Page 9, 5th May 1972

5th May 1972
Page 9
Page 9, 5th May 1972 — Moral dilemmas on the wards

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Moral dilemmas on the wards

by the Rev. W. Dempsey, chaplain University Colic . e Hospital

WHEN asked to write for this Nursing Supplement I wondered if there was anything new that was really worth saying. I was asked to write as a hospital chaplain and therefore in close contact with the medico-morat problems of nurses.

My position is possibly unique in that I started life as a nursing brother and qualified in a London hospital. The result is that I am generally involved with the doctors and nurses in any decisions of a moral nature that crop up where Catholic patients are concerned.

I find the medical staff most co-operative. In effect I relieve the nurses of any anxiety over moral matters, for which they are most grateful.

A nurse in her training will be told that she must have a strong sense of duty and the Christian Commandment of Love Thy Neighbour should never he lost sight of. So to hegin with the moral issues in the field of nursing are not discussed in a cold, abstract manner and do not lack a sympathetic approach. (A similar comment can be made on the Statement Concerning Mora! Questions of the Bishops' Conference of England and Wales.)

Patients are not just customers and the nurse just a counter-hand. The needs of the patients are not really expressed in his own demands. He is told what his needs are, and he must carry out the instructions of the medical team.

Patients' needs

The nurse belongs to that medical team, but she has little say in the decisions that are made on the patients' needs. Because of this the whole ward nursing staff may find themselves in disagreement with the doctors.

Examples can be given. A patient has become anxious about his illness but the doctor thinks that he should not know the true facts. Also the medical staff may press for the continuance of treatment that can prolong life only for a few weeks : death is such a defeat to medical science. Operations on old people often cause acute anxiety to nurses. Views on these points are now being expressed by nurses in seminars and conferences. This is the new challenge. If the nurse were to continue with the idea: "Do as you are told and don't ask any questions" then there is nothing more to be said. But that is changing very rapidly.

The nurse is helped to face this challenge by the fact that she now requires a higher standard of education. The way is being prepared to give her a greater voice in her work. This is the first moral requirement: the nurse should receive a training designed to help her in sharing the decisions made by the doctors on patients.

I would regard it as grossly immoral if any society expected its members to work in a situation where they exercise no influence in that field. Anything else is slavery.

Different role

Account must also be taken of the fact that many nurses feel that the hospital is acting in isolation from the rest of the community. Taking temperatures and giving injections are all very well; but what of the home background and future wellbeing of the patient?

in other words the nurse. must be given a chance to treat the whole person or to belong to a team that caters for all aspects of the patients' condition. On these two points alone a great deal of work must be done:

(a) To equip the nurse with sufficient technical skill to share in decision-making.

(b) To establish that she is treating a whole being.

There is no suggestion here that the nurse should become a quasi-doctor. Her role is different from that of the doctor; she humanises a clinical situation.

Also it would be wrong to ignore the efforts of social workers for patients. The weakness at the moment is that there is not enough consultation with the nurse by the doctor and the social worker.

It will be interesting to see the results of the new training scheme introduced by a number of nursing colleges which is based on the model system

oriented to the needs of the patients. Included in this is the team of chaplains.

A hospital is not properly served by each chaplain going his own way. The chaplains must work together. If they do their job well they can make the hospital staff realise that they form a community of service and are not to be regarded as an emporium of medical expertise.

I have already said that patients are not customers in that they do not express their own needs or tell the doctors what treatment they should have. There are exceptions to this. A woman may ask for an abortion which is legal. Also patients both male and female may want to be sterilised.

On the question of abortion most nurses feel that it is an abominable practice. An attempt is now being made to keep nurses in training away from wards where abortions are carried out. The further effort to set up clinics outside of hospitals is a step in the right direction.

Nurses enjoy full freedom to withdraw from the scene of an abortion. This is part of the conscience clause. It is only right to point out that there should be a sympathetic understanding of the patient and her problem. A great deal can be done in the post-operative stage by dealing very delicately with the problem of guilt. (One might add that no chaplain should refuse to see a patient.)

As regards sterilisation, some feel there may be room for flexibility if one is thinking of co-operation in an evil act. A person can ask to be sterilised. That is a free choice legally acceptable. The fact that a doctor carries it out does not signify approval.

Stringent restrictions

He is not taking away life, which makes it different from abortion. He is taking away the means of transmitting life, which most nurses feel is less grave than abortion. It is certainly not murder.

Many nurses and doctors feel that the moral restrictions placed upon them by the Church in the practice of their profession would seem more stringent than on other profes

sions, For example, a Catholic judge can grant a divorce in this country.

A Catholic lawyer can defend a murderer and even free him from the capital sentence. In both cases there is involvement in evil acts of a serious nature.

The statement concerning moral questions by the Bishops' Conference deals with abortion but not sterilisation. Is this deliberate? Furthermore, it states "that in a pluralistic society we have a duty to respect the honestlyheld convictions of others which differ from our own."

I merely want to point out that among doctors and nurses there is a grasp of the wide difference between abortion and sterilisation. Also, there is great anxiety about forthcoming legislation on sterilisation which could result in the removal of Catholic doctors and nurses from certain fields of medical practice under the Health Service.

The statement by the bishops deals with euthanasia. It would seem to imply a greater trust in the medical profession : "Care for the dying does not mean keeping a person alive by extraordinary means when there is no hope of recovery."

Recently there was a very good discussion on this subject at Hemel Hempstead chaired by the Anglican Bishop of St. Albans. Much praise was given to the work of St. Joseph's Hospice and Dr. Cicely Saunders for terminal cases.

Very often the chief problem for the ward nurse is avoiding the questions of patients who are suffering from fatal diseases. "Nurse, am I dying?" Fortunately the nurse can seek the help of an experienced ward sister.

Relationship of trust

The chaplain is often asked the same question, and it usually denotes a relationship of trust between himself and the patient. For that reason the priest can approach the whole matter with a definite confidence. He must tell no lies and use no cover-ups.

IL is helpful to begin by asking the patient why he feels so. He then enters into a full dialogue with the doctors and nurses and relatives. The chaplain must handle everything

very carefully. The net result is that he brings everyone close to the patient which is a great source of comfort to him.

The presence of a chaplain when patients are being kept alive "on the machine" is also very beneficial, especially when the final decision is being made. On these occasions the atmosphere can weigh heavily on the staff. The chaplain can relieve this a great deal.

The moral problems facing nurses in their work, like all other moral issues, are part of the dialogue within the Church today. Greater account is taken of the insight of those engaged in a particular sphere of activity.

All this makes the Christian Message more meaningful. The nurse has a great deal to contribute. Everything must be done to encourage her.

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