ethics and some on organisational ethics. These committees
are uniquely equipped to deal with the complexities of
modern healthcare because they are interdisciplinary and
provide a forum in which radically divergent views can be
aired without fear of repercussion.
Nurses and midwives bring an important voice to the
ethics committee. When clinical issues are being reviewed,
they can help to ensure that the technical facts are under-
stood, that the appropriate decision makers have been
identified, that the person’s medical and overall best interests
have been identified, and that the course of action selected
from the alternatives is justified by sound ethical principles.
Nurses’ and midwives’ strong backgrounds in interpersonal
communication allow them to contribute unique knowledge
about the person and their family to the discussion and to
facilitate the ethics committee’s group dynamics.
Nurses and midwives also play an important role in
policy making. They are frequently able to identify what
policies are needed to address recurring ethical concerns and
to suggest needed modifications of existing policies. See
Chapter 10 for further discussion of the role of ethics com-
mittees in healthcare research.
ADVOCACY IN CLINICAL PRACTICE
By bridging vulnerable people with the resources they need
to secure health outcomes, nurses and midwives have
always been strong patient advocates.
Advocacy
is the protec-
tion and support of another’s rights. This role is increasingly
important because of people’s changing expectations and
demands, and because the public has learned that in our
increasingly market-driven healthcare economy, there are
no guarantees that the healthcare system will work to secure
their safety and health.
Nurses and midwives who value patient advocacy:
•
Make sure their loyalty to an employing institution or
colleague does not compromise their primary
commitment to the person
•
Give priority to the good of the individual rather than to
the good of society in general
•
Carefully evaluate the competing claims of the person’s
autonomy (self-determination) and patient well-being.
Woods (1999) describes how a nurse may become an
advocate though a nurse’s story of a 7-year-old Ma
–
ori boy
who was terminally ill. He requested that the nurse support
him in refusing any more blood transfusions; he understood
that without the transfusions he would die within the next
week or two rather than in a few months. The nurse tried to
coax and cajole him to accept the transfusions but he was
adamant; he needed her support to confront his family and
doctors with his decision. A meeting was convened and the
nurse advocated on behalf of the boy, helping him to present
his point of view. Despite intense emotions and pressure, the
boy and nurse convinced all concerned that stopping treat-
ment was in his best interests. Woods suggested that the
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Chapter 11 Values, ethics and advocacy
nurse’s strong moral conviction could have resulted in a
breakdown of relations between her and the doctors.
However, she sensitively navigated a complex moral situa-
tion and in doing so upheld Article 12 of the United Nations
Convention on the Rights of the Child (UNCROC, 1990),
which conveys the right of a child to have an opinion and for
that opinion to be heard in all contexts.
When respecting autonomy, you respect and support the
person’s right to make decisions. Informed consent is
described in Chapter 10. When promoting patient well-
being, you must act in the best interests of the person.
Ideally, both autonomy and patient well-being are promoted
in every interaction between you and your patient; however,
conflicts sometimes arise.
Representing patients
Most nurses and midwives would agree that a great deal of
time is spent representing patients’ interests or guiding
people in protecting their own rights. They are often involved
as an intermediary between the person and the family, espe-
cially when the person and family have conflicting ideas
about the management of healthcare situations. For example,
a person with terminal cancer may want to go home to die.
He tells this to his nurse. The person’s family, however, tells
the nurse they cannot care for him at home. As an advocate,
the nurse recognises the rights of both the person and his
family. The nurse then works to assist them in finding a
solution that benefits both the person and his family. By
informing the family of the availability of home care and
hospice care, the nurse gives them knowledge that may help
satisfy the person’s right to a dignified death. Working
alone, most people would be unable to get the financial help
needed for such care. Nurses have the resources available to
help them and can arrange referrals from other healthcare
workers, such as social workers, to achieve the desired out-
comes.
Patients with special advocacy needs include those who
are uninformed concerning their rights and opportunities,
those with sensory impairment, those who do not speak
English well or at all, the very young and older people, those
who are seriously ill, those who are mentally or emotionally
impaired, those with physical disabilities, and those who
lack adequate financial or human resources.
Promoting self-determination
Advocacy is linked to the belief that making choices about
health is a fundamental human right that promotes the indi-
vidual’s dignity and well-being. Ethical dilemmas may arise
when people are unable or unwilling to make choices, or
when they are not given the opportunity to do so. Faulty
communication among patients, family members and carers
frequently contributes to these dilemmas. Nurses have an
important advocacy role in educating the public about the
value of written advance directives (ADs) (described in
Chapter 26), and midwives provide a powerful voice in
