Smith, S., Ladd, R., Pasquerella, L. (2008).Ethical Issues in Home Healthcare(2nd ed). Springfield, IL: Charles C Thomas, 237 pages

Ethics is a complicated subject interfacing with law, morality, and personal beliefs that all humans hold dear. The ethical circumstances that nurses encounter in home health are exceedingly different from those faced by acute care nurses. The tenet of self-determination, key to the environment in which home health nurses practice, has been captured by the authors in the case examples cited.

The authors have successfully described and analyzed many of the behaviors displayed by the patients of home health nurses. More than 125 thought-provoking case examples have been created to illustrate these dilemmas. Among the topics discussed in the 10 chapters of this volume are privacy, cultural differences, end of life, caring for the mentally ill and children, the role of the family, and patients who do not "follow orders." Two chapters, "Patients' Decisions" and "Nurses' Dilemmas and Nurses' Responsibilities," discuss nurses' rights specific to the situations all home health nurses encounter at least once in their career. Dilemmas surrounding patient confidentiality, threats of suicide, sexuality, and potential neglect or abuse add to the breadth of the situations covered.

Three appendices (2 new) with additional case examples, guidelines for forming a home health agency ethics committee, and descriptions of legal rulings affecting healthcare are presented. Each rationale regarding a case example is thoroughly dissected using ethical principles and in-depth discussion to arrive at conclusions. The only reason the many examples cited do not cover all situations is that we home health nurses deal with humans who have many unique ideas about what is or is not right for them.

This book is definitely recommended reading for all home health nurses who try to meet the needs of their patients while respecting their autonomy.

Sandy Whittier