1. Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 1 Ethics in Healthcare

2. Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 2 Learning Objectives List four current ethical issues of concern in twenty-first century health care. Explain the differences among ethics, morals and values. (Cont'd…)

3. Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 3 Learning Objectives (…Cont’d) Discuss how nonmaleficence is more complex than the definition of “do no harm.”

4. Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 4 Ethical Issues in 21st Century Health Care in vitro fertilization artificial insemination surrogate motherhood cloning organ donation § Including cadaver, child, and aborted fetus donations stem cell research/procedures (Cont'd…)

5. Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 5 Ethical Issues in 21st Century Health Care (…Cont’d) abortion euthanasia assisted suicide advance directives § living wills, power of attorney right to die

6. Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 6 Ethics, Morals, and Values Ethics—a system of standards or moral principles that directs actions as being right or wrong Morals—system dealing with right or wrong behavior (conduct) and character (will vary from person to person) Values—the worth a person assigns to an idea or action (will change as one moves through life)

7. Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 7 Nursing Ethical and Legal Responsibilities Ethics: the values and principles governing practice, conduct, and relationships § Responsibilities: focused on ideal behavior, morality, and higher standards Legal aspects: state laws that apply to licensed persons and the situations in patient care that could result in legal action § Responsibilities: focused on rules, regulations, and obligations mandated by law

8. Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 8 See the patient as more than just a disease Western Secular Belief System § Individual autonomy: patient’s freedom to choose § Individual rights: patients rights are limited if they clash with the health professional’s § Belief systems and decision making will vary from culture to culture and person to person

9. Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 9 Principles of Ethics Nonmaleficence (Do No Harm): the principle of doing the least amount of harm possible to a patient Most beneficial treatments involve harming the patient to some extent Examples: § skin puncture (you need the IV fluids, or the antibiotic shot!) § drug side effects (cost vs. benefit) § physical manipulation (you have to reposition people frequently… even if it causes pain while doing it)

10. Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 10 Beneficence Two major duties associated with beneficence: § Put patient interests first § Place the good of patients before one’s own needs includes organizational and other work-related needs

11. Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 11 Autonomy (Free to Choose) Four steps of autonomous decisions: § Thinking through all the facts § Deciding on the basis on an independent thought process § Acting based on a personal decision § Undertaking a decision voluntarily, without pressure from anyone else (Cont'd…)

12. Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 12 Autonomy (Free to Choose) (…Cont’d) Patient’s right to privacy § choose care based on personal beliefs § accept or reject treatment § avoid needless exposure Personal values may be contrary to medical ethics § patient can refuse care for religious, cultural, or personal reasons

13. Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 13 Fidelity (Be True) Fidelity: Acting in patients’ best interests when they are unable to make free choices § does not include resuscitation or paternalistic decisions § must differentiate between your own feelings and those of the patient

14. Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 14 Justice (Fair to All) Justice: give patients their due and treat each patient fairly and equally (i.e., with dignity and respect) avoid letting personal ethics and values interfere with patient justice

15. Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 15 Beneficent Paternalism a disrespectful attitude toward the patient and his or her contribution to personal care and recovery § “I know what’s best for you” § discounts the patient’s self-knowledge § often occurs with female patients in response to female-specific health issues Examples: § deciding in advance that a patient fits into a certain category § developing a care plan without patient input § influencing a patient’s choice

16. As You Read.... Pay attention to the following legal terms: Tort, Assault and Battery, Negligence, Malpractice, Defamation, False Imprisonment, Implicit Contract, Implied Contract, Expressed Contract, Durable Power of Attorney, Patient Self Determination Act

17. And the following Ethical Qualities: Freedom, Reliability, Equality, Respect, Truthfulness, Caring, And the following responsibilities: Attitude, Authorization, Dependability, Method, Qualification, Safety,