conflict, that the interests of the child ought ethically to prevail )in their judge-
ment), and they cannot simply withdraw from the case on grounds of conscience.
For example, suppose, as sometimes happens, that a caesarean section would be
very advisable to prevent harm to the child, but the mother is refusing to have the
operation. Legally, it seems, the midwife should support the mother's decision and
not encourage her to expose herself to the risk of the operation; ethically, she might
well feel that she should bring all reasonable pressure to bear in order to get the
mother to agree. What she should do is a disputed matter; it might for example be
argued that, since the mother, however she feels now, does not want a brain-
damaged child, the duty to both mother and child is to bring the pressure to bear.
But it is important to point out that it is possible, though hopefully very rare in
practice, for health professionals to decide that they have an ethical duty to the
child which conflicts with their legal duty to the mother. What they should then do
±and different courses of action may be appropriate in different circumstances,
depending on the exact possibilities and likely consequences ± is a matter for the
person involved rather than the academic theorist.
The second case of conflict between law and ethics concerns a health care
professional who is given instructions that they believe to be wrong or mistaken.
Under such circumstances the nurse, for example, is legally required to question
the orders, and advised by the UKCC, if they are still in doubt, to demand that the
doctor administer the treatment )e.g. the drugs). But if the orders are confirmed by
the doctor or higher authority before being acted on, the nurse is not regarded as
negligent, whereas in contrast failure to follow established hospital or national
policy, unless there are good reasons in a particular case, may be regarded as
evidence of negligence.
So the law will support a nurse who, under appropriate circumstances, ques-
tions an order or policy, or demands that a doctor carry it out personally, or for
good clinical reasons exempts a particular patient from the established hospital
policy. Paragraphs 11 and 12 of the Code of Practice go beyond this and require
the nurse, midwife or health visitor to:
`report to an appropriate person or authority. .. any circumstances in the
environment of care which could jeopardise standards of practice ... any
circumstances in which safe and appropriate care for patients and clients cannot
be provided.')This incidentally provides a fourth example of a duty not required by the law, but
required by ethics.) But ethically this may not be enough. If the consequences of,
for example, administering a drug were sufficiently terrible, it would seem that
there could be a moral duty not only to refuse to give the drug but also to prevent
the doctor from administering it.
For while it is entirely reasonable that nurses, midwives and health visitors
should comply with doctors' orders )if the orders relate to medical practice),
nevertheless if in their professional judgement those orders are likely to result in
harm to the patient or client, they have a clear moral and professional duty to
question them and even to refuse to carry them out or, if this is practicable, to
prevent their being carried out. The preamble to the UKCC Code makes each
health care professional `personally accountable', and following orders does not
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