sible cure. Sometimes this can be dealt with by being left to the patient; some-
times it is not in the nurse's hands, but a matter for the doctor or the doctor and
patient; sometimes the answer is obvious. But there is a residue of situations
where the task of weighing up the pros and cons is going to fall on the nurse. And
here the legal position is different from the ethical one. Legally, if things are
balanced in this way, the nurse is probably covered whichever course of action
they take. Ethically, they are still obliged to consider carefully )in so far as time
permits) what is the best thing to do.
It is perhaps worth pointing out ± though this is largely drawing attention to the
obvious ± that these problems cannot be solved by a demarcation of the duties of
the nurse and the doctor. There has been a tradition of seeing medicine and
nursing as clearly divided, with the functions of the nurse being, for example, to
keep the patient as comfortable as possible and to carry out the doctor's instruc-
tions. It may be questioned whether this ever corresponded to what went on in
practice; but it seems now to be agreed that no such exact demarcation of duties is
either possible or desirable.
One may sum all this up by saying that ethics differs from law, in this field, by
the fact that it operates all the time, and is concerned with avoiding potential harm
and not only redressing actual harm; by the fact that ethics is more complex than
law, and may require not simply doing one's duty but working out the best thing to
do; and by the fact that ethical standards are, so to speak, two levels higher than
legal ones: the Code is more exacting than the law, and the personal ethics of the
nurse ought to be more exacting than the Code. This last point needs a bit more
consideration. Personal ethics needs to be concerned not only with meeting
standards but also with pursuing ideals. So the point needs to be made that
individual professionals, such as nurses, need to be concerned not only with
maintaining a level of care a bit above the minimum required by the law and the
Code but also, where possible, with raising their standard above this, with
remembering that in one sense duty is never completely done.
However, as soon as one says this, one must at once use common sense to
qualify it. On the one hand, one needs an ethics that goes beyond duty; on the
other, one must remember that nurses, like other people, have been issued with
one pair of hands and live through days with 24 hours in them, that hospitals are
under-staffed, and that even meeting the standards of the Code can take all the
time available. Not only would it be unjust to nurses to expect too much ± more
than is possible or even more than is reasonable ± if the standards are set too high,
the practical result will be worse rather than better. What seems to be required
here is a combination of a resolution to maintain a standard of care at least a little
above the minimum required by the law and the Code, with an aspiration to
achieve still more when time, energy and opportunity permit. What is also
required is a sensible use of one's personal feelings, so that they maintain the
standard rather than weakening it. To recognise that one sometimes fails in one's
duty and to resolve not to repeat those failures are both useful, but guilt feelings
which are inappropriate )for example, at a failure of aspiration which is not an
actual failure of duty) or excessive )for example, which persist after the resolution
not to repeat the failure has been made) often have the effect, like excessively high
standards, of making actual practice worse rather than better.
Negligence 93