The Ethical Dimensions of Critical Care Nursing
The ethical issues described by critical care nurses reflect all the dimensions of critical care settings described in earlier chapters. The setting, the rapidly changing technologies, and the evolving roles of nurses in critical care settings, all influence the ethical dilemmas that confront nurses, patients and their families, physicians, administrators, and many others who have prolonged contact in hospital settings.
Society is more and more bombarded with the consequences of contemporary medical treatment. The syndrome of multiple system failure and death from gradual deterioration and/or catastrophic events in a highly technological ICU (intensive care unit) setting is increasingly common. The social, financial, and human costs are immeasurable in such varied aspects of health care as organ procurement for transplants, fetal organ and tissue donation, and experimentation; treatment and privacy rights of patients with acquired immune deficiency syndrome (AIDS) and drug resistant tuberculosis (TB) versus risk to the public health, including the well-being of health care workers; reproductive issues such as contraception, abortion, surrogate parenting, extrauterine conception, and artificial insemination; and the rights of the aged in our society to health care. Issues of quality of life, death with dignity, right to die, and euthanasia emerge with increasing frequency in the treatment and care of terminally ill, dying, comatose, and brain dead individuals. Rapid changes in technology often seem to outpace the redesigning of social and legal structures and moral thought.
All these issues are influenced by problems and inequalities in U.S. society with regard to resource allocation and access to medical treatment. The economics of health care are tied to political and legislative processes and health policy. At the present time, many groups in the United States are underserved because of reduced or terminated services, especially the urban poor, women, particularly pregnant women, children, and minorities. This