appeal to promoting welfare' is not sufficient. A well intentioned intervention is not necessarily in the best interest of clients ,and ,even in those cases where it is , that is not sufficient to justify unwantedinterference' in people's lives.
The possible tension between welfare' andwishes' is one of the key issues in
health care ethics. Many of the contributions in this book discuss it in one form or
another. How should nurses balance promoting the welfare and respecting the
wishes of their clients? This is ,for example ,the background against which the
importance of informed consent is discussed. This issue is so important in health
care contexts because these typically involve ,on the one hand ,a patient who is in
some distress and in a relatively powerless state and ,on the other hand ,a group of
health professionals in relatively powerful positions and who are charged with
looking after the patient. This creates a constant temptation to take over' in one way or another for the sake of the patient ,without proper regard for the patient's wishes. The ideal circumstances are those in which a client is able to discuss and understand the options facing him ,and able to negotiate care and freely assent to any intervention. This assumes that the client is conscious ,of sufficient maturity , mentally well and in an open and non-pressurised environment. When one or another of these conditions is not met then there is scope for ethical debate about how best to act. It is usually relevant to consider what the client would wish if they were able to express themselves freely. This might entail imaginativelyputting
ourselves in their shoes' ,or consulting their family and friends about their views.
Sometimes health professionals or family members may be able to make an
informed judgement based upon the wishes previously expressed by the client.
2.2 Respect for persons and respect for autonomy
Although it is certainly essential to take into account the views or wishes of clients
it should not be assumed that it is always right for these wishes to prevail. What is
needed is an ethical account of why wishes' are of such importance ,and when ,if ever ,they can be overridden. The intuitions which lie behind this judgement are so basic that it is difficult to produce an account. But the idea ofrespect for persons'
helps to articulate it. In brief this is the idea that each of us has an intrinsic value
which ,if we are to recognise one another properly ,cannot be ignored or traded off' for some other end. To treat someone only as an object ,or only as a tool or resource ,is to fail to treat them as a person. This way of expressing the value of persons is derived from part of Kant's moral philosophy ,and for many modern thinkers it is close to the essence of ethics. One way in which respect can be exercised is by taking seriously the autonomous choices which people make and by not ignoring or overriding them. Hence the importance of consultation ,part- nership ,and informed consent. However ,respect for persons does not involve only autonomous choices. Par- ents may recognise the choices of their teenage children as autonomous ,and may choose to override some of their children's wishes without necessarily being guilty of treating them asobjects'. Indeed they may be treating them with great respect
and love ,and they may be motivated purely by concern for their children's welfare.
Acting in what you judge to be the best interests of someone else ,in a way that
22 NursingLawandEthics