The nursing profession is subject to a variety of rules and regulations that are enforceable by various stakeholders including the government. In addition, nurses are guided through their practice by a code of ethics. These two forces (ethics and the law) are prominent features in the activities of any nursing professional. Nevertheless, most professionals find it hard to go about their activities without experiencing conflicts between legal and ethical issues (Varcoe & Makaroff, 2012). Most ethical nursing issues are closely connected to matters of the law. Consequently, most nurses use personal ethics to avoid getting into legal trouble. Ethics are flexible and they might change in accordance with different situations. It is difficult to ascertain whether a nurse’s ethics are right or wrong due to their ambiguous nature. However, most of the legal issues that concern nursing are rigid and non-debatable. Defiance over legal issues might lead to legal-proceedings and subsequent punishment for nurses. Nurses mostly engage with legal issues through prescribed practices that might lead to malpractice and negligence lawsuits. Nevertheless, it is possible for nursing professionals to encounter issues that are ethically acceptable but legally improper and vice versa. Some of the issues that present conflicts between legal and ethical viewpoints include euthanasia and abortion. This paper is a discussion of the conflicts that exist between legal and ethical factors and how nursing professionals react to these differences.
There are several legal and ethical conflicts that might be manifested in the course of nursing practice. Nurses are often faced with the quagmire of honoring their sense of duty towards their clients on one hand and abiding to the legal guidelines that dictate the nursing practice on the other. One of the conflicts that might exist in the course of nursing practice involves situations where nurses do not renew their licenses in time. Registration is an important part of the nursing practice. Consequently, failure to renew a license presents nurses with legal troubles. On the other hand, a nurse can argue that he/she is still skilled even with or without fulfilling licensing obligations. The moral ethics of practicing without a license often conflict with the illegality of this action. Another conflict that might occur in the course of nursing practice involves nurses obtaining medicine for their patients without following the necessary procedures. Most nurses are conversant with the medication that can be used to alleviate suffering among their patients. However, legal stipulation gives physicians, doctors, and other medical practitioners the exclusive jurisdiction of prescribing medicine to patients (Varcoe & Makaroff, 2012, p. 488). Consequently, when a nurse seeks to ‘help’ a patient by obtaining medication for him/her without a prescription, this action fulfils an ethical consideration although it is illegal. This legal-ethical conflict is common in clinical settings where doctors and other higher-ranking physicians might not be present.
Another example of a legal-ethical conflict in nursing involves resuscitation of dying patients. In some cases, doctors and/or family members might issue a ‘do not resuscitate’ order. However, a nurse might feel morally obligated to resuscitate the patient even though this action is illegal. Consequently, a nurse can argue that it is his/her moral obligation (ethical) to resuscitate a dying patient but there is no law that can support such a decision. The ethical belief that it is the goal of nurses and other medical practitioners to keep a patient alive by all means necessary often conflicts with legal stipulations.
The ethics involving money and the health of patients can lead to legal-ethical conflicts. In an age where most medical practices are aligned with capitalism and consumerism, it is common for nurses to be forced to undertake unnecessary procedures on patients with the view of profiteering (Park, Kjervik, Crandell & Oermann, 2012). Nurses can use their personal ethics to identify the procedures that are necessary for their patients. However, hospital administrations can use the provisions of the law to compel nurses to conduct therapies that might contribute towards the wellbeing of the patients. A healthcare provider might be legally culpable if he/she fails to provide any service that might be beneficial to a patient. However, this legal provision is often used to circumvent the ethical considerations of individuals when hospitals and other healthcare organizations are seeking to profit from a patient’s suffering. On the other hand, patients who lack financial means such as a good insurance cover are often denied services on ‘ethical’ grounds.
Professional nurses have several methods of circumventing the clashes that are manifested between ethics and the law. First, there is a code of ethics that stipulates how nurses should deal with issues of conflicts between the law and their own morals. The nurses are also advised on how to react to various environmental factors that might generate legal-ethical conflicts (American Nurses Association, 2011). Nevertheless, in the modern nursing practice capitalism has exacerbated the instances of conflicts between the proper ethics of this profession and the law. Consequently, a nursing professional’s ethical considerations might put him/her in direct conflict with both the law and his/her employer. On certain occasions, the nurses’ code of ethics might fail to offer helpful guidelines when it comes to legal matters. In other cases, the government is the source of conflict between legal and ethical nursing matters. For instance, the government can prohibit nurses from attending to certain individuals or administering some medications or procedures without considering the ethics of these proclamations. On such occasions, nurses are expected to strike a balance between the ethical and legal ramifications of their actions. For instance, if a government’s proclamation is based on political malice, a nurse can find ways of navigating through it without getting into legal trouble.
It is important for nurses to respect the decisions of their patients as long as they have been made by consenting adults. Most of the decisions that are made by the patient’s family precede legal and ethical considerations in the course of the nursing practice. Consequently, nurses should find ways of navigating through a family’s decision to turn down certain patient-based services. Legal proceedings often favor the decisions of the patients and their kin as opposed to the actions of healthcare professionals. Overall, most legal-ethical conflicts originate from individual 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” (Van der, Abma & Widdershoven, 2012). All these values have evolved to become part of the social and moral order in the society. It is important for a nurse to harness these values in respect to the stipulations of the profession.
Historically, nurses have handled conflicts between the law and ethics in a number of ways. History indicates that there is a definite pattern between personal distress in nursing professionals and legal-ethical conflicts. For instance, “when a nurse faces an unreasonable burden, a personal danger, conscientious objection, and, concerns regarding individual competence…this burden manifests in the nurse’s capability to avail safe care” (Gallagher, 2011, p. 87). In addition, statistics indicate that most legal-ethical issues are fueled by situations that involve communicable diseases, violence, sexual assault, and physical abuse.
The American Nursing Association’s (ANA’s) code of conduct is the most used ethical guideline in the nursing profession. Examples of remarkable situations that involve legal-ethical conflicts include cases dealing with life/death choices and incompetence. For instance, in 1975 a patient’s right for self-determination was at the centre of a conflict between the law and ethics (Varcoe & Makaroff, 2012). In this case, a patient named Quinlan was admitted in a hospital and subsequently slipped into an ‘unresponsive’ coma. The hospital was legally mandated with sustaining the patient using life-support equipment but the family was seeking to invoke the staff’s ethical mandate to remove the unresponsive patient from cost incurred but life-sustaining equipment. The matter was taken before a judge who determined that the family could make the decision on behalf of the incapacitated patient. Henceforth, the power of medical decisions became part of people’s final will and testament.
The practice of refusing to feed patients by withdrawing feeding tubes also presented another remarkable legal-ethical conflict. Nurses are tasked with the decision of monitoring patients’ ventilators and feeding tubes. Denying feeding tubes to a patient might qualify as ‘withdrawal of life support’ but it presents a moral dilemma because in ordinary circumstances, no one would voluntarily forego feeding with the view of dying through starvation. This was the case when a car crash victim suffered brain damage and the family requested for the withdrawal of feeding tubes. This decision was taken through a series of courts but the family’s wish was eventually granted by the Supreme Court. Thereafter, “the Self-Determination Act of 1990 was established and it required that all medical facilities accept Medicare or Medicaid funding to provide counseling for patients on advance directives” (Bartter, 2010, p. 67). From that point onwards, the healthcare professionals’ ethical need to protect families when it comes to life/death decisions was catered for legally. Nurses use various codes of ethics that are available to them when they are dealing with legal-ethical conflicts. The main idea in any code of ethics is that it is the responsibility of nurses to prevent diseases, promote and restore healthcare, ease suffering, and take care of the community’s welfare. Consequently, these goals can be used as defenses during legal proceedings that concern legal-ethical conflicts.
Most legal-ethical conflicts occur when nurses fail to apply their respective code of ethics in respect to their responsibility to clients. However, it is possible for nurses’ responsibility to patients to collide with their own rights. The values and moral standards of a nurse can also stand in the way of a patient receiving healthcare. Consequently, it is upon the nurses to isolate a specific legal-ethical conflict and point out the dilemmas that apply to the aforementioned problem. A nurse should move forward by implementing a plan that incorporates all possible solutions to the problem. Patient welfare should not be used as an excuse for contravening legal or ethical stipulations that apply to healthcare.
References
American Nurses Association. (2011) Code of ethics for nurses with interpretive statements. Washington, DC: ANA Publications.
Bartter, K. (2010). Ethical issues in advanced nursing practice. Philadelphia: Elsevier. Gallagher, A. (2011). Moral distress and moral courage in everyday nursing practice. Online journal of issues in nursing, 16(2), 68-75.
Park, M., Kjervik, D., Crandell, J., & Oermann, M. H. (2012). The relationship of ethics education to moral sensitivity and moral reasoning skills of nursing students. Nursing ethics, 19(4), 568-580.
Van der, S., Abma, T. A., & Widdershoven, G. (2012). Moral Case Deliberation as a Platform for Discussing Everyday Ethics in Elderly Care. Health Care Analysis, 20(3), 250-267.
Varcoe, C., & Makaroff, K. (2012). Nurses’ perceptions of and responses to morally distressing situations. Nursing Ethics, 19(4), 488-500.