“Responding ethically might mean having the ability to sit with your patients and be able to listen to their concerns related to their goals of care, to show respect for their humanity and vulnerability when they are often faced with difficult choices.”
CONNIE M. ULRICH, PhD, MSN, RN, FAAN
Lillian S. Brunner Chair, Professor of Nursing and Professor of Medical Ethics and Health Policy, University of Pennsylvania School of Nursing, Secondary Appointment, Department of Medical Ethics and Health Policy, Hastings Center and Salzburg Global Fellow
“Stand Up, Stand Out: The Value of Nurses and Nursing.”
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Q:
The theme for this conference is “It’s Complicated: Responding Ethically from the Beginning to the End of Life.” What does it mean to respond ethically? How does this theme resonate with your current research or practice?
Responding ethically might have a different meaning depending on the individual or individuals involved in a particular ethical issue. Generally, my colleagues and I have written that ethical issues can arise in any situation when one has profound moral questions about the rightness or wrongness of that situation, and it underlies professional decision-making and the beneficent care of patients (families or communities).
To me, responding ethically could simply mean raising a concern about an ethical issue that is troubling you or reaching out to your colleagues to discuss the situation. It could also mean seeking an ethics consultation to gather an outside view and help you better understand what ethical principles might be at stake and how to work through a resolution that is acceptable to all parties. Responding ethically might also mean having the ability to sit with your patients and be able to listen to their concerns related to their goals of care, to show respect for their humanity and vulnerability when they are often faced with difficult choices.
This theme absolutely resonates with my current work as some of my research with clinical ethicists during the height of the COVID-19 pandemic where nurses, physicians and others were overwhelmed with volumes of sick patients and with limited resources. They were often questioning what does it mean to respond ethically when one doesn’t have the resources to do so and to meet all the needs of patients who come before you. Of course, this lead to moral distress and other emotional and physical consequences.
– Connie M. Ulrish
Q:
The last few years we have witnessed a disintegration in civil discourse especially with polarizing topics. Nurses can be caught in these dialogues, both with patients and their families, in their communities, as well as when they are sorting through their own values and determining how they honor them while addressing them as a professional. What are your thoughts on this, and can you give one piece of advice to address these challenges in these turbulent times? What is your perception of the current nursing ethical landscape?
We have indeed witnessed distressing events and I am reminded of this by those nurses who are practicing on the frontlines and have experienced emotional and physical abuse from their patients and families (and colleagues as well). I am very worried about the civil discourse in our society, its coarsening, and the aggression that we are now seeing within the clinical arena. Unfortunately, the larger polarized macro issues of our society funnel down to the micro level and it creates much conflict for nurses as they balance their personal values and ethics and their professional obligations to patients and families. This is no easy task. I would encourage nurses to seek an ethics consultation whenever they feel uneasy about a particular situation where they can talk through why they are feeling the way they are and how to address the conflict between their personal ethics/values/belief system and what their professional ethics might require. Of course, if someone is being threatened or in danger of harm in any way, immediate action is needed. I would encourage every nurse to know whether their institution has policies/procedures for incivility and harm. If not, this is a discussion that I would ask every nurse to begin to have within their institutions and to take the lead and insist that sound policies are needed to protect healthcare workers as they work to care for patients and families.
– Connie M. Ulrish
Q:
What is your perception of the current nursing ethical landscape? Are there ethical dilemmas or questions that are trending in your line of work right now?
I would not be honest if I did not say that I was worried. Nurses have been through so much in the past few years and in some cases continue to face unprecedented ethical challenges. But I also realize that we must work together to continue to address the most urgent ethical issues that nurses are facing. We also need more nurses to take the lead in bioethics so their voices are heard, and changes can be made within the healthcare system. I am currently in the process of working on a grant where I am trying to better understand the ethical challenges that nurses are facing and how this links to nurse and patient outcomes. We continually need to show the data so we can emphasize the seriousness of nurses’ concerns to management, policy makers, and others. We already know the seriousness of the problems but sometimes it takes time (and data) to show others so changes can be made.
– Connie M. Ulrish
Q:
Can you tell us where you are finding joy in life, despite the challenges around us?
First, my husband continues to make me laugh and is the best quipster that I know! I also am fortunate to teach bioethics to nursing students who always keep me on my toes and help me gain greater insights on balancing the challenges before us or provide me with a nuanced way to think about an issue. And I bake. I love to bake, although that is not always the healthiest when you are baking chocolate chip cookies or a chocolate cake every week, but it sure does help! Finally, I am a WORDLE player. Trying to get those five letters in six tries gives me joy as I compete with my sisters!