The field of nursing is shaped by a range of ethical principles; while all of these concepts are important, one could argue that perhaps the most crucial ethical principle is that of beneficence. "Beneficence is the obligation to do good and avoid harm. Nurses help others to gain what is beneficial to them, which promotes well-being and reduces the risk of harm" (Young et al., 2009, p. 75). Having a clear understanding of beneficence is important as nurses are often presented with a range of complex ethical situations and dilemmas and they need strong principles to help guide their actions and nursing practice. As Young and colleagues explain, avoiding the harm that comes to a patient involves balancing this against the perceived amount of benefit. Other theorists see this concept in a slightly different perspective: "Beneficence is the principle of promoting the legitimate and important aims and interests of others, principally by preventing or removing possible harms" (Hitchcock et al., 2003, p.143). Via this definition, one can see how this matter can become complicated as what benefits one patient might harm another, conflict with the objectives of the agency, or clash with other ethical principles such as autonomy or an equal distribution of resources (Hitchcock et al., 2003, p.143). A perfect example of this would be a nurse who denies a patient the right to smoke tobacco to improve their respiratory health and overall immune system. While the nurse is essentially fostering the overall good of the patient's physiological health such as decision and action denies the client of pleasure, life quality and autonomy, another ethical principle. In such cases, the nurse has to be ready to weigh the consequences of her decision against the other moral issues at hand.
Stem Cell Research
When it comes to stem cell transplantation procedure, nurses need to be able to advocate and support patients who want to participate in the therapy; however, with embryonic stem cell research, the rights of the embryo in the arena of creation and destruction have to be acknowledged (Cedar, 2006). As Cedar elucidate, when it comes to donor cord blood procedure the inherent rights of the unborn child also need to be addressed and protected (2006). Many nurses work in interdisciplinary groups of other healthcare professionals, which means there's often a range of opinions and agendas that need to be balanced and promoted (Cedar, 2006). Nurses truly need to apply the concept of beneficence when it comes to their patients as they would any other ethical principle and to do so on a case by case basis. The reality of the advances made in stem cell research is that they truly can be life-saving, replacing dead cells in the brain and spinal cord, saving individuals from destruction and hardship, re-establishing their abilities to live as they are accustomed. While many believe that when it comes to embryonic stem cell research, the destruction of early embryos to derive needed stem cells some feel strongly violates the ethical principle of non-maleficence and is abortive and morally wrong.
Nurse have the obligation to weigh the respective ethical principles against each other and determine which one is more worthwhile and more closely promotes the principle of beneficence, of doing the most good for a given patient while minimizing harm as much as possible. Thus, a nurse doesn't have to have a single, concrete stance on stem-cell research. Rather a nurse can admit that she sees the pros and cons of the issue and the potential good that stem cells can do for human life and that she sees the somewhat destructive nature of this procedure. In order to live peacefully, there's really no problem with a nurse educating herself as much as possible on stem cell research and agreeing to address the issue on a case by case basis while promoting beneficence as much as possible.
Informed consent refers to the act of the medical professional explaining all the possible risks and repercussions that a patient could receive in connection with a given procedure. Patients are exercising their rights to autonomy when they exercise informed consent, as patients have an absolute right to know and understand all potential repercussions, complications and outcomes of a given procedure or drug. This issue can become murky if a patient is going through issues like cognitive failure, depression or extreme fatigue (Addington-Hall et al., 2007). For example, a nurse has to figure out how best to proceed if a patient needs a given procedure in order to live, but is cognitively unable to give their informed consent. In such cases the beneficence of the patient takes over the patient's right to autonomy and a family member will sign over their informed consent on behalf of the patient. This is a common ethical balance and weighing of options that occurs in nursing.
However, such an issue can become even murkier if a patient has a mental and emotional condition that prevents him or her from giving their informed consent for a given procedure. For example, if a patient is suffering from extreme depression and all interest in life and will to live has slowly evaporated, that patient may not give over their informed consent, even if a procedure is in his or her best interest. This can often create an extremely difficult moral and legal issue for a nurse to deal with, but one which a nurse and team of clinician needs to be well aware of their rights and options vs. The inherent rights and options of the patient.
Organ procurement can raise issues and cloud the principle of beneficence in a similar manner as stem cell research can. The issues are similar, but not identical. In a word, "Organ donation by living donors presents a unique ethical dilemma, in that physicians must risk the life of a healthy person to save or improve the life of a patient" (Truog, 2005). The issue of beneficence is truly compacted in such cases. Since with living donors there's a certain degree of risk to the health and safety of such brave people, the medical professionals involves need to weigh all options and constantly perform calculated risks. As Truog reminds one, living organ donations should generally be discouraged unless the proportions for success are relatively high. "In one instance, both parents of a child who was dying of respiratory failure insisted on donating lobes of their lungs in a desperate but unsuccessful attempt to save her life" (Truog, 2005). While anyone can understand the motivations and compulsions of the parents in trying to save the life of their child, beneficence isn't being served by any medical professionals if they're allowing donors to go through invasive surgeries to give up vital organs for procedures that are unlikely to work. Truog also makes other crucial points: in order to serve the ethical principle of beneficence most thoroughly, professionals truly need to examine the motivations and reasons why people want to become organ donors (2005). In the case of the child and her parents, the reasons were clear. However, for other donors the motivations might be murkier, such as dramatic suicide, media attention or becoming involved in the life of the patient (Truog, 2005). Medical professionals need to be aware of all the various issues at play and truly weigh the pros and cons of each donation, not to mention the likelihood of success before the official procedure is underway.
Palliative care is truly one of the most challenging aspects of professional health care and one which abounds with confounding ethical issues. For example, "pain relief is a moral obligation in health care, not an optional extra" (Randall, 1999, p.1). According to Randall, both doctors and nurses have the moral obligation to relieve pain, to…