40 unit 1 | Professional Considerations
It is 1961. In a large metropolitan hospital, ten
health-care professionals are meeting to consider the
cases of three individuals. Ironically, the cases have
something in common. Larry Jones, age 66, Irma
Kolnick, age 31, and Nancy Roberts, age 10, are all
suffering from chronic renal failure and need
hemodialysis. Equipment is scarce, the cost of the
treatment is prohibitive, and it is doubtful that
treatment will be covered by health insurance. The
hospital is able to provide this treatment to only one
of these individuals. Who shall live, and who shall
die? In a novel of the same name, Noah Gordon
called this decision-making group The Death
Committee (Gordon, 1963). Today, such groups are
referred to as ethics committees.In previous centuries, health-care practitioners had
neither the knowledge nor the technology to pro-
long life. The main function of nurses and physi-
cians was to support patients through times of
illness, help them toward recovery, or keep them
comfortable until death. There were few “who shall
live, and who shall die?” decisions.
The polio epidemic that raged through Europe
and the United States during 1947–1948 initiated
the development of units for patients on manual
ventilation (the “iron lung”). At this time, Danish
physicians invented a method of manual ventilation
by using a tube placed in the trachea of polio
patients. This was the beginning of mechanical
ventilation as we know it today.
During the 1950s, the development of mechan-
ical ventilation required more intensive nursing
care and patient observation. The care and moni-
toring of patients proved to be more efficient when
they were kept in a single care area; hence the term
intensive care.The late 1960s brought greater tech-
nological advances, especially in the care of patients
seriously ill with cardiovascular disease. These new
therapies and monitoring methods made the inten-
sive care unit possible (aacn.org, 2006).
Health care now can keep alive people who
would die without intervention. The development
of new drugs and advances in biomechanical tech-
nology permit physicians and nurses to challenge
nature. This progress also brings new, perplexing
questions. The ability to prolong life has created
some heartbreaking situations for families and ter-
rible ethical dilemmas for health-care profession-
als. How is the decision made when to turn off the
life support machines that are keeping someone’s
son or daughter alive after, for example, a motor
vehicle accident? Families and professionals face
some of the most difficult ethical decisions at times
like this. How is death defined? When does it
occur? Perhaps these questions need to be asked:
“What is life? Is there ever a time when life is no
longer worth living?”
Health-care professionals have looked to philoso-
phy, especially the branch that deals with human
behavior, for resolution of these issues. The field of
biomedical ethics (or, simply, bioethics), a subdisci-
pline of ethics—the philosophical study of
morality—has evolved. In essence, bioethics is the
study of medical morality, which concerns the moral
and social implications of health care and science in
human life (Mappes & DeGrazia, 2005).
To understand biomedical ethics, the basic
concepts of values, belief systems, ethical theo-
ries, and morality are defined, followed by a dis-
cussion of the resolution of ethical dilemmas in
health care.Values
Webster’s New World Dictionary(2000) defines val-
uesas the “estimated or appraised worth of some-
thing, or that quality of a thing that makes it more
or less desirable, useful.” Values, then, are judg-
ments about the importance or unimportance of
objects, ideas, attitudes, and attributes. Values
become a part of a person’s conscience and world-
view. They provide a frame of reference and act
as pilots to guide behaviors and assist people in
making choices.Values and Moral Reasoning
Reasoning entails the use of abstractions to think
creatively for the purpose of answering questions,
solving problems, and formulating a plan that
determine actions (Butts & Rich, 2008). Reasoning
allows individuals to think for themselves and to
not accept the beliefs and judgments of others at
face value. Moral reasoning relates to reasoning
centered around moral and/or ethical issues.
Different values, viewpoints, and methods of moral
reasoning have developed over time. Older world-
views have now emerged in modern history, such
as the emphasis on virtue ethics or a focus on what
type of person one would like to become (Butts
& Rich). Virtue ethics are discussed later in this
chapter.