ethics lecture rant (sensitive topic)

fergus51 · Feb 5, 2005

Ginyer, I used to feel the way you do. Then I took a job in an area of nursing that deals with a lot of ethical grey areas. I have asked to be assigned another patient once in my career because what we were doing to that child was so horrific to me that I knew I couldn't provide the best care to the family. I see no value in forcing nurses to care for those patients. It harms the nurse and the patient. Personal feelings probably shouldn't interfere with work, but I'm not a robot. I'm not the perfect nurse. I try to do my best every shift, but some things are just too much sometimes and I'm lucky that I have supportive coworkers who are understanding of that.

Some things that might make you understand where I'm coming from: Would you look after an infant that we were allowing to dehydrate to death and not give it any fluids? Would you be willing to code a child who has a terminal condition over and over (see a code yet? It isn't gentle)? These are both situations I've been faced with as a nurse. One I could deal with, one I couldn't. I hope you can understand, it isn't about judging others, it's about being ablt to live with myself.

smk1, LPN · Feb 5, 2005

I agree, because if you refuse to care for one person for something, where would it stop? Refuse to treat someone with high cholesterol because they eat meat, and you don't? Refuse to treat a drug addict? An alcoholic? Someone that bungee-jumped because YOU would never do it?
Exactly...where would it stop? We are going to come across pt's all the time who have completely different lifestyles than our own. We won't know the whole story or the entire truth of the situation they are in which is why we couldn't appropriately pass any type of judgement on them. Like I said I was just really surprised that my classmates were so quick to say they would automatically refuse to care for this group of pt's. I sure hope they aren't planning on working in the ER.
A student in my class works on the telemetry floor as a pca. She was telling us about a pt that comes in almost every month who supposedly is sexually harassing his female nurses. He'll grab their butt, grab their breasts, talk dirty, exposes himself, and sometimes when they lean over him for something he'll grab the front of their scrub top and pull it down and look down their top. They get male nurses for him when they can but they're rarely available on that floor. I'm not aware of what hospital policy is on this type of stuff. This situation is a different can of worms but we're talking about what would affect our care for a pt. I have no idea how this would affect my care for this pt. Just wondering what yall thought about it.
Ginyer
i am not a nurse yet so i am just anserwing as a woman, but there are public indecency laws that should be enforced here, if he is constatly exposing imself and grabbing someones private parts, that is sexual assault, and public indecency. If it has been well documented by a few different nurses and nothing has been done, i personally would call the police the next time it happens. He needs to be taught a lesson. :angryfire

NurseFirst · Feb 5, 2005

And I am pro-life.

I won't ever work in a PP clinic, nor give them my money from United Way.

Nor would I work in a fertility clinic -- I'm one of those people who believes life begins at conception.

You are on dangerous, dangerous grounds if you refuse tx based upon lifestyle choices. Isn't it like 75% of disease is preventable, and is due to lifestyle choices (DM II--though not all suffers; CA from smoking; any number of diseases from obesity; alcoholism). DM II is a huge one, because so many of the pts in other departments (CV, Ophthalmology, PVD, surgery d/t amputations) are due to complications of DM. So, the DM is a case in point, right? Who's to say that someone has DM II because of lifestyle choices and who could have avoided it?

NurseFirst

Soleilpie · Feb 5, 2005

I think there's a difference between treating someone with what you would consider to be unethical treatment and treating someone who has different morals than you do. Certainly we can probably all agree that we would not participate in the unethical treatment of a patient. After all, you have your license to protect. Now treating someone with different morals is another issue. The actions that bring a patient to the hospital may go against your morals, but it's not unethical to treat them. It would be unethical not to provide ethical treatment for them. What level would we be stooping to, if we chose not to help a patient? Would we be any better than the person who we thought acted immorally? Could we say that by not helping that patient we are acting morally or ethically?

If you cannot help all patients regardless of their beliefs, then health care probably should not be your career choice.

allnurses Guide · Feb 5, 2005

The difference as I see it is as others have mentioned, not assisting with an abortion if you are pro-life and see that as killing an innocent. However you most likely won't be faced with that if you don't work for a facility that performs abortions so that discussion is moot.

Taking care of someone who then comes to your floor from the ER after hemorrhaging at home is completely different. You are not helping facilitate an abortion, you are helping a women who was bleeding. You can't, in good conscience refuse to care for her, in my opinion.

Circumcision also - you have a right not to help the doctor with that but you should continue to care for the infant afterwards. To not do so would be wrong, again in my opinion.

That sexually deviant guy is a completely different story - we do not have to put up with being treated that way - it is harrassment and no one can force you to care for a patient who is harrassing you.

School is a good place to hash this stuff out though . . .these are things that before becoming a nurse most of us had not thought about. Better to hash it out in school than be faced with it at work and have no idea how to respond.

I think your teacher did a good thing to encourage discussion . . .. sometimes you find yourself changing your mind a bit when you hear others out.

Forced to assist in an abortion if you are pro-life - no. Taking care of a patient with complications - yes.

steph

fergus51 · Feb 5, 2005

. Certainly we can probably all agree that we would not participate in the unethical treatment of a patient. After all, you have your license to protect.

I'd be careful there. What is ethical/moral and what is needed to protect your lisence are not necessarily the same thing.

Long Term Care Columnist / Guide · Feb 5, 2005

The difference as I see it is as others have mentioned, not assisting with an abortion if you are pro-life and see that as killing an innocent. However you most likely won't be faced with that if you don't work for a facility that performs abortions so that discussion is moot.
Taking care of someone who then comes to your floor from the ER after hemorrhaging at home is completely different. You are not helping facilitate an abortion, you are helping a women who was bleeding. You can't, in good conscience refuse to care for her, in my opinion.
Circumcision also - you have a right not to help the doctor with that but you should continue to care for the infant afterwards. To not do so would be wrong, again in my opinion.
That sexually deviant guy is a completely different story - we do not have to put up with being treated that way - it is harrassment and no one can force you to care for a patient who is harrassing you.
Forced to assist in an abortion if you are pro-life - no. Taking care of a patient with complications - yes.
steph

That's where I draw the line, too, Steph.......It's why I don't get people like that one pharmacist who refused to dispense birth control pills---if you don't believe a particular task or procedure is right, then you shouldn't work for an employer who expects you to perform it in the normal course of your job duties. It's a no-brainer........but then, some people have to make a statement , don't they? :rolleyes:

Soleilpie · Feb 5, 2005

i'd be careful there. what is ethical/moral and what is needed to protect your lisence are not necessarily the same thing.

there are standards put in place that define the scope of everyone's practice, which involves the ethical treatment of a patient. can anyone truly say that there is an instance where it would be ethical to withhold the treatment of a woman who had an abortion? there are probably some gray areas that are harder to define, but i can't think of any right now. maybe this one will do...the subject of physician assisted suicide... some consider it unethical to allow a terminal patient to die without any mercy. others think it goes against good morals and is considered murder. some view healthcare professionals as people who are supposed to prevent death, not hasten it. others see it from the perspective that healthcare professionals should not cause suffering and yet allowing them to die without assistance is causing suffering. right now, i believe pas is only lawful in oregon, but should it become lawful everywhere, no one is going to force anyone to participate against their will. this is the kind of "treatment" where the healthcare professional can choose not to assist the patient in. some of you may come up with better ethical dilemmas with respect to non-treatment by a healthcare professional that involves a gray area.

fergus51 · Feb 5, 2005

How about the ones I mentionned Soleilpie? Would you care for an infant and not provide it with fluids because we are allowing it to dehydrate to death?

It's situations like that which have led me to be a little more understanding of nurses who don't wish to participate in abortions and the like. There are certainly many black and white cases where nurses should have to provide care, but there are a lot of grey areas too. I just want people to consider that before passing judgements on their colleagues.

allnurses Guide · Feb 5, 2005

there are standards put in place that define the scope of everyone's practice, which involves the ethical treatment of a patient. can anyone truly say that there is an instance where it would be ethical to withhold the treatment of a woman who had an abortion? there are probably some gray areas that are harder to define, but i can't think of any right now. maybe this one will do...the subject of physician assisted suicide... some consider it unethical to allow a terminal patient to die without any mercy. others think it goes against good morals and is considered murder. some view healthcare professionals as people who are supposed to prevent death, not hasten it. others see it from the perspective that healthcare professionals should not cause suffering and yet allowing them to die without assistance is causing suffering. right now, i believe pas is only lawful in oregon, but should it become lawful everywhere, no one is going to force anyone to participate against their will. this is the kind of "treatment" where the healthcare professional can choose not to assist the patient in. some of you may come up with better ethical dilemmas with respect to non-treatment by a healthcare professional that involves a gray area.

you bring up good points as does fergus . . .i would quarrel with the way you phrased how some who don't believe in assisted suicide don't believe in letting a patient die with mercy.

your definition of mercy = assisted suicide. i think mercy means letting someone die a natural death with more than adequate pain relief.

i don't think not believing in assisted suicide means i'm unmerciful.

so, just a difference of opinion of mercy.

otherwise - good discussion everyone - keep going.

steph

Soleilpie · Feb 5, 2005

How about the ones I mentionned Soleilpie? Would you care for an infant and not provide it with fluids because we are allowing it to dehydrate to death?
It's situations like that which have led me to be a little more understanding of nurses who don't wish to participate in abortions and the like. There are certainly many black and white cases where nurses should have to provide care, but there are a lot of grey areas too. I just want people to consider that before passing judgements on their colleagues.

Fergus, I was never judging you. The situation you were involved in can be a gray area for some. For me, I see that particular treatment as unethical because by allowing the infant to dehydrate to death is causing a tremendous amount of suffering. I don't see dehydration as a form of treatment or a form of mercy. So, I would probaby have reacted just like you did. Your dilemma was very clear to me. :cry:

fergus51 · Feb 5, 2005

I actually didn't refuse to care for that infant Soleilpie. Surprised? New research says dehydration is not painful and that infant was well medicated and I believe his death was merciful. Other nurses in the unit did not care for him because they felt as you do and I respect that.

The child I refused to care for was the one who had a condition that was incompatible with life, but whose parents insisted be a full code. I could not reconcile that with my beliefs because I thought it was cruel. Other nurses could. I guess my point is with enough understanding coworkers, nurses shouldn't be forced to do things that they find unethical or immoral because it doesn't do anyone any good. If we're going to suggest that people can't go into nursing if they can't look after every patient we are going to lose a lot of good people.

Can anyone tell me the benefits of forcing a nurse to care for such patients when there are other nurses who are willing to do it and don't have the same ethical qualms?