What Would Florence Nightingale Think about Today's Bioethical Issues?

2010 is the International Year of the nurse. Today's nurses face a host of complicated issues in their day-to-day practice. During the centennial of Florence Nightingale's death, Nurse.com asked noted Nightingale scholars to predict what the founder of modern-day nursing would make of it all.

What insights does Florence Nightingale bring to today's ethical dilemmas?

I'm so glad to see that this next paragraph was included in ethical dilemmas. What back when I first came out of nursing school in the mid 70's the nurse was not really allowed to engage the patient in conversation about end of life issues, such as whether or not they wanted to be DNR.  I was severely disciplined for having done this without the doctor's permission. Now it is a matter of common practice. Here is what the above article says on that topic:

Nightingale would be pleased today with the ways in which nurses engage in end-of-life care in hospice and create healing environments in hospitals, as well as their strategies for bringing closure to personal affairs, such as medical directives, living wills and durable powers of attorney. She would ask us to bring more healing rituals into dying and to be reminded that patients should not be left to die alone unless that is their choice.

A related issue is Parent's Right to make healthcare decisions for their Children. Save the Child is a contemporary novel written by Margaret L. Turley, an RN with 34 years experience. She was inspired to write on this topic because of current events like the Parker Jensen Case in 2003, and the Danny Houser case in 2009. Turley's blog post on bioethics discusses ways families can deal with such situations. As nurses we should be aware of possible situations that require extra assistance and counseling in this area.

Save the Child will be released in September, 2010 during a unique book launch that is sponsoring a fund-raiser for the American Association for Cancer Research by the group Turley belongs to: Writers Unite to Fight Cancer.

Advice for Parents When They Disagree With the Doctor.

News Stories such as the Danny Hauser and Parker Jensen cases start people thinking about what is just, what is right, what is safe, and what is best for the child. A recent discussion with an attorney who specializes in healthcare and bioethics helped sort through some of the dilemmas we face as parents, grandparents, family members, caregivers and medical providers. Cultural and religious backgrounds are only two reasons of many why parents and doctors may disagree. Many kinds of available treatment also pose challenges during this already stressful decision making process. Often, as Nurses we find ourselves caught in the middle.

Rachel: If a parent disagrees with the doctor about administering chemotherapy to their child, what is the best course of action for the parent to pursue for the safety and health of the child and to maintain the integrity of the family?
Attorney:  First talk with other family members to determine if there are any differences of opinions. If there are differences within the family go to other trusted authority figures (Parents, grandparents, extended family members) and try to address the differences. Usually the problem is that the individuals involved have no previous experience with the particular issue. If the above doesn’t work go to trusted persons for mediation such as social workers, family counselors, or clergy.

Ask for a Second opinion. Ask what the reasonable chance is for an expected good outcome. Most hospitals have bioethics committees to refer these situations to and individuals and families may ask for a consultation with the bioethics committee. Seek for resolutions to the differences rather than escalating to conflict. When the Medical practitioners and the patient’s family have diametrically opposed desires the bioethics committee can play a vital role in helping to determine which side should weigh heaviest. Circumstances such as age of the child, religious values and beliefs and differing goals can be evaluated.

Third the medical practitioner should provide an expected outcome and prognosis with planned treatment course. For instance if the expected outcome is less than a month it is a reasonable presumption to defer to the family for the decision on whether or not to proceed with the outlined plan of care. Only when there is a good reason such as psychosis, or behavior that a majority of persons would recognize as unacceptable should action be taken to remove custody of the child from the family and or sever legal ties to the parent/s.


Fourth  when a child is old enough to be making decisions for themselves they should be given the opportunity to talk with someone outside of the presence of their parents – as it is unknown how much the parents are pressuring the child to make decisions against their own will. This person can be clergy, or a trusted adult such as a counselor, and should preferably be someone the child already knows and trusts.

Taking matters to court should be the Last resort. Usually hospitals would rather not get involved in such disputes. This always expensive and both sides focus on “winning” rather than the patient.


Rachel: Legal proceedings not only add financial burdens but also add lengthy proceedings to an already tense and usually time sensitive situation. Thank you for succinctly outlining the course we should follow. I especially appreciate that you pointed out that family members need to agree with one another first so that they can be united in their approach in caring for their child. Your counsel is much appreciated.

 In review: If  you have questions regarding rights to make medical decisions and what the best course of action would be for yourself or your loved one seek help from family members, a social worker, clergy, or a family counselor. If issues remain unresolved seek a second medical opinion, ask to change doctors or hospitals that may be more open to the approach for care that you prefer to use. You can ask for a review from the Bioethics committee. When these measures do not result in a satisfactory outcome seek advice from an attorney who specializes in healthcare and or bioethics in the area where you live as laws differ from state to state.