The introduction of new technologies and approaches has affected nursing. In particular, the domination of “Obamacare” and health care reform caused ethical challenges for health care providers. However, the key principles of care have remained the same, including respecting the patient’s dignity, avoiding all the types of discrimination, and protecting privacy and confidentiality. This paper discusses three major ethical challenges and the ways of solving such conflicts. Besides, the paper analyzes the history of handling conflicts, particularly devoting the attention to strategies used before the implementation of the health care reform.
Ethical Challenges of Obamacare
Before analyzing three major ethical challenges health care professionals experience, there is a need to discuss a legal challenge. Thus, it was believed that the Affordable Care Act (ACA) requirement to buy health insurance is against the U.S. Constitution. The government has never demanded individuals to purchase any goods or services to stay in the United States. However, the ACA requires every working individual to pay into Social Security and Medicare, which is endorsed by the U.S. Supreme Court. In 2012, the court explained that the federal government could fine residents for not purchasing insurance because it was viewed as a tax (Lachman, 2012). Nurses should avoid discrimination of people with the lack of insurance and provide them appropriate care.
As for ethical challenges affecting health care providers, three key issues have to be addressed. The first ethical challenge is electronic medical records. In particular, health care reform requires saving all medical data in an electronic way, which can cause ethical issues related to privacy and confidentiality (Lachman, 2012). This requirement of the ACA needs significant sums of money, but the American Recovery and Reinvestment Act only gives $20 billion for information technology, which is not enough (Lachman, 2012). Moreover, it is expected that patients will keep their personal health records in their gadgets and will take them to health care facilities. Another possible way is retrieving health records via the Internet. Furthermore, the health care in rural areas will have some specific features. Moving to electronic medical records will be performed through telehealth and telehomecare (Lachman, 2012). These options will allow patients making the best decisions concerning their treatment. Despite the numerous benefits of these innovations, health care professionals might have difficulties with providing informed consent and confidentiality (Lachman, 2012). Nevertheless, they try to avoid sharing the medical records in any form. Thus, health care facilities should develop strict guidelines concerning privacy and confidentiality. Today, nurses receive intensive training about the ways of keeping privacy of electronic data and they should follow all the recommendations.
The second ethical challenge is the way of chronic disease management. Patients with chronic disease have many benefits of palliative care service during all stages of illness and not only at end-of-life care (Lachman, 2012). According to the ACA, an approach to chronic disease management is integrated and it involves “screenings, check-ups, monitoring, and coordinating treatment, and patient education” (Lachman, 2012). This approach is against feminist ethics, which stands for personalized service. The supporters of feminist ethics believe that a morality could not be based on rules because it leads to losing the variety of moral dilemmas individuals experience (Lachman, 2012). They say that only situational knowledge of the person may allow dealing with moral problems of life. Today, the nurse should follow the requirement of the ACA as well as provide personalized service to their patients.
The third ethical challenge is developing health care policy. The Code of Ethics for nurses says that these health care specialists are required to work either individually or in a group through political action to achieve social change (Lachman, 2012). This obligation raises concerns about neglecting “the individual mandate for society” (Lachman, 2012). The libertarians and free-market supporters believe that such approach strengthens the idea of American individualism, whereas the idea of responsibility for oneself and other people loses its influence. It means that people are encouraged to forget that they are not only free individuals with the right to choose but also the society members who should take care of a common good (Lachman, 2012). Nurses should think about their interests and participate in solving social issues.
Therefore, nurses have the ethical challenge to support patients whose rights are limited. In particular, health care providers should take care of individuals without a medical insurance or with specific health status. Another ethical challenge is assuring lasting sustainability of the American health care system. The advantage of nurses over other specialists is that they interact with diverse groups of people, so they can identify the cases of injustice in health care (Sorrell, 2012). Besides, the nurse can determine which groups of patients are particularly discriminated. All these aspects allow nurses improving individual and societal health (Sorrell, 2012).
Handling Conflicts between Ethics and Nursing before Health Care Reform
Nurses have experienced ethical challenges throughout their history, not only after health care reform. Thus, soon after the appearance of modern nursing practice in the mid-1800s, the American Nurses Association started to discuss the importance of writing the Code of Ethics. Nevertheless, this idea had not been put into practice for many years; therefore, the nurses had to use Gretter’s Nightingale Pledge, which served the same purpose as Hippocratic Oath for doctors. The first version of the Code of Ethics called Nursing’s Ethics for Hospital and Private Use appeared in the early 1900s. This Code explained the responsibilities of the nurse and described the creativity which was necessary for providing nursing care. In 1926, this version of the Code was published. The main parts of the document were the nurse and patient, the nurse and medicine, and the nurse and profession. For instance, the part about the nurse and patient included such a requirement as applying “all the knowledge and skill” to the practice (Epstein & Turner, 2015). Therefore, most of the time nurses had to rely on their creativity and intuition while handling conflicts between ethics and profession.
Later, experts started to state that the character is a key factor in solving ethical challenges. For example, Crawford stated that the character makes the nurse (Epstein & Turner, 2015). If nurses have right principles, they will make a right decision. Furthermore, Crawford developed rules of behavior for nurses in health care facilities. Besides, the expert identified the features of the character for a successful career in nursing. Thus, nurses should be industrious and flexible. They should also accept authority, think wisely before starting to talk, and be ready to work in difficult situations (Epstein & Turner, 2015).
In 1940, a Tentative Code was developed. It depicted nursing as a profession but this version of the Code was similar to the previous one (Epstein & Turner, 2015). The first formal Code for nurses appeared only in 1950. In 1960, it was slightly changed. This Code for the Professional Nurses had seventeen provisions and required nurses to protect life, reduce suffering, and promote health. Nurses were also encouraged to participate in research and be involved in the legislative process relating to nursing. In 1968, the Code was revised. The new version had a few important changes. First, the authors of the Code developed clear interpretations, so nurses could understand how to apply the rules. Second, the number of provisions was reduced from seventeen to ten; hence, it became easier to find necessary guidelines (Epstein & Turner, 2015). Finally, the language changed in the new version of the Code. The nurse’s obligations became deeper and were based on the duties. For example, the nurse had to respect the dignity of any person and protect the patient’s right to privacy. Later, new obligations were added, including advancing the profession, as well as creating and keeping a healthy work environment.
The current version of the Code explains the profession’s values and obligations, but it does not contain exact activities. Therefore, nurses have to take their responsibility and make their decisions while handling conflicts between ethics and profession. In the past and today, nurses have to take care of all the patients, especially the ones without a voice. In the case of conflicts, they should think what is better for a patient. However, they are also expected to maintain the privacy of medical records. The Code of Ethics only provides guidelines, but it does not say what exactly the nurses should do.
The health care reform caused a number of ethical challenges for nurses. First, the new legislature started to require purchasing a medical insurance by each working individual. Unfortunately, some people cannot afford to buy an insurance but the nurses still need to protect the rights of these individuals. Besides, nurses provide care to diverse populations, so they can monitor their needs and respond to them. Others cannot check following these recommendations, so it is a question of moral responsibility of nurses. Another ethical challenge is electronic medical records. The new legislature demands to save data about patients in an electronic way but does not give enough money for this. The main challenge for nurses is assuring informed consent and confidentiality. For example, patients are expected to take their medical records in their devices, so everybody could have access to this information. Changing attitude to chronic disease management is another ethical challenge for health care providers; particularly, this process will become less personalized. Finally, the health care reform focuses on the idea of American individualism, so nurses might forget that they are also society members who should care about the common good. Before the health care reform, nurses had to rely on their character while handling ethical conflicts. The current Code of Ethics does not describe exact activities, only major values and obligations of nurses. Nevertheless, key principles have not changed and nurses still have to focus on the interests of patients and protect their privacy.
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