Question

How has morality and ethics affected your work as a nurse? Has there ever been a moment in your career where it was hard to think critically about a situation because of your belief?

Answer 1

Ethics is a subject used every day. You may not identify your decisions as using 'ethics' but, whatever you do in life, there are reasons why you follow certain paths.Over the centuries, people have looked at why individuals follow different paths and have considered frameworks to identify trends. This is loosely what ethical theory is. Thomson et al define ethics (which is from the Greek word ethos, meaning the spirit of a community) as the collective belief and value system of any moral community, or social and professional group.It is one of the ways by which a group/community can live in harmony. This definition introduces two more words: 'morals' and 'values'. Again, according to Thomson et al, morals and morality refer to the domain of personal values and the rules of behaviour regulating social intercourse.

Human values
Morality and ethics deal with human relationships how humans treat other beings so as to promote mutual welfare, growth, creativity and meaning as they strive for good over bad and right over wrong.Values can be described as one set of personal beliefs and attitudes about the truth, beauty and worth of any thought, object or behaviour. Values are action oriented and give direction and meaning to one's life'. Values are the starting points for morality and ethics. These three concepts of values, morals and ethics can be seen to interact and relate to each other. Each person's morals and ethics develop over a lifetime and originate from a variety of things valued. Thus, these values and morals have been acquired from a variety of sources.It is not easy to define exactly what constitutes a value. Perhaps your definition of a value indicates that it is something very important to you, it is personal, precious and, very often, something you would take risks to defend.To find out what a person values and why it is valued, it is useful to look at anthropology, geography, sociology, psychology and theology, as they relate to the individual. It may be argued that values are not static, they help us navigate our lives on a personal and professional level, they can also be the means and instruments for making decisions, be ends in themselves and define us as people. Values can be seen as dynamic in that they change and develop through life. Not all values are held to be as important as others; there is a tendency to put them into hierarchies.

The technological advances of the past century tended to change the focus of medicine from a caring, service oriented model to a technological, cure-oriented model. Technology has led to phenomenal advances in medicine and has given us the ability to prolong life. However, in the past few decades physicians have attempted to balance their care by reclaiming medicine's more spiritual roots, recognizing that until modern times spirituality was often linked with health care. Spiritual or compassionate care involves serving the whole person—the physical, emotional, social, and spiritual. Such service is inherently a spiritual activity. Rachel Naomi Remen, MD, who has developed Commonweal retreats for people with cancer, described it well:

Helping, fixing, and serving represent three different ways of seeing life. When you help, you see life as weak. When you fix, you see life as broken. When you serve, you see life as whole. Fixing and helping may be the work of the ego, and service the work of the soul (1).

Serving patients may involve spending time with them, holding their hands, and talking about what is important to them. Patients value these experiences with their physicians. In this article, I discuss elements of compassionate care, review some research on the role of spirituality in health care, highlight advantages of understanding patients' spirituality, explain ways to practice spiritual care, and summarize some national efforts to incorporate spirituality into medicine.

COMPASSIONATE CARE: HELPING PATIENTS FIND MEANING IN THEIR SUFFERING AND ADDRESSING THEIR SPIRITUALITY
The word compassion means “to suffer with.” Compassionate care calls physicians to walk with people in the midst of their pain, to be partners with patients rather than experts dictating information to them.

Victor Frankl, a psychiatrist who wrote of his experiences in a Nazi concentration camp, wrote: “Man is not destroyed by suffering; he is destroyed by suffering without meaning” (2). One of the challenges physicians face is to help people find meaning and acceptance in the midst of suffering and chronic illness. Medical ethicists have reminded us that religion and spirituality form the basis of meaning and purpose for many people (3). At the same time, while patients struggle with the physical aspects of their disease, they have other pain as well: pain related to mental and spiritual suffering, to an inability to engage the deepest questions of life. Patients may be asking questions such as the following: Why is this happening to me now? What will happen to me after I die? Will my family survive my loss? Will I be missed? Will I be remembered? Is there a God? If so, will he be there for me? Will I have time to finish my life's work? One physician who worked in the pediatric intensive care unit told me about his panic when his patients' parents posed such questions. It is difficult to know what to say; there are no real answers. Nevertheless, people long for their physicians as well as their families and friends to sit with them and support them in their struggle. True healing requires answers to these questions (3). Cure is not possible for many illnesses, but I firmly believe that there is always room for healing. Healing can be experienced as acceptance of illness and peace with one's life. This healing, I believe, is at its core spiritual.

Two examples illustrate ways to deal with questions related to meaning in life. Many studies have shown that people desire to be remembered (4). Some wish to fulfill this desire through their family, and others through their life's accomplishments or impact. One of my patients has had ovarian cancer for 7½ years. Recently, the cancer metastasized and is no longer as responsive to chemotherapy. She has been involved in lecturing to a class of my medical students for a 2-week period each semester, talking about medical care from a patient's perspective. Now that she is facing the end of her life, she is determined to continue those lectures; she finds purpose in the significant impact they have had on future physicians. Her treatment team was able to work around certain therapeutic protocols to enable her to achieve her dreams and goals. Another patient was dying of breast and ovarian cancer in her early 30s, and she was depressed. Antidepressants weren't helping. Through talking with her, I understood the cause of her suffering: a fear that her 2-year-old daughter would not remember her. I suggested that she keep a journal to leave to her daughter; the hospice nurses videotaped her messages to her children. These activities helped resolve her depression.