Guest: Dr. Leah Curtin
Presenter: Neal Howard
Guest Bio: Dr. Leah Curtin is an internationally recognized nurse leader, ethicist, speaker, and consultant in the nursing field. A strong advocate for the nursing profession as well as the quality of patient care, Dr. Curtin has long been known for her contributions to the nursing community and brings a wealth of experience and expertise to her audience. Dr. Curtin is the executive editor of American Nurse Today, the official journal of the American Nurses Association, and a clinical professor of nursing at the University of Cincinnati College of Nursing and Health.
Segment overview: Dr. Leah Curtin discusses the conflict between doing what is good and doing what is right, for the nurse, and the difference between what is legal and what is right.
Health Professional Radio – Moral Dilemmas Nursing
Neal Howard: Hello and welcome to Health Professional Radio. Thank you so much for listening today. In the world of healthcare the nurse is normally the well the second line of defense, especially if first responder is involved, the EMT or maybe the police or the fire department. When they come to the ER, the nurse is the next one to have hands-on or maybe the first line of defense before seeing someone, a healthcare provider. Our guest in studio today is Dr. Leah Curtin, she is a strong advocate for improving the quality of patient care especially from a nursing standpoint. She is here today to talk with us about some of the conflicts involved when doing what is good and doing what’s right for the nurse and the difference between sometimes what is legal and what is the right thing to do. How are you doing today Dr. Curtin?
Dr. Leah Curtin: I’m doing just fine. Thank you.
N: Thank you so much for lending us some of your time.
C: Oh thank you for asking me.
N: Now as I said you’ve been hailed by many as a living legend in nursing well by the American Academy of Nursing and internationally recognized nurse leader, ethicist and advocate as I said. What prompted you, first of all to go into nursing in the first place?
C: Well what prompted me was I wanted to do something good with my life. I’ve wanted to be able to physically improve things for other people and emotionally and also spiritual too. And nursing offers all three of those things or at least the opportunity to do all three of those things.
N: Well there’s lots of stress of course dealing with life and death situations on a daily basis or even if you’re not in the ER, just dealing with the day to day routine and responsibilities of someone who has such hands-on contact with patients. The moral issues are bound to come up, sometimes you can’t go by the book. You have to throw the book out and go by your instincts, maybe twist your training a little bit to do what’s right and what’s good as far as the patient is concerned. Am I right in that assumption that sometimes you can’t always go by the book?
C: Well sometimes you don’t even have the opportunity go by the book.
C: And that’s for sure. But I’d like to make a little distinction here. And that is that “ethics” and thinking about what is the right thing to do in the given situation, that has to do analysis. And it has to do with thinking through things. And the biggest thing is thinking through things, whereas “morality” has to do with decisions I make about myself, “ethics” has to do with decisions I make about other people.
N: Great, thanks. That’s excellent clarification, thank you much.
C: And nurses, well we face the same problems all human being face. But we maybe face some of it a little more often because we are there with the patient 24 hours a day, 7 days a week, and certainly with the institutionalized patient. And many of our problems come up more in intensive care than they do in the emergency room. In the emergency room is pretty clear.
N: Uh huh.
C: You are there, right there and you do what needs to be done the way it needs to be done as quickly as you can.
C: Whereas in something like an intensive care unit, you’ve got an extended situation and you’ve got time to make decisions and you’ve got the ability to see the results of the decisions that you make and that other people make. And often times families have time to tell you what they want done, patients may or may not depending upon the condition therein have the ability to tell you what they would like and what they wouldn’t like. But often times in emergency situations there is no time for such reflection. But in intensive care or in long term care or in hospitalized patients in general, on general medical surgical ward there is time to think thru things.
N: Well now not being a nurse myself, when it comes to your training aren’t there contingencies for just about every situation where you can go by the book? Don’t they lend some credence to there not being anytime, having them make a split decision and say “Well if this happens then do procedure A, if that happens do procedure G.”
C: If they think of everything. How many times what happens is that the books don’t cover the problem. The books don’t say everything you ought to do, that and of course we have nurses prepared at many different levels. We have nurses prepared at one year preparation, I’m licensed practical nurses and we have nurses prepared to doctoral level who have baccalaureate or master as well as doctorate. And you can see where the problems and the thinking and the training and the education are very different so we have different problems.
N: Now that being said and understanding that there are different problems associated with different levels of training and experience, does the industry as a whole hold everyone responsible at the same level regardless of their training as far as ethics and morality is concerned?
C: There is a code for nurses that is promulgated by the American Nurses Association and it pretty much applies to all nurses in the United States. And so that the answer to that would be ‘yes.’
N: Okay. So if something like that is in place, I mean are we talking spirit of the law or letter of the law that is most often taken into consideration when there is a problem? Or does it depend on…
C: Now what’s legal and what’s ethical are not always the same thing. For example if you happen to live in Oregon, the patient can choose what is called physician-assisted suicide.
C: But if you happen to live in Ohio, that choice cannot be made. So if you are in let’s say Oregon, you can take care of a patient and assist him or her as they take their medicine for themselves. That’s the key to these bills, the patient takes the medicine himself or herself, no one, no physician, no nurse gives the patient a legal overdose. The patient may take it and the physician may prescribe it but if you lived in Ohio that’s not an option.
N: Now if you’re living in a state were that is an option but morally you don’t subscribe to that ideology, can you I guess up doubt or refuse to for lack of a better term, do your job if your asked to do that.
C: When there is a problem of conscious. In almost any institutionalized, organized setting someone else can take care of that patient and not the nurse who has a moral objection to it. So it isn’t that the patient doesn’t get the care, the real question here is this, “What you call moral?” Moral is doing what you think is right not even that’s really what I think is right, not even necessarily what the law thinks is right, is doing what you think is right. And what therefore is the opposite of moral? It’s “immoral” which means doing what you think is wrong.
C: Can you understand what I’m saying?
N: I do. So it has it can be legislative,
C: Now how many immoral people do you want taking care of you?
C: Exactly. So it’s much better to find someone who’s thinking is in keeping with the patient thinking than is to try to strong arm something in someone in doing what they believe to be wrong.
N: And this is also, it swings both ways as far as the nurse or nurse practitioner deciding for themselves what is right. And the patient deciding for themselves what is right. When there is a conflict you say that often times there is someone else who can step in?
C: There can be or you can reach a negotiated way of dealing with an issue.
N: In your experience, having a lot of experience dealing, training with nurses, dealing with physicians, EMT’s, the entire gamut of healthcare – in your experience how do nurses deal with this conflict, sometimes having to go through with something that they felt was morally against what they felt was right.
C: Well fundamentally, if they google against what they think is right, then they have just made themselves immoral. Do you understand? By their own definition. So that if we’re trying to preserve the integrity of the practitioner, we have to understand there are rights, patients have rights and nurses have rights and so physician have rights. And some of them are clearly outlined in the law and some are not and the law by the way is not always right but we’ll get back to that at some other time. But the real issue for the nurse when facing a problem, he or she believes is against his or her conscience is to act in the best interest of the patient as humanly possible.
N: You’ve been listening to Health Professional Radio, I’m your host Neal Howard. We’ve been in studio today talking with Dr. Leah Curtin, the Executive Editor of American Nurse Today, the official journal of the American Nurses Association and the clinical professor of nursing at the University of Cincinnati College of Nursing and Health. She is authored 360 articles primarily published in pear review journals and more than 450 editorials and as authored or co-authored several books for nursing professionals on topics such as Nursing Delivery Models and Nursing Ethics. In 2009 she was declared a living legend in nursing by the American Academy of Nursing for her extraordinary and sustained contributions to nursing as a role model and as a positive impact of her career and influencing nursing and healthcare overall. It’s been great having you here with us today Dr. Curtin.
C: Thank you very much.
N: Thank you. Transcript and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to our podcast on iTunes.