Oncology Nursing as Ethical Practice

Many of us have patients we remember who left us with lasting memories. One such patient I cared for was a young man from Ghana. This young man had a wife, two children, and terminal cancer. He would not discuss the seriousness of his illness with his doctors, his nurses, his wife, or his community. However, from his hospital bed, he decided to go to Ghana to visit his mother. I was the clinical nurse specialist on the oncology unit at the time, and the nurses on the unit became upset with this man’s plan because they knew that he would probably never return from Ghana. He would not die with his wife or his children surrounding his bedside, as in a U.S. healthcare setting. He would die with his mother in his country—in his own way.

This patient’s choices created an ethical dilemma for the oncology staff. How many of you have had an ethical dilemma like this while caring for your patient with cancer? Consider the patient who decides to have bilateral mastectomies because she has tested positive for the BRCA gene, the patient who decides to stop treatment because of the side effects, and the family who must decide how to pay for cancer treatments.

Ethics is at the core of oncology nursing care, and the American Nurses Association ([ANA], 2015) calls 2015 the “year of ethics,” marking the first revision of the Code of Ethics for Nurses since 2001. The revision ensures that the code applies to modern clinical practice and quality care while keeping pace with transformations in health care. The ANA recognizes the impact ethical practice has on patient safety and the quality of care.

The revision of the Code of Ethics for Nurses coincides with the release of the “Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit,” an implementation plan for individuals and organizations to improve work environments, healthcare quality, and health outcomes (ANA, 2015; Berman Institute of Bioethics, 2015). To complement this ethics-in-nursing awareness, ANA is bringing together experts from across the healthcare spectrum for an ethics symposium in June 2015 in Baltimore, Maryland. Representatives from the Oncology Nursing Society (ONS) were at the national nursing summit, and ONS is a sponsor for the symposium.

ONS confronts ethical issues through our Ethics Special Interest Group (SIG), in position statements, in articles published in the Oncology Nursing Forum and Clinical Journal of Oncology Nursing, and in other publications. ONS position statements on palliative care, cancer pain management, screening for distress, and access to quality cancer care are only a few of the ethical stands taken by the ONS Board of Directors. Ethical issues that arise in oncology nursing education, practice, and research include moral courage and distress; genetics and genomics; end-of-life issues; euthanasia, assisted suicide, and aid in dying; and protecting and promoting human dignity and rights. Oncology nurses lead quality initiatives related to patient safety, care coordination, patient and family engagement, and affordable care.

Ethics is an essential component of oncology nursing practice and is inextricably linked to quality care. The ONS mission is to promote excellence in oncology nursing and quality cancer care. One of ONS’s core values is integrity, which is defined as “the organization and its members exhibit[ing] integrity and earn[ing] trust through ethical behaviors and uncompromising professionalism to all parties in business, professional, and personal interactions” (ONS, 2015, para. 4). Oncology nurses have a responsibility to uphold quality and ethical standards in practice to ensure the delivery of superior health care to patients. The code of ethics serves as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.

The National Nurses Week 2015 theme is “Ethical practice. Quality care,” and it begins May 6. Look for ways that you, your nursing organization, and healthcare facility can participate in and promote 2015 as the year of ethics. Remember that nurses are recognized by the public for upholding high ethical standards and rank as the most trusted professionals. The Gallup (2014) survey on honesty and ethics found nursing to be the most ethical profession for the 13th year in a row, with 80% of Americans polled asserting that nurses have “very high” or “high” honesty and ethical standards.

Do you recall an assignment in your nursing program to read the Code of Ethics for Nurses? Have you thought about what the code of ethics means for you as a nurse in general and as an oncology nurse in particular? Maybe it is time to go back and read, reflect, and remember what it means to practice as an ethical oncology nurse.

References

American Nurses Association. (2015). Code of ethics for nurses. Silver Spring, MD: Author.

Berman Institute of Bioethics. (2014). A blueprint for 21st century nursing ethics: Report of the national nursing summit. Retrieved from http://bit.ly/1uS8tWq

Gallup. (2014). Honesty/ethics in professions. Retrieved from http://bit.ly/1dkogSe

Oncology Nursing Society. (2015). Our mission, vision, and values. Retrieved from http://bit.ly/1EJS2Bx

About the Author(s)

Margaret Barton-Burke, PhD, RN, FAAN, is the Mary Ann Lee Endowed Professor of Oncology Nursing in the College of Nursing at the University of Missouri and a research scientist at the Siteman Cancer Center, both in St. Louis, and the president of the Oncology Nursing Society Board of Directors. Barton-Burke can be reached at bartonburkem@umsl.edu, with copy to editor at ONFEditor@ons.org.