When we talk about something like parish nursing, ethical principles shouldn't be far behind. Here is a list of ethical principles as described by Ruth Stoll, RN, director of the Parish Nursing and Health Ministry Course at the Samaritan Counseling Center in Lancaster, PA.
1. Beneficence. Do good and prevent harm to any and all aspects of a person. The principle is to act to promote the well-being of individuals wholistically. This includes an assessment of burden in respect to benefit, where a treatment should be considered morally obligatory when the benefits hoped for or obtained are proportionate to the burdens. A treatment would not be morally obligatory, though it still may be employed, if it is of little or no benefit or if the burdens outweigh the benefits. Again, the burdens and benefits must consider the whole person. However, we must remember that we do not determine this, nor does a family; it is the individual that must determine this for himself or herself.
2. Non-Maleficence. Do no harm. This is (or certainly should be) a core directive in every caregiver's practice, and is based on our belief in the dignity and sacredness of human life. Our intent must be never to intend to directly harm or kill another human being.
3. Autonomy. Otherwise known as self-determination. Autonomy is the ethical principle we seem to hear most about. It concerns each person's right to choose their own course of action in accordance with their individual values, life goals, beliefs, etc. Whether we agree with that choice or not, a person's choices should be honored whenever possible. The exercising of autonomy is based on informed consent. Therefore, individuals have a right to information concerning their own health and wellness, including diagnosis and prognosis. It requires that the person comprehends and understands the significance of the benefits and risks proposed for their health care based on their values and beliefs, has the capacity to make a decision, and makes any decisions without coercion, manipulation or undue influence. Informed consent is not a once-and-done discussion, but must be an on-going process.
4. Veracity (honesty). Do not deceive others. Those with whom we work should be given adequate and accurate information about their condition along with possible courses of action. Decisions made to withhold information or mislead individuals are rarely justifiable. This can sometimes be very difficult for parish nurses. In a hospital setting painful honesty is expected. In a parish setting we are expected to be more "caring," plus we usually know the people we are dealing with. We do not want to hurt them or cause them distress, so we can usually find ways to waltz around a problem before confronting it. It is your responsibility and duty to work with people and guide them if need be, so small problems in the present do not become overwhelming problems in the future.
5. Fidelity. Do not betray the trust of others. Honor your promises. Keep confidences.
6. Justice. We don't talk about justice much, but both the Hebrew Scriptures and the New Testament are very heavily weighted in their concern for justice. The importance of justice cannot be overstated and involves three issues:
Equality of Persons - Treat similar cases similarly, without prejudice or discrimination.
Reciprocity - Give to each person what belongs to or is strictly owed that person.
Social Justice - Distribute benefits and burdens equitably in your congregation, your community, and in society as a whole.
7. Professional Integrity. Act within the scope and standards of practice. Do not act contrary to your morals, ethics or conscience. Know scripture and live it out. Be above reproach and do nothing questionable. We are representatives of the Church of Jesus Christ and should act like it. Yes, this can be difficult, but whether we believe we have been called by God to work in this vocation or not, in essence, we have all chosen this path and should live according to its requirements.
