National Nursing Ethics Conference Day 2 Press Release

This press release was written for the second day of the 2023 National Ethics in Nursing Conference on May 24, 2023.

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Keynote – Ethics of Abortion Access Kate Watson, JD

The second keynote discussed the complex ethics of abortion access after the fall of Roe v. Wade. Kate Watson, JD highlighted the responsibilities of nurses and doctors providing abortion care, and explored the ethical considerations doctors and nurses must make as new laws continue to go into effect.

Watson said while there may be differences in religious affiliation among patients, she found one of the most comforting conceptualizations of abortions to be based in reincarnation – that even if an abortion is ridding a mother of the child’s body, the soul will return to their child at a later time. Among nurses, differences in religious and moral opinion can be resolved with requests to not participate in abortion care, but even with this request Watson said the patient’s care must always come first, she said.

“Situations may arise in which the prescribed course of treatment or care for a patient may be in conflict with the personal values or religious beliefs of a staff member. Managers also are responsible for ensuring patient continuity of care while addressing the staff member's request,” wrote Watson in one of her presentation slides.

Watson also discussed increased travel times for women seeking abortions and the rising rates of maternal mortality in the US. According to Watson, a demographer recently predicted a 21% increase in maternal mortality, especially among Black women, as more women are forced to carry to term. In the face of overwhelming odds, Watson recommended re-centering care and consciousness on the patient.

In each patient interaction, said Watson, there are two forms of consciousness: the patient, and the patient’s decision about the best course of action. Nurses must center themselves around the patient’s consciousness, in order to provide successful care. A good model of this, she said, would be to step back and allow care, even if there is a personal conscientious objection to that care.

“I think it's a good model of the shield model of saying, Well, this is about me, I'm going to pull back, but I'm not going to stand in your way. And in fact, to make sure that you get what you need,” Watson said.

“Consciousness is something concerning moral integrity or values that are a core component of identity. So the idea is that I wouldn't be who I am. If I did X. I couldn't sleep at night if I did x, right. It's just a broader and I think richer standard,” she said.

Plenary — The Value of Life, at the End of Life: Matthew Shea, PhD

Matthew Shea, PhD, focused on the moral and ethical values nurses must contemplate throughout end of life care – such as wellbeing and dignity – and the complexities involved in cultivating those values with individual patients. According to Shea, the most important values nurses can carry with them are the ones they learn from patients, but it can be challenging to determine the values that belong to human life and how to respond to those values.

“The moral life is primarily about responding appropriately, to the values that we encounter, the good things and the bad things around us. And these encounters can occur in our personal relationships and our professions and our societies and within ourselves,” Shea said.

According to the Nursing Code of Ethics, nurses should “practice with compassion and inherent dignity, worth and unique attributes and human rights of all individuals.” Shea explored these concepts further than the code elaborates, asking how nurses should understand the concepts of well being and dignity; what the nature of dignity and wellbeing are at their essence; why they are valued, and the significance of wellbeing and dignity for end of life ethics, especially as they relate to debates around euthanasia and assisted suicide and assisted death.

Shea spoke about the complex philosophies behind the concepts of wellbeing and dignity: Hedonism, which dictates that individuals are infallible judges of their own well being because that experience happens inside their own bodies, and they know and understand what they want; Personhood, which dictates that the dignity surrounding the person is grounded in their ability to function, and each person reasons at different levels; and humanism, which implies equal ability, well-being, and dignity among all humans, because they are capable of thinking rationally. These concepts apply to end of life care, said Shea, because they inform the proper approach to health care and to end of life care — to promote, respect and avoid violating the well being, dignity, and humanity of the patients being cared for.

“My goal is to show how the concepts and questions and theories that we've explored have significant implications for end of life ethics, disputes about the morality of assisted death can often be traced back to more fundamental disagreements about the nature of well being, and the nature of human dignity,” Shea said.

After discussing cases of assisted death and end of life care, Shea said that the proper response comes down to an internal sense of intrinsic good.

“Is it possible to participate in some way or facilitate those practices or participate in a direct way? Without that person intending the very thing that they think is wrong? Right. That's the hard question. As far as I can tell, if the answer is yes, and you think that it's always wrong to intend evil, which is kind of a traditional view that a lot of people hold that then you would say there. It's impermissible to kind of directly participate because you can't avoid intending the evil that you think is wrong. If you have a different account, then you wouldn't say that right? You'd be able to have more direct participation without the intention. But this gets you into deeper waters, about theories of agency and theories of intention, too, which is a whole nother can of worms, but I think, as you brought out, hard to avoid if you really want to get to the bottom of the ethics of it,” he said.



Closing — The importance of mattering, Beth Epstein, PhD, RN, HEC-C, FAAN

Beth Epstein, PhD, RN, HEC-C, FAAN spoke about nurse burnout, mattering at work, and the importance of finding a health care that is a community that shares and acts upon its foundational moral values.

Epstein discussed how the health care system is uniquely suited to be a moral community – a group that shares and acts on common moral value – given the myriad considerations that fall on health care organizations, like health equity, safety culture, financial stability, healthcare providers scope of practice, well-being, patient care quality, team-based care, community engagement, and more.

Epstein shared studies that found burnout among nurses comes less from other nursing colleagues and more from the levels of acknowledgement nurses feel from management and hospital administration. During group exercises where attendees determined the level at which they felt they mattered at work, many felt that they mattered to their coworkers, but that their boss would be upset if they knew they may leave their job. Words that attendees felt captured the idea of mattering at work included “gratitude”, “appreciation” and “respect”.

She called on attendees to look out for the ways they can communicate their values and suggested action plans to address nurses mattering at work to their healthcare organizations. Action plans centered on creating measures for determining the level of moral community, developing a way to strengthen ethics consultations and build safeguards against moral distress and burnout in healthcare settings.

“ Such a place cannot function well, without a constant focus on its foundational moral purpose, which is caring for the ill and vulnerable,” she said.