms, and attempting to make a distinction can
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to recognise that an ethical issue exists in a given clinical cause confusion. Difficulties arise in ethical decision
situation, knowing when to take ethical action if and making where no consensus has developed or where all
when required, and a personal commitment to achieve the alternatives in a given situation have specific draw-
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78 moral outcomes. This diverse understanding of ethics is backs. These types of situations are referred to as ‘ethical