Foundations in Evidence Based Practice Introduction to Ethics

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

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

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

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

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

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

4 Key Ethical Principles autonomy beneficence non-maleficence justice

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

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

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

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

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 ?

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

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

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

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)

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.

References http://www.nursingethics.ca/articles.html 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 http://www.iep.utm.edu/e/ethics.htm#SH2a http://www.nursingethics.ca/articles.html http://www.freedomtocare.org/iane.htm http://www.lib.flinders.edu.au/resources/sub/healthsci/a- zlist/ethics.html