remove this personal accountability. Benjamin and Curtis [1] put the point very
clearly:
`In so far as a nurse has an obligation to follow a doctor's orders, it is only a
prima facie obligation, and may be overridden in certain circumstances by other
factors. A nurse must be careful not to confuse a well-grounded prima facie
obligation with blind faith.'Similarly, hospital policy, or the policy of one's employer, whether in a private
nursing agency, for example, or in industry, does not remove personal account-
ability. There is again a prima facie duty to comply with the rules and policies of
one's employer or organisation, but this needs to be overridden if the policy does
not meet agreed professional standards or fails to serve the best interests of the
patient. Although this seems ethically clear, it is supported by the law only up to a
point. Questioning the law or policy is positively required; refusing on professional
grounds to carry out the policy has legal backing. But refusing on any other moral
grounds is supported by the law only in the case of abortion; and trying to prevent
an order being carried out has no support at all, as far as one can see. Reporting to
the appropriate authority what is going on ± whistleblowing' ± is not required by the law, but is required, as we have seen, by the Code and is safeguarded by the law. There is a real problem here. On the one hand, the running of any institution requires that individuals make some sacrifice of their personal judgement of what is best to the judgement of those in charge; life would be impossible if individuals constantly prevented decisions from being carried out, and even the questioning of orders ± which is, up to a point, a good thing ± has to be kept within limits if activities are not to grind to a halt. It is also important to remember that anyone taking the drastic step of trying to prevent an order from being complied with may well face disciplinary action and find that, however morally right they may be, the law and the Code do not protect them. Evenwhistleblowers', who if they are
reporting genuine instances of unsatisfactory practice are precisely obeying the
Code, may find that, whatever the theory, they are in fact in serious trouble. But on
the other hand, despite the need to keep the institution running, and despite the
importance of not encouraging people to put themselves on the line when it is not
necessary, one must always remember the harm, sometimes terrible, that can be
done if people take no steps to prevent wicked actions or policies, or even well-
meant but mistaken actions or policies.
In the end, each health professional must decide for themselves when the
moment has come to put themselves on the line; one hopes most will be spared
ever having to make such a decision. The only guideline one might suggest is that
this should be considered only if the alternative is something widely agreed to be
seriously harmful. It remains important to acknowledge that one's moral duty can
conflict with one's legal duty. Which should be given precedence, in these
unfortunate situations, has to be a matter of individual conscience, and with
awareness that there may be a price to pay.
Negligence 97