Outcomes
. Is she, for example, most concerned with the reputation of the hospital?
. Is she concerned for the safety of her other patients, who may be endangered if
she devotes herself solely to the care of V?
. Or is her priority the injured person directly in front of her?
She may not, in a short space of time, be able to think through all the ramifications,
but it will help her considerably if she feels she understands which of these
possible goals are, in principle, the most important.
Obligations
Does she have any obligations or duties which override thecontext?Must she, for
instance, as a `caring professional' do all she can to help V, who is clearly suffering?
This is for her to decide. However, as she thinks about this she must be aware that
not only must she justify her decision to herself, but she may also have to justify it
to others. So, if she decides she is obliged to intervene wherever she sees suffering,
she must also be able to say whether this is ageneral obligationand is always
incumbent on her, or whether there are factors !such ascontextandoutcome)that
may sometimes cancel out such a duty.
8.14.2Casetwo
Consider now the second case study !set out in section 8.9) of W, the night duty
charge nurse believing that the standard of care had dropped prior to a patient
dying in distressing circumstances. In this case, even more than the first, there are
evidently two distinct right things to do'.To do the right thing 1' in this case is
either to do nothing because the context is so overwhelming !the nurse may know
that similar staffing difficulties are being experienced across the country ± how can
her situation be made an exception?), or to pursue the matter through the official channels', as explained in section 8.9. However, since all theofficial channels' are
themselves part of the system which allows !or is forced to allow) such a situation
to arise, it is extremely unlikely that this course of action will bring about an
improvement in the situation on the nurse's ward. To do the right thing 1' would almost certainly mean that little would change. However, if the nursedoes the right thing 2' it may be a different matter.
Although she might in the end reach the same conclusions as generated by doing the right thing l', the nurse must first try to think as an individual uninfluenced by the system. What, she might ask,oughtto be done in these circumstances? The questions she must address are similar to those considered by N in Case one, and again might usefully be divided into the three categories. What are the risks in thiscontext?Willwhistle-blowing' be effective? How
important is the nurse's career? !There are well-known examples of nurses
destroying their careers in the pursuit of causes they believe to be just.) Are the
nurse'sobligationsto her patients paramount, or does she have wider duties !to her
colleagues or to those future patients she might not be able to care for if she is
suspended from work or sacked)? In principle, whatoutcomesdoes she value most
154 NursingLawandEthics