Introduction: All civilizations have faced health challenges from ancient times to the present. They impelled the groups of healers and encouraged the codes of ethics to manage the treatments offered by that group of healers. During the pre-Christian era, these codes reflected the social values and social status of the society. Hence, with the historical development these codes of ethics marked medical education and practice as a profession. Now we can see not only how western medical training and advance practice but also how deep-rooted the place and medical concerns about confidentiality, end-of-life treatment, abortion, the changing role of technology, and the social status of medicine have always be present. John Gregory and Thomas (17th and18th centuries) articulate new standards for professional behavior. Their work provided many American and Canadian doctors who studied in London with the intellectual foundation from which to formulate formal codes of ethics when the American and Canadian medical associations were created in 1847 and 1867, respectively. During the 20th century, medical practice moved from the home to the hospital and the codes of ethics altered to reflect the impact of specialty training. They present as the Golden Rule, that the principles enunciated are basically as for good of the patient and the public at large. They respond to funding about health system and bioethical challenges that arose when the HIV/AIDS epidemic erupted. In 1990, the CMA (Canadian Medical Association) created a department of ethics and legal affairs that assisted the Ethical Committee. They revised the code against Bill C-43 on abortion and presenting a brief to the Royal Commission on Reproductive Technologies. The committee showed that a major revision was needed to address current concerns such as “euthanasia; confidentiality of medical records; resuscitation of the terminally ill; proxy decision-making etc.
In traditional practice, an ethicist usually used a case-based approach to medical ethics if challenged with a complicated ethical decision, would study a similar but simpler case in order to work out an answer to the specific case under discussion. As has already been mentioned, casuistry has been used as a method of analysis for centuries in Jewish medical ethics. However,Medical ethics refers to the discussion and application of moral values and responsibilities in the areas of medical practice and research. Hence, the questions of medical ethics have been argued since the beginnings of Western medicine. Medical ethics as a typical field came into prominence only since World War II. This change has originated as a result of developments in medical technology, scientific research, and telecommunications. These developments have exaggerated closely every aspect of clinical practice, from the confidentiality of patient records to end-of-life issues. Moreover, the increased involvement of government in medical research as well as the distribution of health care resources brings an extra sort of ethical questions.
What is ethics?
Ethics is a branch of philosophy that covers entire relations of belongings that have a true significance in everyday life. “Ethics is a discipline involved with good and bad, moral duty, obligations and values. Ethics is also concerned with social and political philosophy and the philosophy of law” (Lindberg, J.B. et al 1994).
Potter and Perry, (2010) present the central idea of bioethics is that moral decision making in health care should be guided by four principles. The terms moral and ethical are commonly used interchangeably. It is a human fundamental right to take the decision that what is right and wrong for him/her. Moreover, Beauchamp and Childress addressed the four moral and health care principles. Firstly, respect for patient autonomy. It means the individuals have the rights to decide, which course of action good for them. Respect for patient autonomy is a basis and keystone of nursing practice. Secondly, beneficence means that ethical behavior must do good. Thirdly, non-maleficence means the moral obligation to do no harm is recognized within both medical and nursing practice. Lastly and fourth one is the justice which is the principle of justice suggests that ethical behavior is a conduct that treats people equitably. Nurses are morally obligated to provide safe, competent and ethical care to all patients. These principles give us understanding about the nature of obligations related to these principles. (Proof)
However, according to Islamic context, Pakistan Nursing Council offered the professional code of ethics for the student nurse and registered nurse gives guidance for decision-making concerning ethical matters and serves for self-evaluation and reflection regarding ethical nursing practice. Hence, the code also informs other health care professionals and the public in general about the moral commitments expected of the nurse. The professional code of ethics shall act , at all times, in such a manner as to protect and promote the interests of the individual patient; serve the interests of society; justify public trust and confidence; and uphold and enhance the good standing and reputation of his/her profession (PNC).
Moreover, the application of ethical theory in health care generally focuses on dramatic situations of acute care medicine the balance between respect for the autonomy of the patient and thedesire to act in a beneficent manner often results in dissimilarity and tension. (Campbell 1994).
According to given scenario-based question, “a nurse is an assigned to a patient who has been diagnosed with an inoperable tumor and is terminally ill. The medical staff and the family insist that she is not to be told about her prognosis. She keeps asking the nurse, “Am I dying”. What should the nurse do in this situation?” We will discuss about this moral dilemma which arise due to clashes between moral principles, such as truth telling decisions, not to resuscitate patients and the general topic of autonomy and obligations of beneficence and non-maleficence. These three codes of ethics can create conflict with the principle of justice. Mainly two types of issues arise from nursing practice. On the one hand, there is a conflict between obligations to respect of autonomy and on the other hand, obligations of beneficence and non-maleficence. In reality, there are many other types of situations in which this type of conflict occurs, such as feeding and giving medication to a patient against their wishes, entering a patient’s house without their permission and trying to prevent a patient from committing suicide etc.
One limitation of the “Four Principles” approach is that when different persons, such as health care team involved in an ethical decision might disagree about the relative weight to be given to each code. For example, a patient who wants to be taken off a life-support system could argue that the principle of autonomy should be top priority, while the clinical staff can maintain that the principles of beneficence and non-maleficence are more important. The health care principles do not describe and indicate a hierarchical ordering by them. In this example, if patient need still life support system and nurse or doctor decides to take off a life-support system in the favour of respect of autonomy, they will lose the role of paternalism. In this way, autonomy will be high weighted rather than paternalism. If they do not take off life support system and keep a paramount of beneficence and mal-eficence then paternalism will be weighted. Actually, there will be no justice for the principle of justice. In nursing, justice often focuses on equitable access to care and on equitable scarce resource allocation.