A computer, the Web, and an ethical dilemma

By Deepa Arora
Illustration by Malcolm Garris/PhotoDisc
July 2, 1998

When nurses face an ethical dilemma, where can they turn? Hundreds have looked to the Nursing Ethics Network (NEN), an organization that gives nurses a high-tech way to solve ethical dilemmas and access the latest ethics resources.

Nurses can visit the NEN’s Web site to submit their ethics questions, which are then referred to one of the 20 members of the network’s advisory board, all nursing professionals with expertise in areas such as end-of-life issues, nursing ethics, and palliative care. Board members are careful not to give answers to questions—they only provide the resources to help a nurse find his or her own solution.

"I don’t think they [nurses] want others to solve the issue for them," said Joan Riley, EdD, RN, chair of the NEN and associate professor and chair of the department of nursing at Emmanuel College in Boston. "They just need a way to reframe the issue, and they will solve the problem themselves."

Not Dear Abby

"We are not a consulting service," said Margaret Mahoney, PhD, RN, an NEN board member and assistant professor in the College of Nursing at Northeastern University in Boston. "We validate their concerns and try to help solve their problems by referring them to resources where they can find help. But we are not a Dear Abby over the Internet."

The NEN, which is affiliated with the Boston College School of Nursing, has been unable to get feedback on the decisions nurses ultimately make because the online queries are anonymous.

The NEN and its free online service began three years ago when long-time friends Riley and Mahoney decided to use their interest in nursing ethics to further ethics education for nurses in diverse work settings. Brainstorming with other professionals interested in ethics led to the formation of the Nursing Ethics Network. "Most programs incorporate ethics into the nursing curriculum, but it is very theoretical and doesn’t make the transition into practice," Mahoney said. "Nurses said the ethics education they had received was not very useful."

Plans for the future

In addition to the online inquiry service, the network is undertaking a study of ethics issues in New England that members hope will ultimately help them develop a better ethics education agenda for practicing nurses.

"Ethics will probably be the single most important issue of health care in the future," Mahoney said. Technological advances that help keep premature infants and the elderly alive beyond what was previously thought possible, the tracking of genetic causes of disease, and further cost cutting in health care will present the next generation of nurses with different ethical dilemmas, she said. "We have to develop a value system so that nurses can provide care that they are comfortable with," Mahoney said. "A lot of nurses are not comfortable with their practice today. I hope that the ethics network can mitigate some of the moral distress."

One nurse who used the network worked in a long-term care facility. Her patient wanted to stop aggressive medical intervention, but the family wanted to continue taking measures to prolong the patient’s life. While the nurse felt an obligation to the patient, she also empathized with the family. She logged onto the NEN Web site and asked for help. An NEN advisory board member sent her information on advanced directives, durable power of attorney, and living wills, all the while steering clear of telling her what she should or should not do.

Another nurse wanted to know whether she could refuse to care for an HIV-positive patient. She was given information on the state practice act and code of ethics, as well as the American Nurses Association’s position paper on the subject.