Ethical /moral points of view:

I really enjoy teaching in Singapore the array of different cultures and ethical / moral points of view always make me reflect on life and consider another point of view: Ethics and morality are often interchanged…. Some people confuse ethics and think that it is ethical standards or a code of ethics even religion, which it is not…there is a subtle difference between ethics and morals….. Ethics is how society views social structure where as morals are a personal characteristic which often includes a religious flavor…. However generally people use the terms to mean one and the same…. Let’s face it morals are influenced by our religious, spiritual, cultural, scientific or learned experiences. Ethics goes one step further than morality in the sense that we have ethical theories (Utilitarian & Deontology)and principles, such as autonomy, beneficence, non-malefence, justice and veracity. Peter Singer states “Ethics has no necessary connection with any particular religion, nor with religion in general."


Interestingly I believe as we get older we generally change our point of view…. I think with maturity comes an understanding and wisdom and letting go of idealism. I think back to the days when I was a nursing student at 18… young and idealistic; I wanted to save the world from its self… I was given this knowledge as a student nurse and it was fantastic…. This particular day I was working in a rehabilitation ward looking after an elderly man recovering from major surgery, taking his blood pressure…and suddenly there was no blood pressure… I looked at the man and yes he was grey, pale, he had just passed away as I was talking to him….my first instinct was to resuscitate him…..so I did… when the team arrived someone read his chart and said….”he’s not for resus so maybe we shouldn't be doing this” I looked up and continued for a few more minutes then stopped. The man had died. The matron who was a nun asked me to see her in the office….. I had no idea what I had done wrong…. She asked me why did you resuscitate the patient. I am embarrassed now by my answer…. But I said… “God has given me the knowledge to resuscitate this man if he wants him to die he will die anyway”. The nun just looked and me and said nothing…..As I look back I can see I thought I knew best…. Ask me what I would do today…. I would respect the patients request not to be resuscitated…. I am not saying all young people are like this but I do think as we get older our morals, values and ethical views change due to our life experiences…. That is just part of life and getting older……

As a health practitioner I maintain that you have to have a good sense of “self” in order to care for your clients. That is understanding your own moral and ethical grounding, this sense of self awareness allows you to understand why you react in the way you do and allows you to step back and not be judgmental in the care you are providing to the client. I must say I did not become self aware until I was in my 30’s.


As we know there is no right or wrong when it comes to discussing ethics; however when you focus on the hard issues such as capital punishment, abortion, organ transplant, euthanasia, genetic testing, and allocation of health resources the students came up with some pretty black and white answers, they are rather pragmatic about the whole issue. Singapore’s Medical Council is currently reviewing its code of ethics to keep in line with the advancing technological age (biotechnology) and the demand for organ transplants and genetic issues. This is an attempt to hold the health profession more accountable for decisions made within these areas.

Recently President Obama called on Americans to “expand our moral imaginations, to listen to each other more carefully, to sharpen our instincts for empathy, and remind ourselves of all the ways our hopes and dreams are bound together”. This was an attempt to defuse the abortion debate in America which often reverts to violence due to such opposing views. But the reality is we all worlds apart in finding solutions – everyone has their own idea about polices and justice. Often our moral imaginations are so divergent that never the twain shall meet.

When I asked the students how valuable do they consider human life within today’s society? Everyone said it is valued, and yes it is wrong to kill another human being; except if they have killed another person…..(Singapore has the death penalty) I then asked what about drug traffickers? They haven’t directly killed anyone. Again most agreed that yes they deserved to die because they contribute to someone else’s death or changed circumstances; even though they are really only the carrier or victim because the real culprit is rich and to clever to be caught….this was food for thought. So in essence the wrong person is being killed: In order to question the rules of society I then asked what about the woman who is stoned for committing adultery….(not in Singapore). In this instance the person that is being killed is the woman; the man did not get the same punishment. This did generate some discussion and most agreed that this was wrong……however most agreed with the philosophy that if some takes a life theirs should be taken.

Abortion always creates a debate…. No one can agree on this topic, I wonder if the world will ever reach a consensus on this; Pro Choice v Pro Life; with a multi-cultural, multi-religious class it was an interesting discussion at least there was a discussion and an expression of opinions however the divide still remains; does life begin at conception? Or when the fetus moves @ 16 weeks or when the fetus can live independently from its mother? Is abortion under 12 weeks acceptable? What about late term abortion for abnormality or not? All these questions need to be explored by the people and policy makers in a peaceful and respectful way.

The ethical debate will continue on many subjects, should the alcoholic or drug addict have a liver transplant, the smoker have a triple bypass, what if a prisoner for murder needs a kidney transplant.....Should the pregnant woman who is a drug/alcoholic be in prision?(as they do in America), I hope this never happens in
Australia, the list is endless... what is the individuals responsibility towards health care....rich v poor.... if you can't help yourself in improving your health care.... should the government support your treatment....? we are spending billions of dollars on health care.... what is the solution? the debate about health care resources continues.

Sailing Solo around the world at 16yrs, what do you think?

An ethical dilemma or is it?

Like many of you watching the news today, it has been dominated by the on going debate of Jessica Watson's decision to sail around the world at 16. In fact over the last several days this issue has been debated at many levels.

Why are we making such a big issue of a 16 year old girl making a solo trip around the world? is it that we are a paternalistic society? do people think she is to young to make this decision or trip? why is it such a big deal?

Jessica is an accomplished sailor, she has been sailing from knee high to a grasshopper. (I do hope that she has been prepared correctly for this trip, which has not been reported). Her parents are supporting her to realise a dream....so why is the world not saying, "great Jessica" and wishing her all the best. Instead many people have been pleading with her and her family to call off the trip. I wonder why?
Here is someone who is willing to undertake this task realise her dream, who is well aware of the consequences of her actions. Why is it such a big debate?

When we consider the law in terms of consent to medical treatment for minors,(clarifying that a minor is under the age of 18) the minor has to be able to understand the consequences of their actions. This means that the child understands the illness, procedure, outcomes, pros and cons and consequences of the action. This in English Law is considered "Gillick Competent", therefore the child does not need parental consent. There is a proviso within Gillick Competence and that is, a child can not refuse life saving treatment.
If this is the case for medical treatment, do we not consider that Jamie is Gillick Competent, therefore capable of making her own decisions and living or dying with the consequences. The question I think you have to ask, is it in Jamies best interest to do a solo sailing trip around the world?
I hope that Jamie realies her dream and becomes the youngest woman to sail around the world.

Why is there all this debate?

An Ethical question, "my sisters keeper"

I went to the movies to see "My sisters keeper" with my girlfriend, we had a superb night. The movie does raise ethical questions about genetically created babies, or babies created for 'spare parts'.

The movie is based on Jodie Picoult's book - the opening I thought was brilliant and quiet true, in that most babies are created by accident, where as Anna Fitzgerald (Abigal Breslin) was conceived by means of invitro fertilization. She was matched genetically so that she could provide stem cells etc for her sister Kate (Sofia Vassilieva) who stars in "Medium".

The long and the short of the story is that Ann 11yrs old sues her parents for the control of her body. This is an interesting concept because I believe that children who are sick or have a major illness are very well informed and have a good understanding of the disease process. Therefore, I also credit these children to having a greater awareness, understanding and depth about their illness. It stands to reason then that these children will a greater comprehension of the consequences of the illness and treatments.

In order for a minor (usually under 18) to be able to give consent to treatment they need to meet certain criteria and generally that is to be "Gillick competent". The other issue is that it is in the child's "best interest".

An important issue here is the right to self determination, the right to choose what happens to your body. This is particularly important for women, making decisions when pregnant. Who's body is it? the woman's, the doctor or the babies? do you force a woman to have a cesarean section to have her baby?

Imagine that a member of your family needs your kidney and you do not want to give them your kidney, for whatever your reasons and that family member dies because no one else is compatible, you can not make anyone give you a kidney because you are going to die - then think about a woman choosing not to have a cesarean section to save her baby? for what ever her reasons, providing she is mentally well. Do you force her to have c/section? I think not, this would be considered "assault and battery". Food for thought!

This movie was good in highlighting these types of ethical decisions, which I think we will see more of in the future - because these issues are not always thought through to the end, and certainly it all begins in Amercia.
Lastly, the book ends differently to the book, this was disappointing, however I think I prefer the movie ending!

The movie is worth seeing, just take some tissues!

Ethical question: should we be encouraging octuplets?

Has the idea of fertility gone mad, eight babies to a family who already have six children what is the point or have I missed something? The chances of eight babies being conceived naturally are inestimable. I thought the idea of fertility treatment was for couples who could not conceive naturally.

I would argue that the doctors concerned in this case are negligible on ethical basis, why? Because they knowingly put this woman at risk and high risk is what doctors should be avoiding.

What do you think? Do you think there is any responsible reason why octuplets should be conceived?

To read the complete story click here

Should nurses & midwives be allowed to work as a health professional once they have committed a criminal offence?

Nine msn reported on an interesting story in Victoria, regarding nurses found guilty of serious offences. This information was found through The Freedom of Information,the offences included manslaughter, sex offences and torturing animals.

Nurses in Victoria found guilty of serious offences including manslaughter, sex offences and torturing animals have been given approval to care for sick and vulnerable patients.

Nursing authorities in Victoria have in the past three years approved registration of more than 100 nurses who had admitted being found guilty of crimes including stalking, drug trafficking, possessing child pornography and manslaughter, News Limited newspapers said.

This raises several questions, what was the crime? have they repaid society for the crime? and are they now trustworthy?

Have they by the very nature of the crime, forfeited the right to work as a nurse? one could also argue,that the nurse has bought the profession into disrepute therefore should not be allowed to work as a nurse again.
Would you like this person looking after your mother, father, son, brother etc.

Off course there is the other side of the coin - they have paid the price to society for the crime, whether it be a fine or goal time and they have proven to be trustworthy. Is it then unreasonable to allow them to work as a health professional again? However, It does seem bizarre that a nurse convicted of sex offences and torturing animals would be allowed to work as a nurse again?

Do we allow policeman who have been convicted of a crime and gaoled to be re-employed as a policeman?

What do you think? should nurses & midwives who have committed a serious criminal offence be allowed to re-register and work as a nurse?

Soooo busy marking papers! no time for blogging!

I am so busy marking papers I can not see the forest for the trees. I am dreaming case studies, law and ethics. Marking is fun when your students are getting it right - however marking is so much harder when they get it wrong, there has got to be a better way of testing knowledge. The biggest issue I am facing is incorrect referencing, paraphrasing or incorrect paraphrasing and PLAGIARISM, role on next semester when I will use a computer system that detects plagiarism for you. I am sure that will make both the students life and mine easier. I found this great site that helps you understand referencing, paraphrasing and plagiarism - have a look and pass it on to others who may be interested it is called The Owl at Purdue:
Must go, marking calls, the joys of lecturing/teaching.....................

Posing the ethical question?

Last week in the news I heard this story and it was thought provoking so I thought I would share it and hopefully generate some discussion. I am interested to see what everyone thinks about these ethical dilemmas.
With the health care funds being in such high demand, not enough to go around, is it now time to think about who gets specialised health care? and if so, this then will have greater implications on society.
Posing the question: Should a serial rapist who shows no remorse or signs of rehabilitation and serving time in goal be allowed to have a life saving kidney transplant? The Queensland government has put such a person on a taxpayer funded program for a transplant. As we are aware there are many, many people waiting for a kidney transplant, so should assessments be based on purely medical need or personal character and to what value they have in society?

http://www.news.com.au/couriermail/comments/0,23836,23662358-952,00.html

Remembering - The ethical principle of Justice - "fairness and equity to all"
What do you think?
It is an interesting question? will the day come when we make these sorts of decisions? I hope not!
Let me know what you think?

Finally a direction: Legal & Ethical issues in Midwifery

This is my newest grandchild due 12 July 2008 - 20 week scan.

I have been bloging for about 10 weeks now. During this time I have experimented with different topics and I have not had any clear direction, except that I wanted to share knowledge with women and midwives regarding pregnancy and childbirth. I have read many other blogs from both midwives and women, some of them have a theme and others do not. I also enjoy having a commentary regarding the subject material. At this point I would like to acknowledge the support of fellow blogers Carolyn McIntosh and Sarah Stewart who have been good mentors. I do find it frustrating sometimes when I do not have the technical / computer skills required to do the things I want to do with my blog. This then entails reading pages of material trying to put a link on the blog. Despite these challenges I do enjoy bloging and find that it is quite contagious even though it can be time consuming. However, I have decided that as an educator it is important to focus on a particular area within my scope of practice. My passion is “law” and “ethics”, to get the message across to midwives the importance of professional practice issues; these being; Legislation that governs our practice, ANMC Competency Standards, ANMC Code of Ethics, Code of Conduct and Nurses & Midwives Board requirements, negligence, confidentiality, consent, documentation, Scope of Practice and any other topic that may come under this heading. This means that this blog will now specifically look at legal and ethical issues (women's rights vs fetal rights) relating to pregnancy and childbirth, of which there are many. If you as a reader of this blog have any questions or issues that you would like to discuss and or cover please just leave me a comment and I will follow it up. Each month I will cover a legal or ethical topic relating the subject to legislation and midwifery practice. If you have any burning issues please ask the question or share the experience so that we may all learn from it.