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Chapter 11 Values, ethics and advocacy
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relationship. These prerequisites relate not only to skills and
clinical competence but to the values and beliefs of the
nurse or midwife. Therefore, nurses and midwives must
have a well-developed understanding of the role of ethics in
professional practice and how their own ethical position will
affect the care they deliver. Ethics, or morality, poses ques-
tions about how we ought to act and how we should live. It
is an inquiry into the justification of particular actions (e.g.
Are these actions right or wrong?), as well as a search for
traits of moral character that promote more human growth.
Nurses and midwives need to have a clear and well-
developed personal moral compass to deal appropriately
with the trust that is placed in them through the intimate and
often privileged relationship they have with communities
and individuals. They are increasingly confronted with
moral and ethical decisions; the more that science and tech-
nology increase the options available to people and
healthcare providers, the more frequently nurses and mid-
wives will find themselves confronted by situations not
previously encountered. In these situations, often the ques-
tion you will be confronted with is not ‘How do I do this?’
but, rather, ‘Should I do this?’ or ‘We can do this, but should
we, here and now, for this person?’
Healthcare professionals can be distressed by the failure
of society to provide adequate care for its most vulnerable
members. Nothing is more disturbing for professional
nurses and midwives than seeing first-hand the conse-
quences of unmet healthcare needs. When caring for people
who may lack the ability to comply with medical treatment
on an ongoing basis, they have special advocacy obliga-
tions. A shortage of nurses further complicates the nursing
work environment, creating the necessity for nurses to be
skilled advocates for safety, quality care, and their own
needs. Never has it been more important for nurses and mid-
wives to grasp the ethical dimensions of professional
practice and to be confident in ‘doing the ethically right
thing simply because it is the right thing to do!’ With their
moral integrity under scrutiny every day, they need to be as
skilled ethically as they are intellectually, interpersonally
and technically.
VALUES
Ethical issues are a part of daily life in nursing. Such ‘every-
day’ nursing practices as administering medication,
providing physical care or communicating with patients all
have the potential for ethical implications. Therefore, nurses
require core professional and personal values. Johnstone
(2009, p. 11) suggests that, when discussing and advancing
debates on ethical issues in nursing and healthcare, it is vital
all parties involved share a working knowledge and under-
standing of the meanings of terms and concepts fundamental
to the issues being considered.
A
value
is a belief about the worth of something, about
what matters, that acts as a standard to guide one’s behav-
iour. If you think back to how you spent your last weekend,
you may observe something about your values. The amount
of time and money you devote to relationships, work, study,
fitness activities, leisure and other experiences reveal some-
thing about the importance (value) you attach to these
endeavours. Values are the link that ties together personal
perceptions and judgements, motives and actions.
A
value system
is an organisation of values in which each
is ranked along a continuum of importance, often leading to
a personal code of conduct. A person’s values influence their
beliefs about human needs, health and illness; the practice of
health behaviours; and human responses to illness. For
example, individuals who place a high value on health and
personal responsibility often work hard to reach their fitness
goals. Individuals who value high-risk leisure activities may
attach less value to life and health. Some values held by indi-
viduals may be at odds with the values of others in the same
family, community or society. This situation raises issues
about the rights of individuals to express their values, about
societal judgements regarding which values are to be toler-
ated, and others’ tolerance for difference. Nurses and
midwives who work effectively with people are sensitive to
others’ values while being clear about how their own values
influence their actions and interactions.
The impact of personal and professional value systems
can be explored in the following scenario.
Abdul Naljib is an alert 32-year-old man in the inten-
sive care unit who is begging to be removed from the
ventilator. He understands it is highly unlikely he will be
able to breathe on his own without the ventilator. He
writes on the communication board: ‘If I die, I die. I can’t
keep living like this.’ In this potentially very distressing sit-
uation, you will have to consider your own personal value
position as well as that of the profession. Now reflect on
what your own personal value position would be if you
were the nurse who had to respond to Mr Naljib. Would
your own value system alter the way you responded?
Investigate what the value position of the profession is
towards such a request made by Mr Naljib. Then further
reflect and consider if this aligns with your own
values and, if not, does this change your position?
Development of values
People’s values develop in response to the environment,
family and culture in which they are raised and in relation to
the meaning they attach to their life experiences. Quality of
life can be seen therefore as a product of physical, mental,
social, environmental and spiritual health.
As children observe the actions of others, they quickly
learn what has high and low value for family members. If the
parents spend a large portion of each day cooking, and the
family spends a long time eating and talking at the table, the
children learn to value food and the good times it represents.
Similarly, children learn that helpfulness is a good and
respected quality if praised when helping parents, grandpar-
ents and siblings. Values are further refined through discipline
