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40 unit 1 | Professional Considerations CikguOnline
It is 1961. In a large metropolitan hospital, ten son or daughter alive after, for example, a motor
health-care professionals are meeting to consider the vehicle accident? Families and professionals face
cases of three individuals. Ironically, the cases have some of the most difficult ethical decisions at times
something in common. Larry Jones, age 66, Irma like this. How is death defined? When does it
Kolnick, age 31, and Nancy Roberts, age 10, are all occur? Perhaps these questions need to be asked:
suffering from chronic renal failure and need “What is life? Is there ever a time when life is no
hemodialysis. Equipment is scarce, the cost of the longer worth living?”
treatment is prohibitive, and it is doubtful that Health-care professionals have looked to philoso-
treatment will be covered by health insurance. The phy, especially the branch that deals with human
hospital is able to provide this treatment to only one behavior, for resolution of these issues. The field of
of these individuals. Who shall live, and who shall biomedical ethics (or, simply, bioethics), a subdisci-
die? In a novel of the same name, Noah Gordon pline of ethics—the philosophical study of
called this decision-making group The Death morality—has evolved. In essence, bioethics is the
Committee (Gordon, 1963). Today, such groups are study of medical morality, which concerns the moral
referred to as ethics committees. and social implications of health care and science in
human life (Mappes & DeGrazia, 2005).
In previous centuries, health-care practitioners had To understand biomedical ethics, the basic
neither the knowledge nor the technology to pro- concepts of values, belief systems, ethical theo-
long life. The main function of nurses and physi- ries, and morality are defined, followed by a dis-
cians was to support patients through times of cussion of the resolution of ethical dilemmas in
illness, help them toward recovery, or keep them health care.
comfortable until death.There were few “who shall
live, and who shall die?” decisions. Values
The polio epidemic that raged through Europe
and the United States during 1947–1948 initiated Webster’s New World Dictionary (2000) defines val-
the development of units for patients on manual ues as the “estimated or appraised worth of some-
ventilation (the “iron lung”). At this time, Danish thing, or that quality of a thing that makes it more
physicians invented a method of manual ventilation or less desirable, useful.” Values, then, are judg-
by using a tube placed in the trachea of polio ments about the importance or unimportance of
patients. This was the beginning of mechanical objects, ideas, attitudes, and attributes. Values
ventilation as we know it today. become a part of a person’s conscience and world-
During the 1950s, the development of mechan- view. They provide a frame of reference and act
ical ventilation required more intensive nursing as pilots to guide behaviors and assist people in
care and patient observation. The care and moni- making choices.
toring of patients proved to be more efficient when
they were kept in a single care area; hence the term Values and Moral Reasoning
intensive care. The late 1960s brought greater tech- Reasoning entails the use of abstractions to think
nological advances, especially in the care of patients creatively for the purpose of answering questions,
seriously ill with cardiovascular disease. These new solving problems, and formulating a plan that
therapies and monitoring methods made the inten- determine actions (Butts & Rich, 2008). Reasoning
sive care unit possible (aacn.org, 2006). allows individuals to think for themselves and to
Health care now can keep alive people who not accept the beliefs and judgments of others at
would die without intervention. The development face value. Moral reasoning relates to reasoning
of new drugs and advances in biomechanical tech- centered around moral and/or ethical issues.
nology permit physicians and nurses to challenge Different values, viewpoints, and methods of moral
nature. This progress also brings new, perplexing reasoning have developed over time. Older world-
questions. The ability to prolong life has created views have now emerged in modern history, such
some heartbreaking situations for families and ter- as the emphasis on virtue ethics or a focus on what
rible ethical dilemmas for health-care profession- type of person one would like to become (Butts
als. How is the decision made when to turn off the & Rich). Virtue ethics are discussed later in this
life support machines that are keeping someone’s chapter.