ETHICS VERSUS ETHOS

As nouns, the difference between ethics and ethos is that ethics is (philosophy) the study of principles relating to right and wrong conduct, while ethos is the character or fundamental values of a person, people, culture, or movement. Ethics is the systematic study of what is morally right and wrong – while it is clear that ethics could have come into existence only when human beings started to reflect on the best way to live.

This reflective stage emerged long after human societies had developed some kind of morality, usually in the form of customary standards of right and wrong conduct. The process of reflection tended to arise from such customs, even if in the end it may have found them wanting. Accordingly, ethics began with the introduction of the first moral codes. Ethos is strongly related to health professions and especially the nursing profession (Dlugan: 2018)

A BRIEF OVERVIEW OF THE HISTORY OF NURSING

In essence, the nursing profession has very much been around since the beginning of time, though it has drastically evolved over the course of history. Prior to 1880, the hospital treatment of illness was rare. Where possible, a sick person was attended by the family doctor and either by female family members or servants. The intimate body services to be done for the patient were considered to be unseemly or immodest for young unmarried or well-bred females, especially if not a family member. Cleaning and feeding of another person were regarded as domestic tasks performed by servants.

However, from the middle of the nineteenth century, the discovery and application of anaesthetics and antiseptic surgery advanced medical technique and allowed all classes to seek treatment in hospitals. For many nurses, the skills of nursing or caring lie at the heart of their work. Until the mid-nineteenth century, nursing was not an activity, which was thought to demand either skill or training. Nor did it command respect.

I do however wish to refer to the Christian Bible which mentions midwives in Genesis: … the Israelites remained faithful to God’s command to be fruitful and multiply (Gen. 1:28). That entailed bearing children, which in turn depended on the work of midwives. In addition to its presence in the Bible, the work of midwifery is well-attested in ancient Mesopotamia and Egypt. Midwives assisted women in childbearing, cut the infant’s umbilical cord, washed the baby, and presented the child to the mother and father (Theology of Work Project, Inc., 2014. http://creativecommons.org/licenses/y-nc/4.0/deed.en_US).

The first recorded aspects of nursing place the inception of the profession during the height of the Roman Empire, around 300 A.D. It was during this time that the Empire sought to place a hospital within every town under its rule. As such, there were many “nurses” during that time that assisted in-patient medical care within the newly created hospitals, alongside doctors (Klainberg, Holzemer, Leonard & Arnold 1998).

Since the inception of nursing and nursing philosophy, it is closely interlinked with ethos, whether it is nursing practices or nursing training and education, based on a sound value system.

CODE OF ETHICS FOR NURSING PRACTITIONERS IN SOUTH AFRICA

Ethics is indeed an integral part of the nursing profession and forms the foundation thereof. This Code of Ethics for Nursing in South Africa reminds all Nursing Practitioners of their responsibilities towards individuals, families, groups and communities, namely to protect, promote and restore health, to prevent illness, preserve life and alleviate suffering. These responsibilities will be carried out with the required respect for human rights, which include cultural rights, the right to life, choice and dignity without consideration of age, colour, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status. The persons in the care of every Nursing Practitioner must be able to trust such Nursing Practitioner with their health and wellbeing (SANC, 2013:3).

PURPOSE STATEMENT

Nursing practitioners function in a wide variety of clinical settings inside and outside Health Care facilities and are confronted daily with all types of challenges including ethical and moral dilemmas. This code of Ethics is the cornerstone of ethical decision-making and aimed to inform nursing practitioners and the public of the following ethical and moral principles applicable to nursing practitioners in the performance of their duties (SANC, 2013.

These ethical and moral principles assist both the practitioner and the healthcare consumers with the following:

• identifying ethical values and principles that form the foundation for professional conduct;
• providing the framework for reflection on the influence of ethical values on the behaviour and interaction between nurses and the public, stakeholders and healthcare users;
• providing the framework for ethical decision-making for practice;
• indicating to the public, stakeholders and healthcare users the standards and ethical values they can expect nurses to uphold; and
• providing guidance to professional conduct or ethical committees regarding decisions relating to unethical behaviour (SANC, 2013:3).

ETHICAL PRINCIPLES

Essential in ethical decision-making is the application of ethical values and principles in difficult and conflicting situations that nurses may face in specific circumstances during the practice of their profession. Nurses are at all times expected to observe and apply fundamental ethical principles in their interaction with healthcare users.

Such ethical principles include, but are not limited to the following:

• (Social) Justice – Nurses are at all times expected to act fairly and equitably where there is a competition of interest among parties, groups or individuals. Such interests may be, among others, related to access to healthcare resources, issues linked to prioritising care or any situation that may be perceived or experienced as unequal. Nurses should therefore pursue justice and advocate on behalf of vulnerable and disadvantaged healthcare users and should be able to justify their decisions and actions.
• Non-maleficence – This requires a nurse to consciously refrain from doing harm of any nature whatsoever to healthcare users, individuals, groups and communities.
• Beneficence – Nurses are required to do well and to choose the “best option” of care under given circumstances and act with kindness at all times. It gives expression to compliance with the “duty to care” as a professional practice imperative.=
• Veracity – This principle requires the nurse to act with truthfulness and honesty and to ensure that the information provided to and on behalf of the healthcare user is always in the best interest of the healthcare user.
• Fidelity – This entails adherence to factual and truthful accounting and balancing that with respecting, protecting and maintaining confidential information pertaining to the delivery of healthcare, including health records of healthcare users.
• Altruism – Nurses are at all times expected to show concern for the welfare and wellbeing of healthcare users. The nurses are to be mindful of the fact that wishes and actions of healthcare users may be in conflict with the values and principles of the code, e.g. where healthcare users refuse treatment to the detriment of their health and that of others.
• Autonomy – Respect for the autonomy of eligible persons (healthcare users) to make their own decisions and choices in matters affecting their health.
• Caring – Nurses are required to demonstrate the art of nurturing by both applying professional competencies and positive emotions that will benefit both the nurse and the healthcare user with inner harmony.

These Ethical Principles have to be upheld at all times by all Nursing Practitioners in whatever role they fulfil as direct or indirect patient care providers, including, among others, educators, administrators, researchers, policy developers and others, in any setting whatsoever (SANC, 2013:3).

VALUE STATEMENT 

This Code is based on the belief that nurses value:

• human life;
• respect, dignity and kindness for oneself and others;
• the uniqueness of individual healthcare users and also acknowledge the diversity of people in their care;
• the right to access quality nursing and healthcare for all;
• the provision of accurate and truthful information in accordance with informed consent or refusal of treatment to enable individuals to make informed decisions in respect of matters affecting their health;
• integrity of persons in their care as well as the image of the profession;
• Confidentiality and privacy of personal information and belongings of healthcare consumers; and a culture of safety and an ethically-friendly environment, which includes the protection of healthcare users from colleagues who may be unfit to practise due to impairment or disability, posing a threat to the health and well-being of healthcare users (SANC, 2013: 1-2)

 ETHICAL DILEMMAS

The following is a non-exhaustive list of examples of ethical dilemmas that confront nurses in their work environment and sometimes challenge their own value systems:

• Termination of pregnancy;
• Trading of products of conception and other human parts;
• Participation in and/or conducting clinical research;
• Providing healthcare and specifically nursing care to vulnerable, stigmatised and marginalised persons;
• Conscientious objection, meaning entitlement to consciously refuse to participate in activities and treatment the nurses believe, on religious or moral grounds, are unacceptable and/or questionable, ethically, morally and legally;
• Situations of conflicting values (diverse cultures, sexual orientation, etc.);
• Conflicts between individual, social and professional values;
• Participating in moonlighting activities and in so doing, compromising the nurse’s ability to provide quality care;
• Euthanasia;
• Intimidation and violent acts in the workplace; and
• Participating in strikes and boycotts and in so doing, compromising quality nursing care.

The nature of ethical dilemmas is often complex and controversial.

It may be advisable wherever possible, to make some of the decisions within an ethical committee where diverse values, perceptions and views are taken into consideration by a collective. The more diverse the group in such an ethical committee, the more ethically and morally sound the decision will be. This will be relative to the urgency of the situation (SANC, 2013: 1-8)

I wish to conclude with the word NURSE and indicate how it can assist nursing practitioners with performing their functions with commitment and responsibility.

N – Needs, nearness, necessitate, negotiate, negligence, nestle

U – Uniqueness, unity, unwell, uncertainty, unbiased, unselfish, unconditional, undaunted, unjustified.

R – Realistic, reason, reality, reassure, rely, rapport, rarefied, recipient

S – Serve, sacrifice, serene, scrupulous, sentiment, subservient, sustenance

E – Expertise, example, energise, excellence, eloquent, empathy, endearing and extension of yourself by being the:

• Eyes for those who can’t see
• Ears for those who can’t hear
• Mouth for those who can’t talk
• Arms for those who can’t feed and help themselves
• Legs for those who can’t walk.