Based on the clarification, Ms. Worthen acted inappropriately. In the spirit of Categorical Imperative, the Codes of Professional Ethics for Nurses imposes a sense of duty on the part of any professional nurse practicing in a hospital. The code states that, “[t]he nurse’s respect for the worth and dignity of the individual human beings applies irrespective of the nature of the health problem [whether] disabled as well as the normal, the patient with the long-term illness as well as the one with acute illness, or…one who is terminally ill or dying.”The Ethical Codes for nurses are binding to any professional nurse in a hospital. Since they apply to a generalized population of the nurses and the clientele, one has to view them as unconditional categorical motives that must be executed to the letter, as they have been framed based on reason.
However, perhaps, Ms. Worthen was motivated by moral virtues like compassion for the patient’s dire condition, which was made worse by the dialysis. It is noteworthy from the case study that the patient “suffered cardiac arrest and severe hemorrhaging” when Ms. Worthen performed the procedure. This made her halt the procedure as she was “convinced that the dialysis was more harmful than beneficial to the patient.” Her decision was rather motivated by the Hypothetical Imperative, since it was informed by her desire to ease the pain the patient underwent during the procedure. In acting this way, though, she upheld the Categorical Imperative “formula of the end in itself”, in the sense that she was cognizant of the patient’s deplorable condition and thus exercised restraint by not giving in to pressure from the other parties. In acting this way, Ms. Worthen was exercising her degree of autonomy, which in this case was an authentic action as it was in tandem with her virtues of compassion. However, her autonomous action was not a free action as the head nurse, the physician, and the family members directly or indirectly wanted her to proceed with the procedure.
The head nurse also overstepped the Kantian ethical perspective of moral decision making. In the light of the Categorical Imperative “formula of the End in itself”, the head nurse used the patient as a “means” to an “end”, contrary to what the formula champions. The “end” in this case was to carry out the wishes of the patient’s family since they endorsed the dialysis without which their beloved one would cease to live. Therefore, the head nurse was not sensitive to the plight of the patient but was concerned more on carrying out the desires of the patient’s family. The physician allied himself to the head nurse’s decision and was, therefore, no better. As opposed to Ms. Worthen, the head nurse acted out of a sense of duty and upheld the ethical code, which states in part “the nurse withdraws from this kind of situation only when assured that alternative sources of nursing care are available to the client.” Perhaps the head nurse reassigned this patient to Ms. Worthen because an “alternative source of nursing care” was unavailable. Furthermore, the actions of the head nurse impede the autonomous decision of Ms. Worthen, and the right of the patient to some degree of autonomy in deciding whether the nurses could proceed with the procedure or not was infringed. The head nurse was just concerned with maximizing utility (happiness) of the family and fulfilling of her duty, thus using the patient as a “means” to achieve her “ends.”
The analytical perspectives above show how divergent opinions in the professional frontier can lead to a standoff. In addition, moral virtues can be strong motivating factors that propel an individual to act in contravention to relevant ethical codes. It is, thus, notable that individuals can either make decisions as a way of living up to their sense of duty or backed by entrenched moral virtues. Either way, an individual will be praised or vilified based on the philosophical paradigm employed. In the above case, the Kantian ethical paradigm has displayed some loopholes, particularly with the Categorical Imperative and Hypothetical Imperative.
On the one hand, it encourages an individual to act based on a sense of duty (Categorical Imperative), while, on the other hand, it fosters decision making based on an individual’s desires and goals (Hypothetical Imperative). The implication of the latter is that an individual who allows desires, such as fulfillment of moral virtues, to shape their decisions is also accommodated by the Kantian ethics. Casting this impasse in decision making in the light of Kantian ethics, thus, presents some confusion and will mean a win-loss situation for both parties as analyzed above.