Nurses face issues related to ethics in their everyday practice (Butts & Rich, 2015, p. 72), for they often have to make difficult decisions and choose between two or more options neither of which is satisfying. While developing one’s ethical principles, it is crucial to study landmark cases that have affected the development of ethics or simply were vivid enough to make a difference. In this paper, we will study two landmark cases and consider their ethical implications for nursing practice.
One such case is related to a research conducted by Lawrence Kohlberg. The research was reported in 1981 and involved a longitudinal study of the ethical development of 84 boys (no girls were included) over the span of more than 20 years. Kohlberg, grounding his research on Jean Piaget’s achievements, identified six stages of moral development. These stages covered varying age, from childhood to adulthood. When it was attempted to apply the results of the study, the identified stages, to the moral development of women, it was found out that these stages did not describe their moral development of females as well as they did the development of males. Even though it was apparent that not all individuals might reach the sixth stage (at which a person starts to apply universal principles to make moral decisions), it seemed that women mostly reached only the third stage out of six.
As a response, one of Kohlberg’s colleagues, Carol Gilligan, wrote a book where she raised an issue of gender bias and reasoned that women’s moral development differed from that of men, and it led to care-based rather than justice-based reasoning, but it was not deficient. In fact, she proposed a different scale to describe moral development (Butts & Rich, 2015, p. 15-16). The studies conducted by Kohlberg and Gilligan have become an important landmark case for nursing metaethics, as this case shows (proposes?) two different types of reasoning, justice-based or care-based, on which decisions might be grounded; care-based reasoning is one that appears more suitable for nursing practice.
Another landmark case for healthcare ethics took place in 1998-2005, during a court case related to Terri Schiavo, a woman from Florida who suffered a cardiac arrest in 1990 and lived in the persistent vegetative state (PVS) ever since. Her husband in 1998 petitioned a court in order to be allowed to remove her feeding tube (in her state, Terri would not feel anything related to the consequences of discontinuation). It is stated that the husband was attempting to follow Terri’s wishes for treatment that she had given before going into coma. On the other hand, Terri’s parents strongly objected against the discontinuation, claiming that it would be similar to euthanasia, and that it would not be in their daughters’ best interests to do so. The court eventually decided that the tube was to be removed. Although there were mass demonstrations against the decision, the feeding was stopped, and Terri died in March 2005 (Yeo, Moorhouse, Khan, & Rodney, 2010, p. 192-194).
This case represents a many-sided situation which involves numerous nuances. On the one hand, it perhaps was indeed not in Terris’s best interests to stop the feeding. On the other hand, she was unconscious, and it might even have been hard to speak of her as of a being that was self-conscious or sentient. Besides, it was apparently her autonomous decision being fulfilled by the court. The case shows how hard it might be in some situations to follow the desideratum of autonomy, especially when it conflicts other moral principles (Yeo et al., 2010, p. 192-196). It is important for nurses to be able to see similar situations from a number of viewpoints when such situations occur in nursing practice.
As a conclusion, it should be noted that nurses often have to face difficult situations in their professional practice where making difficult decisions is unavoidable. Landmark cases are important for nursing, as they provide examples of ethically difficult situations and allow for development of evidence-based ethics which might be of significant help for nurses in their practice.
References
Butts, J. B., & Rich, K. L. (2015). Nursing ethics (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Yeo, M., Moorhouse, A., Khan, P., & Rodney, P. (Eds.). (2010). Concepts and cases in nursing ethics (3rd ed.). Peterborough, Ontario, Canada: Broadview Press.