Reference no: EM132906975

Ethics In Practice Tension between Individual and Societal Rights Gail A. DeLuca Havens, PhD, RN Codes of ethics can be thought of as moral codes. Moral commitments "to adhere to the ideals and moral norms of the profession," such as maintaining competency in practice, are expressed in the American Nurses Association (ANA) Code of Ethics for Nurses (2001, p. 5) and are made by individuals when they become nurses. The fundamental concept underlying the Code of Ethics for Nurses is respect for persons. Certain principles growing out of this concept guide nurses' decision making. These include fostering self-determination, doing good, avoiding harm, being truthful, respecting privileged information, keeping promises, and treating people fairly. In their moral decision-making hierarchy, Beauchamp and Childress (2001) refer to principles and rules as action guides. Principles are the more global and basic conceptions that justify the rules. When ethical principles are being considered, it is important to remember that individuals are interdependent members of a community. The nurse will encounter situations in which the tension between individual liberty and the need to preserve the health and well-being of the community creates an ethical dilemma in practice.

• For instance, the nurse promises, as expressed by the principle of fidelity in the ANA Code, to maintain client confidentiality. However, such a promise is not absolute when innocent parties are in direct jeopardy (e.g., threatened with being killed) (ANA, 2001). This particular kind of dilemma is made even more troublesome for the nurse who is attempting to deal with two opposing or contradictory promises. For example, the implicit promise of the nurse to maintain client confidentiality, as expressed in the ANA Code, may contradict the nurse's obligation to obey a law that requires reporting a particular situation (ANA, 2001). The nurse also has an ethical responsibility to respect the client and promote self-determination. Consider the following situation. Kay is a community health nurse who has been employed by a home health agency for more than 10 years. Several of her clients live in a homeless shelter and have been referred to her agency for follow-up tuberculosis treatment after hospital discharge. Today she is making her first visit to Paolo, a 33-year-old Hispanic man discharged after treatment in the hospital for acute, infectious tuberculosis. Kay explains that her agency, along with the city's health department, helps persons with tuberculosis continue to take their medication as prescribed until they are cured. Kay asks Paolo how he is feeling this morning. He replies that he is tired; he did not sleep well this first night in a place not familiar to him. After she completes Paolo's admission history and physical examination, Kay tells him that she, or a nurse substituting for her, will be visiting Paolo daily for 2 weeks to observe him taking his medication and then twice weekly for at least 6 months.

• Paolo protests that he is not a child and that he can be depended on to take his medication as prescribed. Kay explains that the current standard of care is that everyone in the community being treated for tuberculosis receive directly observed medication therapy. It will help him remember to continue to take medication as prescribed, particularly when he begins to feel better. Stopping the medication makes the treatment he received in the hospital ineffective. When medication is stopped, often the tuberculosis becomes infectious again. In addition, not completing treatment increases the likelihood that he will develop a type of tuberculosis that is resistant to medication therapy (Centers for Disease Control and Prevention [CDC], 2003a). He could be very ill again. The city has an obligation to protect its residents from becoming infected with tuberculosis. Kay tells Paolo that she will be communicating with health department personnel because they are the ones who referred him to her. Paolo agrees, reluctantly, to cooperate in therapy. He asks how long it will take to be cured. Kay knows that the response to therapy varies, but most persons can be cured within 9 months (CDC, 2003b). Kay explains that 6 months of medication has been prescribed to cure his tuberculosis. Before Kay leaves, Paolo takes his first dose of medication, and they establish a schedule for his observed daily self-administration. Paolo's treatment continues as planned over the next several months. He gains strength and eventually finds a job. Returning to work requires that his medication regimen be modified. Paolo has no trouble adapting it to his more demanding schedule. Several weeks pass with this new arrangement until, one evening, Paolo does not appear. Kay leaves a message for him to call her, but does not hear from him. When Paolo fails to appear again the following evening, Kay returns to the shelter. Eventually, Kay learns that Paolo has not been complying with his prescribed medication regimen. He does not deny it and tells Kay that because he has been taking medication for more than 3 months and feels better, he believes that he is cured of his tuberculosis and no longer needs therapy.

Question 1: How might Paolo be affected by this experience? How might Kay be affected by this experience? Which alternative would you choose?

Question 2: Should individual rights be compromised to control the spread of communicable diseases for the good of society?

Question 3: What is the role of boards of health in your community and state in preventing and controlling communicable diseases?