24. Just because we can, does it mean we should?
Matter for discussion submitted by the RCN Paediatric and Neonatal Intensive Care Forum
That this meeting of RCN Congress discusses the medical and technological advances in patient care and the ethical dilemmas faced in clinical practice
Report on this debate
Congress was urged to discuss how medical and technological advances in patient care now result in an increasing number of ethical dilemmas faced in clinical practice in neo natal care. Quality of life and financial restraints need to be balanced against technology which may now offer hope where before there would not have been any.
Delegates supported the need for a multi-professional debate on the issue and emphasised the requirement for appropriate training to be made available to all staff facing ethical dilemmas. RCN Council was urged to further the discussion and ensure the RCN had a strong voice on ethics.
Andy Meal widened the debate and asked Congress to also consider the care of older people, advising Congress that allowing a dignified death is sometimes the best care that can be offered.
"It isn’t life at all costs" said Linda Marsden, who spoke movingly from personal experience. Judith Carter also urged Congress to give consideration to the need for a peaceful dignified death in some cases, telling delegates about Edward, a child in her care who, after problems during childbirth, had care withdrawn at the age of three years.
Background
Health professionals and their patients face an increasing range of ‘hard choices’ as advances in medical technology enable complex health care interventions that would have been unimaginable in the fairly recent past. Developments in neonatal and paediatric critical care services, for example, have provided opportunities to save or prolong the lives of babies and children with severe congenital defects and life-threatening illnesses. Issues relating to human reproduction, quality of life, and length of life all raise new moral dilemmas, and today’s professional may face difficult ethical decisions concerning the implementation, withholding or withdrawing of costly innovative treatment; decisions that may need to be balanced against institutional efforts to provide a financially viable service.
Examples of how technological developments are influencing health care decisions can be found in the fields of reproductive medicine, genetics, embryo research and organ donation/transplantation. By raising people’s expectations of what is possible, technological advances may also alter perceptions of a health care service’s duty to its patients. In other words, it may be claimed that because a new form of treatment is possible, a health care provider is morally obliged to offer it. Increasingly, ‘because we can, does it mean we should?’ is a fundamental ethical question being faced by society today.
The nature of technological developments is such that new issues will continually arise which demand careful and critical consideration by society and its professional groups. Nurses should be at the forefront of ongoing ethical debate into the applicability or otherwise of new technology within health care. The development of a clear, coherent and robust means of debating such ethical issues in order to provide effective ethical guidance should be an essential component of the RCN’s services to its members.
Advances in technology continue to raise ethical, legal and professional dilemmas. Nurses must be empowered to participate in the ongoing debate concerning the application of technological developments to health care.
References and further reading
Cardozo M (2005) What is a good death? Issues to examine in critical care, British Journal of Nursing, 14 (20), pp.1056-1060.
McHarg L (2007) Medical advances inevitably create ethical dilemmas, Nursing Times, 103 (47), p.15.
Nuffield Council on Bioethics (2006) Critical care decisions in fetal and neonatal medicine: ethical issues, London: Nuffield Council on Bioethics. Available from:
www.nuffieldbioethics.org