By Helen Caulfield
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Extra info for Accountability
A further aspect to take into account in relation to acts and omissions is the doctrine of double effect. This doctrine has been developed largely in relation to death and dying. It is the doctrine that allows a primary action to be taken even though, as an unintended secondary consequence, the person may end up in a worse situation. The key example would be pain relief in a person who is dying. While it would be morally unacceptable to act in a way that hastens that person’s death, it is accepted that the consequence of giving pain relief may hasten the death, even though that is not the prime reason for giving the drug.
Where a patient is in pain and asks for pain relief, the decision to give morphine is an act. An omission is defined as a positive decision to avoid taking an action. Where a child is near to death and is unconscious, an active decision not to intubate is an omission. Where a nurse sees an elderly patient in distress but chooses not to call the crash team, this is an omission. The difficulty with the moral debate on acts and omissions is that the outcome for the individual patient may be the same, particularly at the end of life.
Consider the moral responsibility on Sarah in relation to acts and omissions if she decides not to give the medicine to her father. Consider the moral responsibility on Heidi in relation to acts and omissions if she decides not to share her thoughts with anyone. Application to accountability The aim of this chapter has been to set out the broad range of ethical issues that have an impact on nursing practice. The importance of an understanding of the ethical issues is that the nurse can enrich an assessment of accountability by considering a range of moral issues for which there may be no concrete answer.