看護ケアにおける良心と責任の問題

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Nurses often face ethical dilemmas involving issues of conscience and responsibility. Etymologically, "conscience" (συνειδησιs, conscientia) involves getting to know meaning of one's own act together with the internalized other. In order for a person to protect his or her identity when exposed to danger, conscience is "the internal surveillance organization" which judges orders according to his or her subjective restraint-norm" in relation to a specific act and features "a cognitive element and an influence-element". Not only does it mean the internal moral sense for distinguishing right from wrong freedom of an inside, but also it is inevitably accompanied by an external act in some form, such as an act or an omission. It is possible, however, that one's appeal to conscience makes a wrong decision because of incorrect information, groundless belief etc. But nurses should be allowed to refuse to carry out particular treatment or procedures based on personal appeal to conscience. Therefore the nurse appealing to conscience must undertake a step-by-step process of justification in order to fulfill a duty of care by carefully considering the patient's safety and welfare, based on acceptance of consequence and exact information. Administrators must discern whether the nurse appealing to conscience makes judgment based on appropriate knowledge and correct information and whether the proposed result is safe and acceptable. If so, administrators have a duty to support that result.Although the appeal to conscience is a fundamental right and can reveal someone's dishonesty (the whistle-blowing), it is not positively accepted in Japan. The dignity of each person's identity cannot be protected only by nurse's appeal to conscience. Consequently nursing practice committees or other ethics committees should discuss this and similar issues which include refusal based on a nurse's appeal to conscience.
2005-10-26

著者

朝倉輝一
東洋大学文学部:国立看護大学校

看護ケアにおける良心と責任の問題

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