The relationship between ethics and morality in respiratory care

Respiratory Ethics

Nursing Ethics in Respiratory Care

the primary goal of any medical practitioner -- after first doing no harm -- is promoting the well-being and general health satisfaction of those in their care. This is usually very straightforward from a medical standpoint -- symptoms are treated in a variety of ways to increase comfort, and disease are tackled to increase longevity and eliminate symptoms. This does not make the job of physicians, nurses, and other medical practitioners easy, but it does provide a great deal of clarity and focus as to the goals of any give method or plan of care. As long as a given treatment promotes more health and comfort in the patient than not treating a condition, or alternative available treatments, this treatment can be deemed to be medically warranted and the proper course of actions. Though there are of course specific situations where the proper course of medical action is not abundantly clear, these instances are relatively few and far between, and such cases do not typically amount to major moral dilemmas.

There are ways in which the job of physicians, nurses, and other medical practitioners becomes more complex even from the perspective of the proper course of action and even the general goals of providing care. These grayer areas, which have come into increasing prominence and importance as the practice of medical science has solidified and become, in many ways and areas, more advanced and refined, deal with ethical situations and the effects -- both positive and negative -- of performing in either an ethical or unethical manner. Like such of the scientific practice of medicine itself, many f the prominent issues in medical ethics are fairly straightforward and speak fro themselves. The right to privacy and patient autonomy usually do not raise any serious ethical considerations in the practice of medicine. There are instances, however, when decisions made in these and other ethical issues can greatly affect care.

This is especially true for nurses, who are typically the primary caretakers and educators in most medical situations, including in-home care and hospitalization. Because of this, nurses may be look at increasingly as role models, both for other nurses but also -- and perhaps most importantly -- by patients. Whether such a relationship is beneficial or not, it most certainly exists and cannot be ignored. For this reason, it is imperative to establish and maintain proper standards of behavior and care around patients, especially those who suffer from chronic illnesses that require lifestyle changes and/or behavior modification techniques on the part of the patient in order to correct the disease, control symptoms, or otherwise prolong life and promote health. Behavior on the part of nurses that promotes such changes is a necessary part of treatment; behavior and/or care that does not promote the necessary understanding on the part of the patient, or that in fact promotes negative behaviors, is unethical.

One specific area of medicine where this can clearly be seen is in the treatment of chronic respiratory illnesses. There are obvious ethical issues that could arise here -- a nurse who smokes trying to convince a patient with emphysema to quit might not be incredibly effective, for instance, suggesting an ethical need for nurses treating such patients to behave in the ways they would like their patients to. Though this might seem an unfair limitation on private life, anything in the nurse's control that negatively affects care must be deemed medically unethical behavior, and such behaviors must be corrected in order to promote health.

Other ethical considerations in the realm of respiratory illness are not quite so clear cut, but show even more the complex importance of high ethical standards in both the treatment of patients and general nursing behavior regarding patients and the nursing profession at large. The larger medical profession, as noted by Shiao et al. (2007). In their study of Taiwanese nurses during the SARS epidemic of a few short years ago, they found that nurses were surprisingly likely to stay in their professions despite the risk of infection and other issues caused by the epidemic (Shiao et al. 2007). In instances where nurses did leave, it was found that there was a lack of emotional and administrative support, with especially important factors being the breakdown of personal relationships due to fears of infection, increased fears of fatality on the part of the nurses themselves, and increased stress and workload (Shiao et al. 2007).

The first circumstance is an unfortunate part of being a nurse, and there is not necessarily anything that can be done about this on an institutional level; infectious and fatal respiratory diseases will always cary a certain stigma with them and against those who work wth patients suffering from such diseases. The other factors mention in this study, however, show the importance of working wit high ethical standards no matter what the situation. In some of the situations where nurses quit out of fear for their own safety, not all proper and necessary procedures and precautions were always being taken to ensure that infections were not transmitted (Shiao et al. 2007). Though this was often due to increased stress and workload, meaning nurses had less time to tend to the proper procedures, it is still inexcusable. Had proper value been placed on the treatment of already infected patients, the fear of increasing infections among nursing staff would not have been nearly so high, and more nurses would have been available to implement proper methods -- ethical behavior would have helped to solve the problem.

Ethical care s also, of course, of extreme importance to patients. Respiratory illnesses are often chronic, and may persist for many years without causing fatality but without opportunity for a true cure or full correction/reversal of the disease. This can complicate the ethics of providing care greatly; when the object is no longer the treatment of the disease, but only the alleviation of symptoms, conflicts can arise between what is the best medical alternative in the short-term, and what will have the greater long-term benefits for the patient's health. Selecky et al. (2005) discuss the benefits of palliative care, which "seeks to prevent, relieve, reduce or soothe the symptoms of disease or disorder without effecting a cure." At times, providing this type of care is the only ethical way to proceed from a medical standpoint; when nothing can be done to save a life, improving the quality of life becomes the primary concern.

This raises the issue of compassion in nursing as it related to ethics. There are instances where further treatment might or might not be effective in dealing with a respiratory illness, but will certainly increase or prolong the suffering or discomfort of the patient. In such instances, the patient must be allowed to form a fully informed and unbiased opinion. Suggestions or encouragements from nursing staff promoting one course of action over another can have detrimental effects not only in the case at hand, but on a system wide level by decreasing the trust of the patient in their care providers, and by suggesting to novice nurses that determining the proper course of care is an issue best not left up to the patient, destroying their autonomy.

In their book Foundations of Respiratory Care (2002), authors Kenneth A. Wyka, Paul Joseph Matthews, and William F. Clark lay out the basic ethical ground rules for medical practitioners in general, as well as detailing some of the issues that might arise for respiratory therapists and others involved in treating respiratory illnesses specifically. For instance, respiratory infections can occur during surgery and even as a result of routine hospitalization; answering patient questions while maintaining the integrity of the institution and the other medical practitioners therein can be an ethically nebulous area (Wyka et al. 2002). These authors suggest that before any response is made in such a specific scenario that the nurse/respiratory therapist reflect carefully on the benefits to the patient that could arise from various answers, as well as the detriments to the overall level of care that the hospital/institution/physician is able to provide (Wyka et al. 2002). This should never cross into dishonesty or even a lie of omission; the authors maintain that practicing ethically is the only way to practice, but providing a satisfactory answer does not require implying blame (Wyka et al. 2002).

One of the most important roles that nurses play, perhaps especially in cases of chronic respiratory diseases, is that of an educator to the patient. On study found that patients suffering from chronic obstructive pulmonary disease, or COPD, were fare better equipped to self-manage care of this often debilitating and highly discomforting disease when they had access to a nurse specialized in treating COPD patients (Efraimsson et al. 2008). Rather than simply providing care, such nurse specialists are able to speak to the patient in understandable terms about the causes of their condition and symptoms, and to teach them appropriate lifestyle changes and behavior modifications in order for the patient t improve their own health (Efraimsson et al. 2008).. This points to the ethical responsibility of nurse educators -- it is not enough to treat the disease, bit one must treat the patient.