Are you an ethics champion?
Access to affordable, good-quality care remains a challenge for many, and it is not uncommon for patients to receive too little of the right kind of treatment or too much of the wrong treatment. Perhaps never before has it been so important for nurses to be skilled in recognizing and responding to everyday ethical challenges.
EDITOR'S NOTE: Carol Taylor, PhD, RN, is a senior clinical scholar in the Kennedy Institute of Ethics at Georgetown University in Washington, D.C., a professor of nursing and the former director of the university's Center for Clinical Bioethics. Taylor directs an innovative ethics curriculum grounded in a rich notion of moral agency for advanced practice nurses. She lectures internationally and writes on various issues in healthcare ethics and serves as an ethics consultant to systems and professional organizations.
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Ensure that every patient and family member is treated with compassion and respect
Not everyone we encounter in our busy practices is what we might describe as a polite human being who is grateful for our care. In fact, many are ill because of poor lifestyle choices, act out — sometimes violently — or seek drugs or other inappropriate treatment.

As professional caregivers, nurses are not expected to be OK with being treated disrespectfully by anyone, but we are expected to treat every person we encounter with respect and to ensure that our entire team does the same. In some practices where inappropriate comments are the rule, this requires moral courage.

No one wants to work with a “goody two-shoes,” but it is not unrealistic to establish a culture that prizes zero tolerance for disrespectful speech and behavior for all.
Support patients and their surrogates as they make healthcare decisions
Provision 1.4 of the American Nurses Association Code of Ethics for Nurses describes nurses’ duties to respect and promote patients’ right to self-determination.
According to the code of ethics, patients have the moral and legal right to be given accurate, complete and understandable information in a manner that facilitates an informed decision; and to be assisted with weighing the benefits, burdens and available options in their treatment, including the option of no treatment.
Resolve conflict about the plan of care
All is well when there is agreement about treatment goals and the best plan of care to achieve these goals. Sometimes, members of the professional caregiving team, the patient and the patient’s family disagree about the appropriate goal (recovery, stabilization of functioning or preparation for a comfortable and dignified death) and the best means to achieve this goal. In these instances someone needs to step up and voice the need to address the conflict.
Often the biggest challenge is simply getting major players into the same room at the same time to review the goals and plan of care. A family conference may settle the conflict. If the conflict persists, an ethics consult can be arranged.

In some instances a palliative care consult may help resolve the conflict. Each practice situation is different and the resources available to you may be unique to your setting. Become familiar with how to access the resources you need to resolve ethical conflicts.
Study the ANA’s Code of Ethics for Nurses.
Identify and use the ethics resources in your hospital or facility, including ethics consultants and ethics committees.
Watch for educational opportunities, such as the National Nursing Ethics Conference.
Learn more about moral distress. Check out the Moral Distress Education Project.
You also may want to advance your formal education in healthcare ethics. Sigma Theta Tau International offers a healthcare ethics certification program.
If you are serious about becoming an ethics champion, here are a few recommendations:
Questions for reflection
What priority do you assign to talking with patients and families/surrogates about their preferences for treatment goals and the plan of care? What percentage of your clinical time do you devote to this?
How often do you experience discomfort/moral distress because you believe the patient’s treatment goals and plan of care are not appropriate?
What is your capacity for providing the knowledge and support patients and their surrogates need to make informed decisions consistent with their beliefs and values?
What strategies for clarifying treatment goals and related interventions and ensuring that the entire team is on board have you found to be most helpful?
Provision 1.4 of the American Nurses Association Code of Ethics for Nurses describes nurses’ duties to respect and promote patients’ right to self-determination.
The code also states that the importance of carefully considered decisions regarding resuscitation status, withholding and withdrawing life-sustaining therapies, foregoing nutrition and hydration, palliative care and advance directives is widely recognized. Nurses assist patients as necessary with these decisions.
What’s important isn’t merely that patients or their surrogates make choices, but rather that they make choices that will secure their interests. The object of all clinical decision-making is primarily to secure the health, well-being or dignified end of life for the patient, and to do this in a manner that respects the integrity of all participants in the decision-making process. This often requires more support for the patient and family than simply listing alternatives. Nurses are uniquely positioned to help patients understand how these choices are likely to play out over time.
Good nurses and ethics champions are competent, compassionate, collaborative advocates for patients and families, and are remembered for being and making the critical difference in patients' experiences. They operate within the following three core responsibilities on behalf of everyone for whom they care. Ethics champions:
#1
#2
#3
You are if you promote 3 core responsibilities
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By Carol Taylor
PhD, RN Ethics expert and educator
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