The Necessity of Moral Courage in Healthcare

Still image from police body-worn camera video of Nurse Alex Wubbels during an incident at University of Utah Hospital in Salt Lake City

This essay is in reflection of the incident from the Salt Lake City Hospital in Utah. When the police detective showed up at the ER, without consent, a warrant, or even a reason for obtaining a blood sample from a victim involved in a police-chase car accident. She was arrested for refusing to violate both the law, the constitution, and HIPPA.

As leaders in healthcare, we are forced to contend with complex ethical dilemmas. Clinicians, nurses, technicians, and managers practicing in the modern healthcare environment are met with increasingly complex problems. In situations where our desire to act rightly may be obstructed by the inconsistent values and beliefs of our coworkers, patients, and the community, we must fall back on our moral courage in demanding that right action is taken.

According to Murray (2007), understanding the importance of moral courage aids healthcare leaders to demonstrate moral courage when they face ethical challenges and the creation of an ethical environment. Moreover, a good understanding of our moral courage helps us face the inevitable ethical questions, and guides us at a time when doing the right thing is not easy or popular. To do so requires moral bravery, and a firm conviction to do what is ethical.

Samuel Taylor Coleridge (1772–1834) wrote that moral courage is that which enables us to remain steadfast and resolute despite disapproval. It is, above all other things, insisting that what is right is done, in spite of the risk of ridicule or loss of position. When moral courage fails, it often ends up splashed across television news stories and on the front pages of newspapers. It should not come as a surprise that such visible examples of moral cowardice have helped to fuel our cynical and divided society, even while the basic definition of moral courage has remained unchanged, a testament to both its necessity and is a rarity.

Beauchamp and Childress (2001) point out that ethics in healthcare have enjoyed a significant level of continuity since the time of Hippocrates, further attesting to the moral necessity to treat the sick and injured, preserving the fundamental principles of autonomy, benevolence, and justice. A recent example of moral courage can be seen in the events surrounding the head nurse at the University of Utah Hospital’s burn unit.

According to a September 1, 2017 Washington Post story and accompanying video, when a Salt Lake City Police Detective demanded to be allowed in the room of a badly injured and unconscious patient in order to take a blood sample, the nurse informed him that unless he had consent of the patient, the patient was under arrest, or a warrant for the blood sample —none of which he possessed —she could not allow him to collect a blood sample. This is not only hospital policy, but constitutional law. The detective grew angry and threatened the nurse with arrest. She still refused, citing her responsibility to protect the patient. She was arrested, placed in handcuffs, and shoved into a police car, and accused of interfering with an investigation.

Despite being assaulted by police (as is evident in the video), this nurse showed remarkable moral courage in protecting her patient against threats and coercion by outside agents. What is needed, one could say required for healthcare administrators, is a strong sense of right and wrong, and one that is reflected in action as well as word. We should not be satisfied to simply give lip service to the principles of moral courage, but to practice it in our dealings with our peers, our patients, our staff, and perhaps more importantly, ourselves.

Moral courage is not easy, nor should it be so; easy things do not require courage. Moral courage then is more than a quality, it is a practice. 

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