The social phenomenon known as professional nursing is kaleidoscopic. Nursing is embedded in an intricate network of relationships at all levels. This precludes any simple answer to the question of responsibility in setting limits to professional autonomy. It is useful to examine some of the pieces that one puts into one’s kaleidoscope to look at the question. Asking any question which involves multiple relationships risks finding several possible answers which then require significant decisions and choices having farreaching implications for individuals and groups. “Solutions” often challenge tenaciously held assumptions and values: this question is no different.

Proponents of the death penalty have shifted gears. In the past, gruesome public executions were extolled as a deterrent to others, and even in modern times death has been inflicted on convicted criminals by hanging, firing squads, electrocution and poisonous gas. All of these methods cause significant pain to the victim, and all have the potential for failure and added suffering — both physical and mental. Many have argued that all of these methods of execution are potentially or actually “cruel and unusual” means of punishment, and recent United States Supreme Court decisions have suggested that they could be declared unconstitutional on this basis.

Talking about one's colleagues is a common practice in all employment settings. In the health care setting, one popular topic of conversation is evaluating and comparing the professional competencies of the various personnel.

When a nurse is aware that a colleague has made an error in judgment, or has failed to follow proper procedure, or has harmed a patient in some way, the nurse often chooses to share this information informally with other colleagues, rather than to report it through official channels. The rationale for this approach is generally that informal talking will do no one harm, while reporting through official channels may bring destructive disciplinary action upon the colleague, result in a lawsuit for defamation against the reporting nurse, or both. The problems with this rationale are illustrated by a recent New York court case.