Nursing informatics: ethics, law, and technology in healthcare

Nursing Ethics

In the late 20th and early 21st centuries, medical technology has advanced enough to provide certain measures to keep the body "alive," but not necessarily the brain or the cognitive functions that make up quality of life (O'Keefe-McCarthy, 2009). Despite the fact that death is a cyclical part of life, humans still have a very difficult time dealing with issues surrounding terminal illness: hospice, do not resuscitate, costs for survival, euthanasia, and conversations about end of life planning. For the modern Nurse leader, the core of the philosophical and psychological debate seems to focus on two viewpoints. One believes that the individual has control over their body and the decisions surrounding their quality of life. The other view takes on a more moral and religious stance, believing that life is divinely created and that nurses and doctors, in particular, have society's trust and the responsibility to preserve life at all costs. The conundrum for the modern nurse centers on the issue of doing no harm, when clearly a patient is in pain or distress; but legally being unable to allow the basic principle of autonomy for the individual (American Nurses Association, 1994; International Medical Informatics Association, 2012, p. 4).

The nursing argument is really an argument-based ethical issue involving several aspects of medical ethics: autonomy, nonmaleficence, beneficence, and justice. From a care perspective, nursing can be considered a situationally positive of negative form of appropriate nursing care. Ironically, nursing responsibilities are used in both the pro- and con- arguments. The additional critical issue is that there is no exact answer to the issue -- no complete moral or legal answer that covers every situation and every individual. Legally, the nurse is bound by the overall rules of the State and Nation; nursing ethics may come into the picture, but not if they cause a nurse to break the law (Quaghebeur, et al., 2009).

A Code of Ethics is in place so that professionals have a clear and unambiguous way to help make decisions. With the six fundamental principles of ethics combined with the principles of informatics ethics, we find that there is a duty that is expected of the nurse to provide privacy, openness, security, and support the patient's wishes. In this sense, ethics and legality do not mesh. In the case of euthanasia, for instance, a patient may have the appropriate documentation legally signed (no intrusive measures, etc.), and the nurse must be responsible for maintaining those wishes and keeping the records private. They also have the moral duty of allowing the individual the moral right to choose what is best for them as an extension of the basis on national rights. For the nurse, every Code of Ethics says that suffering and lengthy pain are not moral. Making it easier for the patient to be comfortable when there is no hope for recover is kinder than heroic medical measures that may prolong pain and suffering (IMIA; Information for Research on Euthanasia, 2009).