Codes of ethics
A
code of ethics
, based on universal values relating to nurses’
responsibilities for assisting others to achieve and maintain
their health, was first introduced by the International Council
of Nurses (ICN) in 1953. Such codes provide a standard or
template for nurses in the areas of professional practice,
accountability and public protection. The recent review of the
ICN’s Code of Ethics for Nurses (2012) identifies four funda-
Unit II Foundations of nursing and midwifery practice
200
mental responsibilities for nurses: to promote health, to
prevent illness, to restore health and to alleviate suffering (see
Box 11-3).
The codes of ethics and conduct in Australia and New
Zealand accommodate the increasing ethical demands on
the nurse’s role and provide frameworks for making ethical
decisions based on the professional expectations of nurses’
behaviour. Other functions of these professional nursing
codes include the following:
BOX 11-2 Ethical or moral agency
Situation: A 75-year-old patient with end-stage lung cancer suffers a respiratory arrest and is resuscitated, ventilated, and
admitted to the intensive care unit (ICU). When the receiving nurse reviews his chart, she discovers that, upon admis-
sion, his nurse documented that he ‘did not want to be resuscitated’ and that he wanted to prepare an advance directive
specifying ‘no heroics’. There is no do-not-resuscitate order on the chart, and the nurse can find no advance directive.
Sensibility
The ICU nurse notes the discrepancy between the patient’s documented preferences and the care he has received. She
senses personal discomfort about this disregard for his wishes.
Responsiveness
The nurse can decide to ignore her discomfort and simply provide excellent technological care or acknowledge her dis-
comfort and respond to it. She decides to talk with the attending doctor about his knowledge concerning the patient’s
preferences and learns he was unaware of the patient’s documented preferences and has no personal knowledge of
these. She contacts the nurse who originally admitted the patient and learns that although the patient was quite clear
about his preference, no-one followed up and translated this conversation into orders on his chart. The attending doctor
states that once treatment has been initiated it must continue but the nurse calls an ethics consultant.
Reasoning and discernment
During the ethics consultation, family members agree the patient would not be happy to find himself on a ventilator and
request he be weaned—even if this results in his death. The ethicist explains that weaning him from an ineffective treat-
ment (the ventilator will not cure his lung cancer) that is disproportionately burdensome is an ethically justified action.
Accountability
The nurse initiated the ethics consult because she believed she could not be an advocate for this patient and merely
provide good physical care. Once she knew (or suspected) that his preferences had been ignored, she felt accountable
for determining how the system had failed this patient and for remedying the problem. The nurse prides herself on being
responsible and accountable and therefore could not ‘stick her head in the sand’ and pretend that this was not her
problem! After the ethics consult, she participates in plans to wean the patient from the ventilator and makes sure that
his family is present. The patient does not survive the weaning, and although they are grieving, his family members are
grateful to the nurse for her care for the patient and for them.
Character
Because she had cultivated the virtues of responsibility and fidelity, the nurse’s course of action was natural.
Valuing
Because she places a high value on being an effective patient advocate, the nurse was willing to confront the attending
doctor and initiate an ethics consult, even though these actions caused her some discomfort and the expense of time
and inconvenience.
Transformative leadership
When her colleagues asked her where she got the ‘guts’ to follow through with this course of action, the nurse knew that
the culture within the hospital had to change so that more nurses would choose to do the same thing she did without
fearing negative consequences. She asks the nurse educator on her unit to explore the possibility of pursuing this theme
in a future professional forum and is willing to work to make this happen.
