Ethical Issues

Objectives By the end of the lecture students should be able to: Define common ethical terminologies Analyze personal values that influence the approach to ethical issues Discuss moral implications of N/M and ICN codes of ethics Discuss the role of the nurse in ethical health care issue

Ethics Principles of right and wrong behaviours, beliefs and values(Thompson et al (2007) Ethics is essentially concerned with our life as members of a community and how we behave and function in society Discipline that deals with the rightness or wrongness of actions Ethics is the study of conduct and character Law and ethics overlap in so many areas

Definition of Terms Values- Ideals or concepts that give meaning to an individual’s life. Mostly derived from social norms, religion and family orientation Ideas and beliefs that you hold in highest regard

Activity List ten values that guide your daily interactions Discuss with your partner each of the values you listed and how they guide your interactions Compare your list of values with your partner and discuss similarities and differences Prioritize your list and discuss why you think some are more important than others

Definition CONT’D Advance directives- written statement of a person’s wishes about how he/she would like his health care decisions to be made if he or she loses the ability to make such decisions independently Bioethics-Ethics concerning life (euthanasia ,abortion) Durable power of attorney for health care- spoke person

Definitions CONT’D Ethical dilemma-situation involving competing rules or principles that appears to have no satisfactory solution Choice between two or more equally undesirable alternatives Morals- fundamental standard of right and wrong that an individual learns and internalizes

Definitions CONT’D Moral and ethical principles- fundamental values and assumptions about the way humans should be treated and cared for Moral reasoning-A process of considering and selecting approaches to resolve ethical issues Moral uncertainty-situation that exist when the individual is unsure which moral principles or values apply in a given situation

Definitions CONT’D Code of ethics-written list of a profession’s values and standards of conduct It provides a frame work for decision making for a profession Needs to be oriented to the day to day decisions made by members of the profession

Moral/Ethical Principles Autonomy: Patient’s right to self determination without outside control Implies freedom to make choices and decisions about one’s own care without interference even if the health care team does not agree Or the decisions may not be in the client’s best interest

Principle CONT’D Justice- The duty to treat all patients fairly, without regard to age, socioeconomic status or other variables obligation to be fair to all people Allocation of scarce and expensive health care resources All patient with the same diagnosis should receive the same level of care

Principle CONT’D Fidelity-Duty to be faithful to commitments Individuals obligation to be faithful to commitments made to self and others Professional faithfulness and loyalty Keeping information confidential and maintaining trust and privacy Agreement to keep one’s promise to the client about care that was offered

Principle CONT’D Beneficence-Duty to actively do good to patients Doing good for patients under your care Good- holistic Agreement that the care given is in the best interest of the client Taking positive actions to help the client

Principle CONT’D Non-maleficence- Duty to prevent or avoid doing harm, whether intentional or unintentional Health care providers do no harm to their patients either intentionally or unintentionally Protect from harm those who cannot protect themselves Avoidance of pain or harm as much as possible when giving treatments

Principle CONT’D Veracity- The duty to tell the truth Requires that health care providers tell the truth and not intentionally deceive or mislead patients

Principle CONT’D Paternalism- practices that limit the liberty of individuals without their consent Knowing better what is good for the patient Takes away autonomy

Principle CONT’D Rationalism-basis for how things or conditions appear for decision making Focuses on logical sequencing

Principle CONT’D Pragmatism-process of clarifying ideas objectively through problem solving

Principle CONT’D Standard of best interest-decision made about individual patient’s health care when they are unable to make informed decisions for their own care Based on what the family and health care providers agree upon Respect the individuals expressed wishes either written or unwritten

Principle CONT’D Obligations-demands made on individuals, professions, society or government to fulfill and honor the rights of others Two Categories Legal- formal statements of Law and are enforced under the law Moral- based on moral and or ethical principles but not enforce under the law

Principle CONT’D Rights- defined as just claims or titles or as something that is owed to an individual according to just claims, legal guarantees or moral and ethical principles Types Welfare/legal: legal entitlement to some good or benefit Ethical/moral: moral or ethical principles

Rights CONT’D Option –based on fundamental belief in the dignity and freedom of human beings Freedom of choice and the right to live as you choose

Principle CONT’D Responsibility- execution of duties associated with the nurse’s particular role.

Principle CONT’D Accountability- being answerable for one’s own actions Professional accountability serve the following purposes: Evaluate new professional practices and reassess existing ones Maintain standards of health care Facilitate personal reflection, ethical thought and personal growth 4. Provide a basis for ethical decision making

Moral Reasoning Different approaches to moral reasoning Factors that affect our moral reasoning : Emotions Legal considerations Personal held religious or spiritual convictions

Ethical Decision Making Three models that are commonly applied are: Deantological -moral Teleological- utilitarianism Situational

Deantological - Moral System of ethical decision making that is based on moral rules and unchanging principles Formalistic principles, principle system or duty based ethics Ethical absoluteness of the principle regardless of the consequences of the decision Derived fro Judeo-Christian origins Intrinsic good that are absolutes revealed from God All person are worthy of respect

Teleological- utilitarianism Ethical system of utility Outcome focus and place emphasis on results Based on two underlying principles: Greatest good for the greater number End justifies the means

Situational There are no prescribe rules, norms or majority results that must be followed Situations creates its own set of rules and principles that should be considered in that particular situation

Ethical Decision Making Process I Collect, analyze and interpret data State the dilemma Consider the choices of action Analyze the advantages and disadvantages of each Course of action Make a decision

Ethical Decision Making Process II Presume good will- wanting to find the good Identify all important persons Gather relevant information Identify important ethical principles Propose alternative course of action Take action

Read on the Following Institutional Ethics Committees and their functions Role of the nurse in such committees

Questions Summary Thank you