BMS 115 · Common Core (Tronc commun)Section 2.3 · Professional practice and responsibility
Section 6 of 15
Responsibility, ethical conflicts, norms and beliefs
Explain what responsibility means for a nurse, distinguish moral from professional responsibility and failure to act from a committed act, and show how norms, beliefs and tolerance shape an ethical conflict.
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Why this matters
You will answer for your acts and for what you failed to do for the rest of your career, and the two tribunals that judge you do not use the same evidence. At the same time, the ward where you work will have its customs, your patients will bring beliefs you do not share, and your own conscience will have opinions about all of it. This section gives you the vocabulary to name what is happening when those things collide, instead of managing the collision by habit, by silence or by obedience.
What you need to know first
You should already be comfortable with two things from earlier in the course: that an ethical question is a question about what is defensible, not about what is customary; and the basic moral vocabulary of law, values, conscience, freedom and dignity introduced in section 2.2. If those words are still vague, revise them first, because this section uses them constantly.
Words to know (6)
Responsibility
The obligation to answer for one’s own actions, and to accept the consequences before the authority concerned. A nurse who gives the wrong dose must explain what happened and why, not only repair the harm.
Standard (norm)
Something established by authority, custom or general consent as a model or rule for measuring quantity, weight, extent, value or quality. A published hand-hygiene standard says what counts as correctly cleaned hands; a ward habit does not.
Tolerance
The disposition to admit ways of thinking, acting and feeling that differ from our own, especially in shared social and professional life. Tolerating a patient’s refusal of a religious visit does not mean approving it; it means not imposing your own view.
Moral responsibility
The power of a person to answer for their actions before their own conscience and, for believers, before God. A nurse who hides a mistake may never be questioned by anyone, yet still be judged by her own conscience.
Professional responsibility
The power to account for one’s professional acts before a competent authority, which may engage criminal liability and civil liability. Failing to declare a birth is a professional matter even when no patient complains about it.
Criminal and civil liability
Criminal liability is an offence prosecuted by the state and punished by a fine or imprisonment; civil liability is the obligation to compensate the person who was harmed. Concealing a birth can be prosecuted by the state and, separately, oblige the nurse to compensate the child for the loss of status.
One idea at a timeIdea 1 / 6
In one sentence Responsibility is the obligation to answer for what you do and to accept the consequences, not simply to try hard.
Responsibility means being answerable, not merely careful
The word responsibility comes from responding. Responsibility is the obligation to answer for one’s actions, or for the actions of people, animals or things one is responsible for, before the authority concerned. In care, the example the notes give is responsibility for care. Being answerable means two things: you can be asked to explain what you did and why, and you must accept the outcome of that explanation. Good intentions are not an answer in themselves. Professional responsibility carries two liabilities, and they are not the same. Criminal liability is an offence prosecuted by the state and punished by a fine or imprisonment; civil liability is the obligation to compensate the person who was harmed. A single act can produce both. That is why the question is answered with facts and records rather than with effort, and why a nurse who tried their best but cannot explain the reasoning behind the act is still answerable.
For example
A patient falls during the night. At the review the question is not whether the nurse cared, but what was assessed, what was written down, and what was done about it. Care that leaves no trace cannot be defended.
Pause and check yourself
A nurse misses a prescribed observation. Is she responsible only if the patient is harmed?
Show the answer
No. Responsibility answers for the act itself. Harm changes the seriousness of the case and the route it takes, but it does not create the duty to account, which already exists.
Read detailed explanations
Two tribunals: moral responsibility and professional responsibility do not use the same evidence
Responsibility descends from the Latin respondere, to answer back. The lecture notes draw two tribunals from that single root, and the distinction is the most useful instrument in this section. Moral responsibility is the power of a man to answer for his actions before his conscience and, for believers, before God. Its court is interior and it never adjourns: nobody needs to catch you, and no file needs to be opened for the judgment to happen. Conscience, in the notes’ account, is both witness and judge — it identifies the act, evaluates it and pronounces a sentence. Remorse is that sentence in ordinary life, and the notes warn that it can be severe enough to contribute to a psychiatric depression. Conscience is also guide and law, because it discerns good from evil, denounces malice and indicates the path of good. Professional responsibility is narrower and harder: it is the power to account for one’s professional acts before a competent authority, and it carries criminal liability and civil liability. The two tribunals can return opposite verdicts on the same event. A nurse who conceals a mistake out of shame may satisfy nobody and also be prosecuted by nobody: her conscience has convicted her while the authority never learns. Conversely, a practitioner can be sanctioned by an employer or a court for conduct she still believes was right. Neither tribunal cancels the other, and that is why the notes insist that a professional must self-evaluate honestly before committing to a code. The practical difference for a student is what each tribunal accepts as evidence. The interior court accepts intention, motive and regret. The professional court accepts what was prescribed, what was observed, what was written, when it was written, and who was informed. That is why an undocumented correct action and a harmful action can look identical inside a disciplinary file, and why the habit of writing is not bureaucracy but the raw material of your defence.
Failure to act and committed acts: the two families of offence and the sanctions that follow
The notes say that the criminal responsibility of the health professional may be engaged in two families of cases, and the difference between them decides how you will be judged. An offence by omission is, in law, a failure to act; the notes add that it generally attracts different legal consequences from negative conduct. The examples given are refusal to rescue a person in danger, non-declaration of birth and non-declaration of death. The mechanism matters here. In the ordinary criminal law of most systems you are punished for what you did, not for what you failed to do; an omission becomes punishable only where the law attaches a positive duty to act. A nurse on duty, a midwife attending a delivery and a doctor who certifies a death all carry such duties, and that is precisely why their silence counts. The same chapter lists related denunciations: crimes such as poisoning, abuse, assault and injury on the person of children, sequestration and criminal abortion must be reported. Offences by action form the second family. The notes name illegal exercise of the profession, drug trafficking, title theft — the illegal use of another person’s identity or qualification — wrong in writing, manslaughter, criminal abortion and violation of professional secrecy. Several items appear in both families, which is not a contradiction: a criminal abortion can be read as an act performed or as a declaration omitted. The penalties provided for are fines, imprisonment and temporary or permanent prohibition to practise the profession. Three consequences follow for practice. First, a single mistake can run on several tracks at once — disciplinary, civil and criminal — and the tracks do not wait for one another. Second, the sanction usually attaches to the act or the failure to act, not to the intention, so “I meant well” is not a defence. Third, the most common accusation in real files is not a monstrous act but a small omission repeated: a missing observation, an unsigned drug chart, a temperature never recorded. The protection against both families is the same and it is unglamorous — perform the duty, then write that you performed it.
What an oath commits you to: the Nightingale text read clause by clause
An oath, the notes explain, is a solemn promise, often invoking a divine witness, about one’s future action or behaviour; more sharply, it is an undertaking made before an assembly and before God, before one’s conscience, to practise according to high standards and humanly accepted moral values. It is a pact with one’s profession and one’s conscience, and its violation can have serious psychological and even legal repercussions. That clause is the link to the rest of this section: the oath binds the interior tribunal and the professional tribunal at the same time. The notes then read the content. The candidate commits to a life of integrity — exemplary, loyal and impeccable — and to fulfilling faithfully the duties of the profession, which means observing strictly the code of ethics and deontology. She undertakes to abstain from any criminal or harmful practice, to do nothing that could harm the persons entrusted to her, and never to take or deliberately administer a dangerous remedy. Competence is included, which surprises students who expect an oath to be only about kindness: because a genuine professional possesses sufficient and permanent knowledge, the oath commits the nurse to inform herself and update her knowledge as science evolves, and to take part in research so as to innovate and raise the standard of the profession. Professional secrecy appears as the means of gaining the patient’s trust. Historically, this text is the Nightingale Pledge: it was written in 1893 by Lystra Gretter for the nursing school at Harper Hospital in Detroit and named after Florence Nightingale, and it was revised in 1935. The original wording promises to abstain from whatever is deleterious and mischievous and to hold in confidence all personal matters committed to one’s keeping, and it closes “I shall be loyal to my work and devoted towards the welfare of those committed to my care”. The 1935 revision replaced that closing clause: it added loyalty to the physician and, as a “missioner of health”, “devoted service for human welfare”. Welfare therefore did not arrive with the revision; it was widened from the individual patient to human welfare in general. The lecture notes present it as a national Florence Nightingale oath and quietly blend into it clauses that in fact come from later professional codes. The correction is worth holding on to: the modern ICN code, first adopted in 1953 and revised in 1973 and in later editions, is a secular document setting out duties to patients, colleagues and the profession, and it does not require a divine witness. The ethical content the notes draw out survives that change; the religious framing does not, and a nurse who is not a believer can take the professional undertaking in full without taking the religious part.
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Norms, beliefs and the two tribunals of responsibility
Norms, beliefs and freedom feed an ethical conflict; tolerance and respect for dignity hold the conflict open, while responsibility splits into an interior tribunal and a professional one, and the professional one sorts conduct into failures to act and committed acts before applying sanctions. Select any part to read what it is and why it matters.
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01 / 9Standard (norm)
If the drawing is wider than this panel, scroll it sideways. Labels stay readable; the numbered explanations below show the same ideas.
Standard (norm)
A standard is something established by authority, custom or general consent as a model or rule for measuring quantity, weight, extent, value or quality, and the notes illustrate it with product standards such as airbags and bank cards. A ward habit is only a custom: no one has agreed that it measures quality, so it cannot be used to justify a practice. This is the first move in an ethical conflict — asking whether the rule being quoted is a published standard or merely what people are used to.
Teaching schematic, not a legal opinion and not to scale. The examples of offences and penalties are the ones named in the supplied notes for Cameroon-style professional responsibility; the exact charge, the competent court and the sentence depend on the law in force and on the facts of the case, which is why section 5.3 returns to the same material with the statutory detail.
Key points to remember
✓Responsibility comes from responding: it is the obligation to answer for one’s acts and to accept the consequences before the authority concerned, and good intentions do not replace the answer.
✓A norm or standard is established by authority, custom or general consent as a model for measuring value or quality; a custom counts as a standard only once it has been accepted as such, and an unexamined ward habit has not.
✓Freedom is the power to step back and choose for a reason, and conscience witnesses, judges and guides; a pressured act is an act but not a free moral choice.
✓Tolerance admits beliefs and customs different from ours without approving them, while respect for dignity recognises equal inherent worth in every person and forbids imposing our own view.
✓Professional responsibility carries two liabilities — criminal, prosecuted by the state and punished by a fine or imprisonment, and civil, the obligation to compensate the person harmed.
✓Silence can be an offence: refusal to rescue a person in danger and the non-declaration of a birth or a death are punished as omissions wherever the law places a positive duty to act.
✓Ethical conflicts are ordinary; the professional response is to name the conflict, gather the facts and state which norm or belief is weighed against which, so that the decision can be reviewed.
Go deeper
Worked example
The family asks you to say nothing. Mr N. is 58. The doctor has told him that he has cancer and that it has spread, without going into how long he has left, and has given the daughter the full prognosis in the corridor. On the way out of the room she takes the nurse aside: “He must not know the rest. In our family we carry this for him. If you tell him, you will kill him faster.” The ward custom, the nurse knows, is to let families decide what the patient is told. Mr N. is fully alert, asks the nurse later that evening what the doctor meant by “palliative”, and says he wants to know the truth because he has affairs to settle.
Separate moral responsibility from professional responsibility before deciding anything. The family appeals to a moral and cultural duty: protecting a relative. The hospital appeals to a professional duty: the patient’s right to information and the record. Saying which duty belongs to which responsibility stops the discussion from becoming a contest of personalities.
Name the norm and the belief that are opposed. The norm here is the ward’s custom of letting the family speak for the patient. The belief is the family’s conviction that knowledge harms. A custom is one of the sources of a standard, but only once it has been accepted as a measure of quality; this ward habit has never been examined in that way, and Mr N. is the person the care concerns.
Check the facts that belong to professional responsibility. Is Mr N. competent to receive the information? He is alert, oriented and asking directly. Has he been told anything already? He has the diagnosis of spread, and the family holds the rest of the prognosis. What does the law and the code require? Decree 89/354 of 3 March 1989 permits a serious prognosis to be concealed from the patient, and it separately requires informed consent before a fatal prognosis is communicated to the family. Modern practice, the World Medical Association and the patient’s right to information all pull the other way and treat disclosure as the norm; the duty being weighed here is the older permission to conceal against the duty to answer a lucid patient who asks, and the second duty is the one the profession now expects you to follow.
Apply tolerance without surrendering the duty. The daughter’s fear is real and must be heard, not crushed: the nurse thanks her, explains that lying to a lucid man who asks directly would damage the trust on which his care depends, and offers to be present when the doctor speaks with him.
Give the decision to the right person and write it down. The nurse does not announce the prognosis; the doctor does. The nurse reports Mr N.’s direct request to the team, records what he asked and what was decided, and documents the daughter’s concern so that the next shift does not improvise a different answer.
Mr N. is told the truth by the doctor, in the presence of the nurse, and the daughter is present if she wishes. Nobody has been humiliated: the family’s fear was received with tolerance, the patient’s right to information was respected, and the decision was taken by the person competent to take it and recorded. What made the difference was not choosing between the family and the patient, but refusing to let an unexamined custom decide a question of right, weighing the older permission to conceal a serious prognosis against the duty to answer a lucid patient, and naming the conflict before it became a silent arrangement.
Common misconception
The commonest beginner mistake is to think that responsibility means feeling guilty, so that a nurse who feels bad has somehow discharged the duty. It is the opposite: responsibility is an obligation to answer, and the answer is made of facts, reasons and records, not of remorse. The second mistake is to believe that moral and professional responsibility are the same tribunal, so that being at peace with one’s conscience settles the matter — or, in the other direction, that staying within the law settles the conscience. Neither cancels the other. The third mistake is to treat tolerance as agreement, and therefore to conclude that a nurse who disagrees with a patient’s belief must overrule it, or else that tolerance requires abandoning professional standards. Tolerance governs how you treat the person; it does not suspend the duty of care, the law or the code.
Check your reasoning
Think of a time when you did what the group expected although you believed it was wrong, or the reverse — you refused to follow the group and were criticised for it. Which reason did you act on: fear of the group, respect for a rule, or a reason you could state and defend? And if you had to answer for that act tomorrow before a formal authority, would your explanation still hold?
Reveal an answer
If the answer is “I did it because everyone did it”, or “because I was afraid”, then the act was not a free choice in the moral sense, and it will not survive the professional tribunal either, since custom is not a standard and fear is not a reason. If the answer is a principle — the patient’s right, the duty not to harm, the rule of the code — then the same explanation works in both tribunals, before your conscience and before a competent authority, and that is the practical test of an ethical decision. The uncomfortable part is that the reverse case also holds: an act you can defend formally may still leave you uneasy, and that unease is the moral tribunal doing its work. The professional skill is to let each tribunal speak without either one silencing the other.
Where this comes from
BMS 115 Health Care Ethics lecture notes (Mme Bakume Jessey) · Chapter 2 — the moral vocabulary of practice: conscience, standards, freedom, respect for dignity, tolerance, responsibility (supplied notes lines 94–110); the chapter on professional responsibility: moral versus professional responsibility, offences by omission and by action, penalties (lines 342–362); Chapter IX — analysis and synthesis of the Florence Nightingale oath (lines 398–401).
Nightingale Pledge — authorship, date and revision · the notes call the text a national Florence Nightingale oath and give no author or date. The pledge was written in 1893 by Lystra Gretter for the training school at Harper Hospital, Detroit, and revised in 1935. The detailed explanation uses the original clauses “abstain from whatever is deleterious and mischievous”, “hold in confidence all personal matters committed to one’s keeping” and the closing “loyal to my work and devoted towards the welfare of those committed to my care” (Maxwell & Pope 1910), together with the 1935 replacement, “With loyalty will I aid the physician in his work, and as a missioner of health, I will dedicate myself to devoted service for human welfare” (Crathern 1953).
International Council of Nurses (ICN), Code of Ethics for Nurses · correction of the notes’ framing — the modern ICN code, first adopted in 1953 and revised in 1973 and in later editions, states duties to patients, colleagues and the profession in secular language and does not require a divine witness; the notes’ oath analysis blends the 1893 pledge with clauses from these later codes.
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About this course and its sources
Bilingual lessons organised from the supplied BMS 115 Health Care Ethics lecture notes (Mme Bakume Jessey, St Louis University Institute Douala) and the international texts those notes reproduce — the Universal Declaration of Human Rights 1948, Pacem in terris 1963, the African Charter on Human and Peoples’ Rights (drafting launched at Monrovia in 1979 by Decision 155; adopted 1981; in force 21 October 1986), the 1959 Declaration of the Rights of the Child, the ICN codes of 1953 and 1973, and the Cameroon code of ethics of 3 March 1989. The short guided notes and the longer “Read detailed explanations” panels are written as two different jobs: the notes state one idea plainly, and the detailed panels add mechanism, vocabulary and worked judgement that the notes do not contain. Diagrams are original teaching schematics. Ethics, nursing and French-language review are pending.