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Introduction: Ethical issues in the daily practice of cancer nursing
SEMINARS IN
Oncology Nursing Vol 5, No 2
Introduction:
May 1989
Ethical Issues in the Daily Practice Cancer Nursing -
E
THICAL ISSUES permeate every facet of cancer nursing care. It is the oncology nurse who most often identifies and confronts ethical problems in the ongoing care of the patient with cancer. For this reason, this issue of Seminars in Oncology Nursing will addressethical questions and issuesrelevant to oncology nursing practice. Today, cancer nurses provide valuable input into decisions affecting the care of the patient with cancer. Issuesof concern for the cancer nurse include identifying and resolving daily practice dilemmas, providing humanistic care within an ethical professional practice framework, knowing how to make an ethical decision, understandingthe informed consentprocess,facilitating the patient’s right for self-determination in treatment choices, providing pain management,identifying ethical dilemmas for children with cancer, acknowledging concernsabout death and dying for the patient and family, participating on an ethics committee, and functioning within a clinical researchenvironment. Ethical issues arise from two fundamental concerns. These are individual rights and clinical research. Holleb and Braun’ believe that when the patient has cancer these two areas become even more complicated becauseof the life-threatening nature of the disease and that most interactions involve elements of crisis and decision-making. Given this crisis environment and the needto make decisions, the potential for value conflicts increasesgreatly. Other factors to be consideredare the complexity of the diseaseitself, the number of people involved in the care of the cancer patient, and the many answersto questionsthat were once obvious-the value of sanctity of life versus quality of life-and who decides?’ Previously, many of these issueswere avoided. However, in today’s consumer society, they must now be addressed. Seminars in Oncology Nursing, Vol 5, No 2 (May),
1989:
pp 75-76
of
DEFINITIONS
Whitman2provides definitions for several of the important terms used throughout this issue: Ethics is the theory or scienceof ideal human behavior; it is the study and philosophy of what is right and what is wrong. Morals is the actual behavior of humans; it is the practice of what is right or what is wrong. Bioethics is a new discipline concernedwith ethical problems and moral decisionsthat arise in medicine. A dilemma is a situation that requites a choice between difficult or even conflicting coursesof action; it is a problem seemingly incapable of a satisfactory solution.
Dilemmas cannot be solved, but can be resolved, affording us the opportunity to provide the best option for the patient. DILEMMAS FACING CANCER NURSES
The continued advancement of medicine has madeus a society of high technology. Several ethical dilemmas arise from this development. Who benefits from this high technology? Is it only those who have insurance or can afford to pay? Is it justifiable to put a 70-year-old septic leukemic in the intensive care unit? Can we mandate that a child have chemotherapyfor a diseasethat has not shown a positive response? The dilemma remains-how do we meet the needs of the patient with cancer within an environment of costcontainment and limited resources? Clinical research has the potential to benefit many. Yet, is it undertakento benefit the individual or to advance science?Within this realm, the processof informed consent presentsmany potential dilemmas for the oncology nurse. Does the patient truly understandall treatment options? Has the patient participated in the decision process? 75
76
Has the patient been provided with all treatment options? Does the patient fully understandthe risks versus the benefits? The oncology nurse has the ability to assessand further educatethe patient and family about these issuesand must strive to act as a patient advocate. The issueof sanctity of life versusquality of life takes into account the areasof euthanasiaand the use of extraordinary care measures.Who is best able to make these decisions-the patient or a memberof the health care team?How do we protect patient rights? What is the nurse’s obligation to the patient and family versus the health care team?Whitman identified many of thesesameethical dilemmas in 1980.2 Almost a decade later, many still remain. Donovan3 statesthat there are two major impediments to ethical nursing practice-the practice environment and the individual nurse’s values and knowledge. This past decade has seen many changes in the practice environment. Oncology nurses as a specialty group have spearheadedthe development of advanced practice. Oncology nursesare, in general, actively involved in decision-making within their environments and are recognized as colleagues by physicians. However, the potential does still exist for nurses to remain passive and uninvolved with the decision-making process. This degree of involvement is dependent upon the nurse’s own
JASSAK
AND WEGMANN
value systemand clinical knowledge as well as the ethical framework that guides professional nursing practice. SUMMARY
Cancer nurses face ethical issues daily in their clinical practice. Most issues are resolvable, and the patient is provided with the best treatment option for his individual situation. Ethical dilemmas will continue to exist throughout time, raising more questions than providing concrete answers. Dilemmas force us to examine all possible alternatives and to include the patient in the decisionmaking process.The articles in this issueprovide a broad overview of the ethical issues that cancer nurses face. Patricia F. Jassak,MS, RN, CS Guest Editor
Jo Ann Wegmann, PhD, RN Guest Editor REFERENCES 1. Holleb AI, Braun M: Editorial: Ethical issues and the cancer patient. CA 3656, 1986 2. Whitman H: Ethical issuesin cancer nursing. 1. Defining the issues. Oncol Nurs Forum 7:37-40, 1980 3. Donovan CT: Ethical issuesin cancernursing. II. Impediments to ethical nursing practice. Oncol Nurs Forum 7:40-42, 1980
Oncology Nursing Vol 5, No 2
Introduction:
May 1989
Ethical Issues in the Daily Practice Cancer Nursing -
E
THICAL ISSUES permeate every facet of cancer nursing care. It is the oncology nurse who most often identifies and confronts ethical problems in the ongoing care of the patient with cancer. For this reason, this issue of Seminars in Oncology Nursing will addressethical questions and issuesrelevant to oncology nursing practice. Today, cancer nurses provide valuable input into decisions affecting the care of the patient with cancer. Issuesof concern for the cancer nurse include identifying and resolving daily practice dilemmas, providing humanistic care within an ethical professional practice framework, knowing how to make an ethical decision, understandingthe informed consentprocess,facilitating the patient’s right for self-determination in treatment choices, providing pain management,identifying ethical dilemmas for children with cancer, acknowledging concernsabout death and dying for the patient and family, participating on an ethics committee, and functioning within a clinical researchenvironment. Ethical issues arise from two fundamental concerns. These are individual rights and clinical research. Holleb and Braun’ believe that when the patient has cancer these two areas become even more complicated becauseof the life-threatening nature of the disease and that most interactions involve elements of crisis and decision-making. Given this crisis environment and the needto make decisions, the potential for value conflicts increasesgreatly. Other factors to be consideredare the complexity of the diseaseitself, the number of people involved in the care of the cancer patient, and the many answersto questionsthat were once obvious-the value of sanctity of life versus quality of life-and who decides?’ Previously, many of these issueswere avoided. However, in today’s consumer society, they must now be addressed. Seminars in Oncology Nursing, Vol 5, No 2 (May),
1989:
pp 75-76
of
DEFINITIONS
Whitman2provides definitions for several of the important terms used throughout this issue: Ethics is the theory or scienceof ideal human behavior; it is the study and philosophy of what is right and what is wrong. Morals is the actual behavior of humans; it is the practice of what is right or what is wrong. Bioethics is a new discipline concernedwith ethical problems and moral decisionsthat arise in medicine. A dilemma is a situation that requites a choice between difficult or even conflicting coursesof action; it is a problem seemingly incapable of a satisfactory solution.
Dilemmas cannot be solved, but can be resolved, affording us the opportunity to provide the best option for the patient. DILEMMAS FACING CANCER NURSES
The continued advancement of medicine has madeus a society of high technology. Several ethical dilemmas arise from this development. Who benefits from this high technology? Is it only those who have insurance or can afford to pay? Is it justifiable to put a 70-year-old septic leukemic in the intensive care unit? Can we mandate that a child have chemotherapyfor a diseasethat has not shown a positive response? The dilemma remains-how do we meet the needs of the patient with cancer within an environment of costcontainment and limited resources? Clinical research has the potential to benefit many. Yet, is it undertakento benefit the individual or to advance science?Within this realm, the processof informed consent presentsmany potential dilemmas for the oncology nurse. Does the patient truly understandall treatment options? Has the patient participated in the decision process? 75
76
Has the patient been provided with all treatment options? Does the patient fully understandthe risks versus the benefits? The oncology nurse has the ability to assessand further educatethe patient and family about these issuesand must strive to act as a patient advocate. The issueof sanctity of life versusquality of life takes into account the areasof euthanasiaand the use of extraordinary care measures.Who is best able to make these decisions-the patient or a memberof the health care team?How do we protect patient rights? What is the nurse’s obligation to the patient and family versus the health care team?Whitman identified many of thesesameethical dilemmas in 1980.2 Almost a decade later, many still remain. Donovan3 statesthat there are two major impediments to ethical nursing practice-the practice environment and the individual nurse’s values and knowledge. This past decade has seen many changes in the practice environment. Oncology nurses as a specialty group have spearheadedthe development of advanced practice. Oncology nursesare, in general, actively involved in decision-making within their environments and are recognized as colleagues by physicians. However, the potential does still exist for nurses to remain passive and uninvolved with the decision-making process. This degree of involvement is dependent upon the nurse’s own
JASSAK
AND WEGMANN
value systemand clinical knowledge as well as the ethical framework that guides professional nursing practice. SUMMARY
Cancer nurses face ethical issues daily in their clinical practice. Most issues are resolvable, and the patient is provided with the best treatment option for his individual situation. Ethical dilemmas will continue to exist throughout time, raising more questions than providing concrete answers. Dilemmas force us to examine all possible alternatives and to include the patient in the decisionmaking process.The articles in this issueprovide a broad overview of the ethical issues that cancer nurses face. Patricia F. Jassak,MS, RN, CS Guest Editor
Jo Ann Wegmann, PhD, RN Guest Editor REFERENCES 1. Holleb AI, Braun M: Editorial: Ethical issues and the cancer patient. CA 3656, 1986 2. Whitman H: Ethical issuesin cancer nursing. 1. Defining the issues. Oncol Nurs Forum 7:37-40, 1980 3. Donovan CT: Ethical issuesin cancernursing. II. Impediments to ethical nursing practice. Oncol Nurs Forum 7:40-42, 1980