Why are ethics and laws such a murky subject?

Manuel Velasquez, Claire Andre, Thomas Shanks, S.J., and Michael J. Meyer

Ethics is based on well-founded standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues.

Some years ago, sociologist Raymond Baumhart asked business people, "What does ethics mean to you?" Among their replies were the following:

"Ethics has to do with what my feelings tell me is right or wrong."
"Ethics has to do with my religious beliefs."
"Being ethical is doing what the law requires."
"Ethics consists of the standards of behavior our society accepts."
"I don't know what the word means."

These replies might be typical of our own. The meaning of "ethics" is hard to pin down, and the views many people have about ethics are shaky.

Like Baumhart's first respondent, many people tend to equate ethics with their feelings. But being ethical is clearly not a matter of following one's feelings. A person following his or her feelings may recoil from doing what is right. In fact, feelings frequently deviate from what is ethical.

Nor should one identify ethics with religion. Most religions, of course, advocate high ethical standards. Yet if ethics were confined to religion, then ethics would apply only to religious people. But ethics applies as much to the behavior of the atheist as to that of the devout religious person. Religion can set high ethical standards and can provide intense motivations for ethical behavior. Ethics, however, cannot be confined to religion nor is it the same as religion.

Being ethical is also not the same as following the law. The law often incorporates ethical standards to which most citizens subscribe. But laws, like feelings, can deviate from what is ethical. Our own pre-Civil War slavery laws and the old apartheid laws of present-day South Africa are grotesquely obvious examples of laws that deviate from what is ethical.

Finally, being ethical is not the same as doing "whatever society accepts." In any society, most people accept standards that are, in fact, ethical. But standards of behavior in society can deviate from what is ethical. An entire society can become ethically corrupt. Nazi Germany is a good example of a morally corrupt society.

Moreover, if being ethical were doing "whatever society accepts," then to find out what is ethical, one would have to find out what society accepts. To decide what I should think about abortion, for example, I would have to take a survey of American society and then conform my beliefs to whatever society accepts. But no one ever tries to decide an ethical issue by doing a survey. Further, the lack of social consensus on many issues makes it impossible to equate ethics with whatever society accepts. Some people accept abortion but many others do not. If being ethical were doing whatever society accepts, one would have to find an agreement on issues which does not, in fact, exist.

What, then, is ethics? Ethics is two things. First, ethics refers to well-founded standards of right and wrong that prescribe what humans ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues. Ethics, for example, refers to those standards that impose the reasonable obligations to refrain from rape, stealing, murder, assault, slander, and fraud. Ethical standards also include those that enjoin virtues of honesty, compassion, and loyalty. And, ethical standards include standards relating to rights, such as the right to life, the right to freedom from injury, and the right to privacy. Such standards are adequate standards of ethics because they are supported by consistent and well-founded reasons.

Secondly, ethics refers to the study and development of one's ethical standards. As mentioned above, feelings, laws, and social norms can deviate from what is ethical. So it is necessary to constantly examine one's standards to ensure that they are reasonable and well-founded. Ethics also means, then, the continuous effort of studying our own moral beliefs and our moral conduct, and striving to ensure that we, and the institutions we help to shape, live up to standards that are reasonable and solidly-based.

This article appeared originally in Issues in Ethics IIE V1 N1 (Fall 1987). Revised in 2010.

Since appearing on the annual Gallup Honesty and Ethics poll in 1999, nurses have ranked as the number 1 most honest, ethical profession every year except one. The most recent poll ranks nurses at 85 percent. All professions that follow fall way behind nursing — pharmacists at number 2 lag 17 points behind nurses at 68 percent.

“Ethical codes are systematic guidelines for shaping ethical behavior that answer the normative questions of what beliefs and values should be morally accepted,” Janie B. Butts writes in Professional Codes of Ethics in Nursing. “However, it must be noted that no code can provide absolute or complete rules that are free of conflict and ambiguity.”

Since nurses’ work mainly focuses on patients, ethics in nursing offers a framework to help them ensure the safety of patients and their fellow healthcare providers. The nationally accepted guide is the Code of Ethics for Nurses with Interpretive Statements, or The Code, issued by the American Nurses Association.

The preface contains an explanation of the purpose of The Code: “The Code of Ethics for Nurses with Interpretive Statements (the Code) establishes the ethical standard for the profession and provides a guide for nurses to use in ethical analysis and decision-making. The Code is nonnegotiable in any setting.”

In short, The Code contains the framework for ethical decision-making and analysis for nurses in all roles, at levels and in all settings.

In 1953, the International Council of Nursing was the first to adopt Code of Ethics for Nurses. Like The Code, the ICN’s code has been revised to reflect the current healthcare environment.

Both codes make the patient the focus of the nurses’ work, ensuring they provide compassionate patient care and ease or prevent suffering. These guidelines help nurses with challenging decision-making.

Nurses encounter situations almost every day that require a strong understanding of ethics. Education and guides like The Code help them navigate murky waters in which the right thing to do is not always clear.

Here are situations nurses face almost every day:

• Obtain informed consent. Unless the patient is unconscious, the nurse has a responsibility to obtain a patient’s consent prior to any treatment or procedure. Sometimes the patient will refuse treatment. Nurses ensure the staff follows the patient’s wishes.
• Maintain patient confidentiality. While not everyone on the staff needs to know about the patient’s history or situation, nurses must decide who needs to know without violating confidentiality.
• Tell the truth. Most patients trust nurses, which is one of the reasons the profession has the highest rating for ethics and honesty. Nurses must remain truthful even when reporting news the patient does not want to hear. They also depend on patients to share correct information about their medicines, conditions and other issues.
• Deal with beliefs that conflict with empirical knowledge. Patients and their families may refuse standard treatment that has been proven effective. For example, some religions forbid blood transfusions. Should the nurse explain the benefits of the recommended treatment? Or should the nurse respect the patient’s decision?

Ethical guidelines help nurses work through difficult situations and provide them with a moral compass to do their jobs fairly. At the same time, these guidelines promote high levels of care and attention.

Nurses may not always find the answers they need in The Code. In fact, “Everyday Ethics: Ethical Issues and Stress in Nursing Practice” has found that everyday ethical issues can be stressful for nurses.

The study has identified the following five most stressful ethical topics for nurses:

1. Protecting patients’ rights.
2. Informed consent for treatment.
3. Staffing patterns.
4. Advanced care planning.
5. Surrogate decision-making.

The authors recommend that organizations hold ethics-related interventions for today’s complex healthcare issues. Some organizations may have their own ethics committees and guidelines. These committees allow nurses to discuss dilemmas and acquire resources. For additional support, ANA occasionally issues position statements on ethics and human rights. These cover a variety of topics, such as the use of marijuana as therapy and end-of-life care.

In 2014, the National Nursing Ethics Summit attempted to break the barriers between nursing organizations and other groups such as educational organizations, policymakers and professional nursing nonprofit organizations. The result is Blueprint for 21st Century Nursing. This lists steps on how to prepare and support nurses for practice.

Nurses spend more time with patients than almost any other healthcare provider. They often understand what the patient and family want more than others. Healthcare staff depend on nurses’ knowledge and skills, which both play a large role in the ethical care of patients. The fact that nurses consistently receive the highest ratings for honesty and ethics shows they play a valuable role in healthcare.

The right thing to do is not always obvious. Guidelines like the Code and continuing education such as an RN to BSN program help nurses navigate the ethical challenges they face in helping patients and their families.

Learn about the Lamar University online RN to BSN program.

Sources:

Gallup: Americans’ Faith in Honesty, Ethics of Police Rebounds

Johns Hopkins Berman Institute of Bioethics: Blueprint for 21st Century Nursing Ethics

American Nurses Association: Code of Ethics for Nurses

NCBI: Everyday Ethics: Ethical Issues and Stress in Nursing Practice

Jones and Bartlett Publishing: Professional Codes of Ethics in Nursing

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