Ethical Self Evaluation – Lila Gaudrault
Within the field of healthcare, providers from every profession face a wide range of ethical questions and dilemmas during their careers. Some of these issues are highly controversial, and can even attract media attention, such as Death with Dignity laws or problems surrounding patient confidentiality. Others, however, are more subtle – conflicts between the wishes of a patient and their family, managing patients with impaired decision-making capacities, and providing equitable treatment to all individuals, to name a few. Yet these seemingly smaller dilemmas are no less important. As someone who entered the field of nursing with expectations of memorizing bones and muscles, being quizzed on cardiac dysrhythmias, and learning to start IVs, I am grateful for a class that allowed me to think critically. Nurses, I have learned, are not medication-dispensing robots, nor the servants of physicians. They are not only vital hands in the healthcare team, but also vital brains when it comes to both providing patient care and navigating ethical dilemmas. Thus, I hope to incorporate the principles learned in this class into my future career, and, above all, challenge myself to collaborate and think deeply about issues that arise concerning patient equity and well-being.
Coming from a family of accountants, real estate agents, and engineers, I have grown up with little exposure to the day-to-day working life of healthcare professionals. Thus, I found our Code of Ethics project in particular to be beneficial in that it gave me the opportunity to talk to multiple providers about their work and the ethical dilemmas they face on a day-to-day basis. For the project, I reached out to multiple dental hygienists, and heard back from three, all of whom I spoke with about ethical dilemmas. One story in particular stuck with me. Professor Marji Harmer-Been, the current dental hygiene program director at UNE, shared the case of a previous student who was, at her job, asked by an insurance company to perform tasks outside of her scope of practice. The new hygienist felt stuck–she had been conditioned to follow orders obediently, yet she was faced with carrying out a task that could potentially harm a patient. Fortunately, advised by Harmer-Been, the student spoke with her supervisor and ultimately informed the company she was not able to perform the job. Coincidentally, I found myself faced with a similar situation just days after our talk. While completing clinicals for a CNA class at a skilled nursing facility, I was instructed to assist a patient with a task I was unfamiliar with. On one hand, the other CNAs at the understaffed facility were extremely busy, and I felt guilty asking for help. Yet, on the other hand, I knew that completing this task unassisted would be potentially dangerous to the patient. Ultimately, I asked one of the nurses to assist me, and was grateful that I did. In a society where independence is prized, new healthcare workers must take extra care to put a patient’s safety first, which often means being willing to ask for help and collaborate with others.
If I hadn’t first had the opportunity to speak with healthcare professionals facing similar situations, I don’t know if I would have taken the same actions in this case. Often, I have found that the greatest learning takes place through conversation and discussion. While the textbook readings and presentations were helpful in grasping the fundamental concepts and ethical theories, I found that class discussions, conversations with professionals in the field, and group collaborations allowed my mind to truly stretch and open up to new ways of thinking. I hope that my contributions to the class, whether it be sharing my conversations with dental hygienists, participating in a debate over a case study, or facilitating discussions about Henrietta Lacks, also shaped the learning of my peers, even if in a small way. Healthcare is all about learning from one another, and the opportunity to collaborate with students in different fields was especially beneficial.
One issue discussed in class that stood out to me was the short film about Justine, the young girl who needed surgical intervention for a heart problem, but whose grandmother believed the procedure would be “mutilating,” and impact her in the next life. This case presented the issue of cultural ideas surrounding medicine, and how they can impact a patient’s treatment. It is stories like these that highlight the importance of cultural competence for healthcare professionals. Being culturally competent means not only recognizing differences between cultures, but also possessing the ability to effectively communicate with these individuals whose beliefs we may not fully understand. Furthermore, we must be aware that no matter how much we learn about a culture, we can never totally grasp a system of beliefs that is not our own. This is otherwise known as cultural humility. As a future healthcare provider, I hope to develop culturally competent practices and the ability to communicate well with individuals from all backgrounds. Cultural competence also relates to equity and social justice because it seeks to ensure that all patients, even those who may face barriers with language, finances, or even discrimination, receive equal treatment to fit their needs. Honestly, if a patient’s family came to me wanting to deny life-saving treatment for their child on the basis of religious beliefs, I would probably have a hard time grasping their position. However, through increased cultural competence and empathy, I can see myself striving to better understand their position, encouraging open communication, and seeking to always provide the best information and advice. After all, as illustrated through narrative ethics, patients know themselves and are in the best place to share their individual stories based on their unique lifetime experiences. My job, as a nurse, is to listen, respect their beliefs, and provide the best advice and treatment that I can.
Understanding healthcare ethics can appear to be a daunting task. Yet broken down to its simplest form, ethics are simply ways to make the best decisions for the health of our patients. Oftentimes ethical behavior begins with collaboration, asking for help, and cultural competence, among other things. I am grateful for the opportunity to think critically about what this means for not only my future career, but also for my life as a member of society, throughout this class.
