© MA Healthcare Ltd, 2012. All rights reserved. No part of the Journal of Renal Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. ISSN 2041-1448 Printed by Pensord Press Ltd, Blackwood, NP12 2YA Editor Edda Hendry +44(0)20 7501 6749 edda.h@markallengroup.com Sales Executive Andrew Iafrati andrew.iafrati@markallengroup.com Publishing Director Anthony Kerr anthony.kerr@markallengroup.com Associate Publishers Tracy Cown and Chloe Moffat Team Senior Editor Julie Smith Production Manager Jon Redmayne Production Assistant Larry Oakes Chief Executive Officer Ben Allen Articulating an ethical objection in practice R enal nurses have a unique relationship with their patients and often develop a broad insight into our patients’ needs, more so than those allied to our profession. We often, but not exclusively, spend considerable time with our patients, both in clinical areas and on the phone, and have the privilege of assessing them in the context of their family and private lives. In short, we often have strong feelings about what is right for them. These feelings are often brought to bear in a multidisciplinary setting, when a course of action or decision proposed by a colleague may feel instinctively wrong to you. Examples of these decisions could include the withdrawal of dialysis, activation on to the transplant list or the progress of a questionable live donor to transplantation, among others. Your instincts and feelings about an issue are often correct and can be communicated effectively, but sometimes it can be difficult to do justice to what you feel in front of a tough crowd. Are your instincts enough, and is it adequate to simply state ‘I’m not happy!’? The difficulty lies in the fact that your colleagues also have the best interests of the patient as a primary focus, and often an argument based on diagnosis, prognosis and risk can seem more compelling than an argument based on a gut feeling. The following considerations may be useful to think about when expressing your concerns to colleagues or articulating an ethical objection in practice. First, we need to establish what your primary concern actually is. Does the decision or issue concern you because you consider the process by which the proposed outcome is achieved to be harmful, or do you have concerns about the outcome itself? To put it another way, are you more concerned with ‘how’ things are done or ‘where’ things going? It is important to test your thesis. An argument is only as good as the one that you refute, so think clearly about what the alternative is, should your concern be challenged. For example, if the proposal is