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Foundations in Evidence Based Practice  Introduction to Ethics.

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1 Foundations in Evidence Based Practice  Introduction to Ethics

2 Introduction to ethics  Our care for patients should be based on sound judgement (or evidence based practice!!) ..some of this judgement is about having a strong sense of what is right or wrong ..having a strong sense of what we should be doing and shouldn’t be doing as nurses ..having a strong sense of what our priorities ought to be

3 Introduction to ethics  Nurses frequently have to make difficult decisions for which there is not always a quick, easy or ‘correct’ answer e.g. Can Mrs X be discharged yet? Can Mr Y manage his own medications safely?  Nevertheless, nurses still have to be able to explain and account for these decisions and actions  The NMC Code can act as a guide This can be seen as a ‘code of ethics’ – a set of important principles to help guide nurses

4 Achievement of practice outcomes includes consideration of ethical issues Domain 1 Professional and Ethical Practice 1.3 Demonstrate an awareness of, and apply ethical principles to, nursing practice. Outcomes:  1.3.1 Demonstrate respect for patient and client confidentiality  THIS OUTCOME IS ONLY ABOUT CONFIDENTIALITY. IT IS NOT ABOUT HOW YOU RESPECT PATIENTS GENERALLY  1.3.2 Identify ethical issues in day to day practice

5 What is an ‘ethical issue’?  When you have to judge what is right or wrong  Choosing between options  Deciding whether to do something or do nothing  Should I or shouldn’t I?  Weighing up the potential impact of your decisions or actions  A dilemma – making a difficult choice

6 Ethical issues in health care  We usually think of the ‘big’ issues e.g. definition of life, what is a person, quality of life, prolonging life, ending life, human rights.  But day to day ethical issues can involve:  Respecting people  Treating people with dignity  Treating people fairly  Supporting patient’s choices  These ‘principles’ are encompassed in the NMC code  The code is a useful source of ethical principles in health care

7 Another source of ideas in health care ethics  Principles of Biomedical Ethics (Beauchamp and Childress, 2001) They discuss:  4 key principles  supplemented by 4 rules

8 4 Key Ethical Principles  autonomy  beneficence  non-maleficence  justice

9 Autonomy  Respect a person’s right to make their own decisions  Teach people to be able to make their own choices  Support people in their individual choices  Do not force or coerce people to do things  ‘Informed Consent’ is an important outcome of this principle

10 Beneficence (to do good)  Our actions must aim to ‘benefit’ people – health, welfare, comfort, well- being, improve a person’s potential, improve quality of life  ‘Benefit’ should be defined by the person themselves. It’s not what we think that is important.  Act on behalf of ‘vulnerable’ people to protect their rights  Prevent harm  Create a safe and supportive environment  Help people in crises

11 Non – maleficence (to do no harm)  do not to inflict harm on people  do not cause pain or suffering  do not incapacitate  do not cause offence  do not deprive people  do not kill  Both Beneficence and Non-maleficence underpin EBP

12 Justice  Treating people fairly  Not favouring some individuals/groups over others  Acting in a non–discriminatory / non-prejudicial way  Respect for peoples rights  Respect for the law

13 Justice Distributive Justice – sharing the scarce resources in society in a fair and just manner (e.g. health services, professional time)  How should we share out healthcare resources?  How do we share out our time with patients?  Deciding how to do this raises some difficult questions Patients should get…..  an equal share ?  just enough to meet their needs ?  what they deserve ?  what they can pay for ?

14 4 ethical rules  Veracity – truth telling, informed consent, respect for autonomy  Privacy – a persons right to remain private, to not disclose information  Confidentiality – only sharing private information on a ‘need to know basis’  Fidelity – loyalty, maintaining the duty to care for all no matter who they are or what they may have done

15 Ethics 2 broad philosophical theories  1) consequentialism – taking the consequences of our actions into consideration  2) deontology – basing our actions on a set of principles or duties

16 Consequentialism  Actions are right or wrong according to the balance of their good and bad consequences  the right act is the one that produces the best overall result  Utilitarianism (what action has the greatest utility - use/benefit/positive outcome) is a type of consequentialism

17 Utilitarianism  most prominent consequence-based theory  based on the principle of utility  actions ought to produce the maximal balance of positive value (e.g. happiness) over disvalue (e.g. harm)

18 Deontology  Duty or principle based theory  An act is right if it conforms to an overriding moral duty For example – do not tell lies, do not kill.  E.g. Christian ethics – The Ten Commandments But Christian ethics are not important for some people in the world so moral duties vary between cultures and societies  A moral duty or principle is one that is:  laid down by god / supremely rational being  or is in accordance with reason / rationality  or would be agreed by all rational beings  The NMC Code of Conduct is a product of Deontological ethics – it guides action based on a set of principles/duties.

19 References Beauchamp T and Childress J (2001) Principles of Biomedical Ethics 5th Edition Oxford University Press Hunt G (1994) Ethical Issues in Nursing Routledge. London Seedhouse D (1998) Ethics the heart of Health Care Wiley. Winchester. Watt H (2000) Life and Death in Health Care Ethics Routledge. London zlist/ethics.html

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