better. And better you are going to get.' But nursing ethics seems to require either
that interests and well-being' are given a very wide interpretation, or that the nurse's ethical obligations go beyond observing the Code and include, where possible, safeguarding and promoting the patient's comfort and dignity, so that to imperil either of these would be ethically negligent. There is here a further problem. Both the Code and )if I am right) the higher standard required by personal ethics involve an obligation to promote the interests of the patient or client and an obligation to do nothing detrimental to those interests. At first glance these look fully compatible ± one positive, one negative, but involving the same purpose. But matters are not so simple. Not to care for a patient would very often result in harm or the risk of harm, but most, perhaps even all, forms of care themselves involve some degree of discomfort, harm or risk; there may be no way of absolutely safeguarding the interests of the patient, and it may be amatter of judging what is most in their long-term interests. Often this may be straightforward. The likelihood of a cure may be very high, for example, and the side-effects of the medication a short-term discomfort clearly worth enduring for the sake of the cure; the nurse administering the medication is in this case fairly clearly acting in the patient's interest. But sometimes matters are much less simple, and it is by no means clear how to balance the risks and possible benefits of a particular type of treatment, and how to decide what is or is not in the patient's interest. Even if the sphere of authority of the doctor and the nurse can be dis- tinguished )which is far from certain), these problems arise, sometimes for the nurse as well as the doctor, and they do not arise only over general decisions as to a line of treatment. Ethically, three things seem to be required. One is always, if possible, to consult the patient, so that risks are run and discomfort or pain endured with their understanding and consent. The others are to avoid unnecessary risks, not required for the sake of a likely benefit, and not to inflict harm greater than the benefit to the patient or client. All these arise essentially because of a difference between a legal and an ethical duty. Although, as the section on legal negligence makes clear, the legal obligations of a nurse are not something about which there is total clarity or precision, there is, rightly, an attempt to provide guidelines of such a nature that a nurse who acts according to those guidelines will not be guilty of legal negligence. But the UKCC Code of Professional Conduct is different. As the preceding discussion shows, one cannot simplyact according to them' or `act
within them'; one is forced, whether or not one is conscious of this, to balance
them against each other and to use intelligence and flexibility in translating them
into action.
The reason for this complexity is one which lies at the base of many problems
in health care ethics. Medicine ± here taken to include the activities of nurses,
doctors and other health care professionals ± has three major aims: to cure or
alleviate illness, disease and injury; to prolong life; and to relieve suffering. Very
often these three aims coincide, and the same treatment will contribute to all
three. But when they do not, problems arise about what should be done, and
these problems are made worse by the fact that one is often dealing with probable
or possible rather than certain consequences, so that it is not, for example, a
matter of trading discomfort for cure, but of trading likely discomfort for a pos-
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