“Ought implies can” & missed care

Abstract

The concept of missed care refers to an irrefragable truth that required nursing care, which is left undone, occurs in the delivery of health care. As a technical concept, missed care offers nurses the opportunity to articulate a problematic experience. But what are we to make of missed care from an ethical perspective? Can nurses be held morally responsible for missed care? Ethically speaking, it is generally accepted that if a person has a moral obligation to do something, s/he needs to have the capacity to do it. If a person does not have the capacity to fulfil a moral obligation, then s/he cannot be held responsible for failing to do so. This is captured by the “ought implies can” (OIC) principle. This paper brings the OIC principle to the forefront of the discussion on missed care. It is contended that nurses – qua moral agents – may be discharged from a moral obligation to carry out a required caring act because of some inability that is not of their making and therefore may not be morally responsible for missed care. However, the OIC principle may not be applied to all situations of missed care depending on their causes. In addition, following in the thought of Sapontzis (The Southern Journal of Philosophy, 1991, XXIX, 383–393) it is contended that when an original obligation to deliver a required act of care cannot be fulfilled, other obligations may be generated as summed up in the “Principle of Making Amends” and the “Principle of Appropriate Feeling.” It is the view of this paper that these further principles could prevent the OIC principle from being used to simply excuse omissions of care from a normative standard and could support the view that nurses continue to have alternative obligations to make amends and to respond with appropriate feelings to missed care.

Missed nursing care: An overview of reviews

“…In his philosophic exploration of missed nursing care, Kearns described the “ought implies can” principle 6 . He argues that nurses are not morally responsible for not carrying out care if they do not have the capacity to do so.…”

“…In nursing, this definition has also included the notion that the reason for this rationing is because of a lack of resources 4 . Missed care, on the other hand may not be planned or reasoned and may not be because of a lack of resources 5,6 . In their influential concept analysis, Kalish et al 2 identified a variety of nurse factors influencing missed nursing care including team norms, decision making, internal values and beliefs and habits.…”

Neglecting the care of older people in residential care settings: A national document analysis of complaints reported to the Finnish supervisory authority

“…It is noteworthy that nurses have reported to have limited awareness (Myhre et al., 2020) and competencies to identify different forms of neglect in older people's care in residential settings (Bloemen et al., 2015; McCool et al., 2009; Myhre et al., 2020; Reader & Gillespie, 2013; Winterstein, 2012). However, individual nurses are responsible for their own work (Kangasniemi et al., 2015) and it should be noted that unintentional neglect does not necessarily diminish that responsibility (Woollard & Howard‐Snyder, 2016), but they need to have both personal and organisational resources to carry out care tasks and meet their moral responsibilities (Kearns, 2020). Because older people who live in residential care settings are in a vulnerable position, staff should have comprehensive competencies to evaluate and anticipate their care needs.…”

Cuidados de enfermagem omissos: perceção de enfermeiros de um hospital de oncologia português

“…According to Vryonides et al (2016), an institution's ethical climate may influence the nurses' ability to sustain their moral identity. Kearns (2019) considers that the decision-making process that leads to omissions of nursing care should be carefully reflected upon; nurses may or may not be held ethically responsible depending on the reason for this omission. Identifying MNC is an important step towards unveiling the knowledge of this phenomenon.…”