Critically analyse how ethical, professional and legal issues underpin nursing practice.

Critically analyse how ethical, professional and legal issues underpin nursing practice.

Introduction

Ethics regards standards of moral judgement and professional conduct. Nurses are highly accountable to patients, the public, employers, and the entire profession. It is imperative they have a sound understanding of various ethical, legal and professional issues they will face during their careers. There are three primary duties for nurses, among many others, which are the duty of autonomy, confidentiality, and duty of care to all patients. i These duties are supplemented by the principles of beneficence, meaning promoting or doing good and acting in patients’ best interests, and non-maleficence, meaning to avoid harm. ii These are professional duties which become legal duties if any legislation or policies are breached during practice. In 2001 a study found that there was a perceived need for more advice on ethical dilemmas within the health profession, after increasing legal cases and public inquiries.iii As a result, various Clinical Ethics Committees (CECs) and Research Ethics Committees (RECs) were established within the UK to provide comprehensive ethics support. Constantly changing values in health, behavioural science, and society mean that medical practitioners must be aware of new ethical issues for the medical sector, and learn how to respond appropriately.

2. Regulatory Bodies

The nursing practice upholds its own code of ethics and this is regulated by strict disciplinary guidelines, with the governing body having more influence over its member than legislative entities in medical matters. The Department of Health issued a Health Service Circular 219.99, which mandated some requirements of a new nursing education programme. In the Nursing and Midwifery Order 2001, the Nursing and Midwifery Council (NMC) must establish minimum standards and requirements for nursing education in professional and ethical issues.iv The NMC is an organisation established by parliament to protect the public and regulates the medical and nursing professional standards using the Register of Medical Practitioners (RMP). The Register acts to allow the GMC to monitor entry to the profession only by achieving the standards required to become an RMP, and also by monitoring ‘fitness to practice’ proceedings to ensure all practitioners maintain consistently high standards of conduct. The NMC contains guidelines regarding the expectations of particular duties such as confidentiality, medical research obligations, consent rights, and autonomy. The nursing practice is expected to comply at an individual level with these guidelines on a daily basis. The NMC’s ‘Code of Professional Conduct: Standards for conduct, performance and ethics’ is widely adhered to in the profession. To be registered, it is a general rule that nurses must undergo education in addition to personally indicating through performance and training that they intend to follow ethical standards to retain a licence for nursing.v

The General Medical Council (GMC) is a statutory entity with the role of protecting the public by maintaining a register of medical practitioners fit to practice, while also monitoring complaints about practitioners. There are fourteen key concepts which outline the ethical standards and responsibilities expected of a doctor. The GMC has also provided guidance on particular areas such as consent, confidentiality, and withholding or withdrawing treatment.vi This guidance is not mandatory, but is recognised at law, and in the case of W v Egdell, the court referred to the GMC guidelines on confidentiality.vii The British Medical Association (BMA) is the national association of practising doctors, with its own medical ethics unit which deals with individual ethical queries from doctors and nurses, and provides guidelines on ethical issues. Together, the GMC and BMA act to provide guidance for nurses and other practitioners to assist in ethical decisions, however it should be noted that these decisions are highly personalised, dependent on the patient and situation, and often subjective therefore unable to be entirely answered by these guidelines.

Given that the duty of confidentiality is a combined public interest and individual interest assessment, the judicial system does not provide ample guidance. This creates a problem for nurses and the ethical questions about who to protect. The GMC acts to protect practitioners who breach confidentiality rules if it was in the public interest, although this depends on the circumstances. The GMC will be unable to protect nurses if disclosure amounts to a significant breach towards the particular individual, despite assessment of legal and ethical questions. viii While case law often determines the ‘public interest’ query, individual practitioners and nurses must still exercise professional judgment and are personally accountable for any decisions which may breach ethical standards. ix

However, the ethical guidelines are not entirely subjective, and the NMC regulates the code of ethics which enforces all disciplinary processes for practitioners. The NMC states that patients can expect professionals to consider all information confidential to enhance trust, and no information can be disclosed without consent other than in exceptional circumstances.x Nurses are also under instruction from doctors and employers, required to exercise their own judgment as well as following directions and adhering to the ethics of the team and the Code of Professional Conduct for Nurses.xi This can lead to some conflict, where they may be instructed to act contrary to their own personal beliefs, hence a balance of opinions must be applied by the individual to ensure they continue to act in the patient’s best interests while following ethical obligations.

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