Letter to the Editor by Deborah Santivañez to the Ethics column


January 9, 2014

Response by Deborah Santivañez, to ethics columns

Dear Editor:

As the general public slowly recognizes the nurse practitioner as a primary care provider, society has a right to question whether or not the profession is in keeping with their own unique code of ethics. Aristotle would question, is the nurse practitioner acting in good "moral experience," meaning as a profession is "the actual possession and exercise of good character being applied" (Aristotle, 2012, p. 68). If so, what ethical framework guides the nurse practitioner at the exam table or at the bedside? Is it different from medicine or nursing in general? Should it be?

Is it up to the nurse practitioner profession to educate the public about their identity, characteristics, and role distinction from the medical model? The author believes without hesitation that the answer is yes, it is up to us to educate the public through the media. If not, the media may influence the public to exclude nurse practitioners as a choice for a provider who manages many medical issues.

It has been over 45 years that the nurse practitioner profession has served the public not only where there has been a shortage of physicians, but as an alternative to meeting primary care needs. The profession has extended worldwide. In keeping with the increasing responsibility of health management, ethical issues have risen (Thompson, 2010)

In my opinion, borrowing heavily from such ethical tools developed for research ethics and various bioethical models such as nursing and medicine has resulted in the nascent field of nurse practitioner ethics beginning to feel the limits of those models (Beauchamp and Childress, 2008; Sander-Staudt, 2011). A need to build a unique framework that guides our profession's ethical challenges needs to be developed.

As a nurse practitioner for over thirty years, I propose that a discussion examining various bioethical theoretical frameworks demonstrating their similarities, differences, and values must begin, allowing us to move forward in developing our own framework that the primary care provider nurse practitioner can use as a tool at the exam table or bedside. This framework should answer four questions when making an ethical decision:

  1. How is the patient influenced by the decision?
  2. How is the nurse practitioner affected by the decision?
  3. What is the outcome of the decision on the nurse practitioner's profession?
  4. How will the public identify the profession by the decision made by the nursepractitioner as a new primary care provider?

In general, one of the guiding ethical principles for both nursing and medical professions is the same. Both are rooted in utilitarianism, based on promoting the maximum beneficial management for the patient. The ethical theories of practice, however, differ. (Breier-Mackie 2006; Fry,1989).

In conclusion, too often society is persuaded by impressions which they are given. If the media continues to tout that the only professional who can be a primary care provider is a physician, society will be influenced to believe it is the only truth; when indeed it is not. Society already knows this is not so, for they have come to utilize and depend on the skills and leadership provided by the nurse primary care provider.

Let us begin to distinguish what role does ethics play in the daily activities of the nurse practitioner.

Deborah Santivañez PhD
Email: santivan@aol.com


Aristole. (2012). The ethics of Aristotle. Retrieved from www.amazon.com/Ethics-Aristotle-ebook/dp/B00AQM9Z2G/ref=sr_1_1?s=books&ie=UTF8&qid=1388427450&sr=1-1&keywords=the+ethics+of+aristotle

Beauchamp, T.L., & Childress, J.F. (2008). Principles of bioethics (6th ed.). Oxford, UK: Oxford University Press. .

Breier-Mackie, S. (2006). Lippincott's nursing medical ethics and nursing ethics: Is there really any difference? Gastroenterology Nursing, 29(2), 182-183. Retrieved from www.nursingcenter.com

Fry, S.T. (1989), The role of caring in a theory of nursing ethics. Hypatia, 4(2), 87-103. doi: 10.1111/j. 1527-2001.1989.tb.00575.x

Sander-Staudt, M. (2011). Care ethics. Internet Encyclopedia of Philosophy. Retrieved from www.iep.utm.edu/care-eth/

Thompson, M. (2010). Looking for results. Understand ethics. London, UK: The McGraw-Hills Companies, Inc.