CHAPTER 4 Questions of Values and Ethics

OBJECTIVES Describe the principles of ethicsDescribe the principles of ethics Examine the relationship of critical thinking to the ethical decision-making processExamine the relationship of critical thinking to the ethical decision-making process Discuss how the Code of Ethics serves as a guideline to ethical decision makingDiscuss how the Code of Ethics serves as a guideline to ethical decision making Identify areas that are subject to frequent ethical dilemmas in the clinical settingIdentify areas that are subject to frequent ethical dilemmas in the clinical setting Discuss common areas of difficulty involved in making ethical decisions.Discuss common areas of difficulty involved in making ethical decisions. Differentiate between personal ethics and Professional ethics.Differentiate between personal ethics and Professional ethics.

OBJECTIVES Differentiate between values and personal/ professional ethics.Differentiate between values and personal/ professional ethics. Discuss methods in which values are formed.Discuss methods in which values are formed. Describe the process of values clarification.Describe the process of values clarification. Differentiate between morals and ethics.Differentiate between morals and ethics. Compare and contrast principles and rules of ethics.Compare and contrast principles and rules of ethics. Apply the eight basic ethical principles to an ethical issue.Apply the eight basic ethical principles to an ethical issue. Compare and contrast different types of ethics.Compare and contrast different types of ethics.

OBJECTIVES Utilize the Code of Ethics for Nurses to critically think when making decisions in professional practice. Utilize the Code of Ethics for Nurses to critically think when making decisions in professional practice. Utilize strategies to enhance ethical decisions in nursing practice. Utilize strategies to enhance ethical decisions in nursing practice. Discuss the influence organizational ethics have on nursing practice Discuss the influence organizational ethics have on nursing practice Examine the steps to ethical dilemma resolution. Examine the steps to ethical dilemma resolution. Examine ethical dilemmas that the nurse may encounter in professional practice and in health care. Examine ethical dilemmas that the nurse may encounter in professional practice and in health care. Apply critical thinking to client scenarios and NCLEX-style questions. Apply critical thinking to client scenarios and NCLEX-style questions.

In the beginning… There were no antibiotics There were no antibiotics There were no ICUs There were no ICUs There were no CT scanners and MRIs There were no CT scanners and MRIs There were just physicians and nurses who cared for people in sickness and in health There were just physicians and nurses who cared for people in sickness and in health

1960s Technological advances allowed for the development of ICU Technological advances allowed for the development of ICU New biomedical developments New biomedical developments Advances in surgical techniques, such as open heart surgery Advances in surgical techniques, such as open heart surgery

New Questions The advances created new questions for health care professionals regarding the use of technology The advances created new questions for health care professionals regarding the use of technology The concepts of life and death The concepts of life and death

Bioethics A subdiscipline of ethics A subdiscipline of ethics The study of medical morality The study of medical morality

Concepts of Ethics Values Values Belief systems Belief systems Morality Morality

Value Systems A set of related values A set of related values Intrinsic values Intrinsic values Extrinsic values Extrinsic values Personal values Personal values Professional values Professional values

Value Formation Values are learned Values are learned Values change with maturity and experience Values change with maturity and experience The number of values an individual holds is not as important as what values they consider important The number of values an individual holds is not as important as what values they consider important

Values Clarification Choosing Choosing Prizing Prizing Acting Acting

Belief Systems These are organized ways of thinking about why people exist within the universe These are organized ways of thinking about why people exist within the universe Their purpose is to explain such concepts as Their purpose is to explain such concepts as Life and death Life and death Good and evil Good and evil Health and illness Health and illness

Morals An individual’s own code for acceptable behavior An individual’s own code for acceptable behavior They arise from an individual’s conscience They arise from an individual’s conscience They act as a guide for individual behavior They act as a guide for individual behavior Learned Learned

Ethics Ethics deals with the “rightness” or “wrongness” of human behavior Ethics deals with the “rightness” or “wrongness” of human behavior Concerned with the motivation behind the behavior Concerned with the motivation behind the behavior Bioethics is the application of these principles to life-and-death issues Bioethics is the application of these principles to life-and-death issues

Ethical Theories Deontological Deontological Teleological Teleological Principalism Principalism

Ethical Principles Autonomy Autonomy Nonmaleficence Nonmaleficence Beneficence Beneficence Justice Justice Fidelity Fidelity Confidentiality Confidentiality Veracity Veracity Accountability Accountability

Autonomy The freedom to make decisions about oneself The freedom to make decisions about oneself Nurses need to respect clients’ rights to make choices about health care Nurses need to respect clients’ rights to make choices about health care

Nonmaleficence Requires that no harm be caused to an individual, either unintentionally or deliberately Requires that no harm be caused to an individual, either unintentionally or deliberately This principle requires nurses to protect individuals who are unable to protect themselves This principle requires nurses to protect individuals who are unable to protect themselves

Beneficence This principle means “doing good” for others This principle means “doing good” for others Nurses need to assist clients in meeting all their needs Nurses need to assist clients in meeting all their needs Biological Biological Psychological Psychological Social Social

Justice Every individual must be treated equally Every individual must be treated equally This requires nurses to be nonjudgmental This requires nurses to be nonjudgmental

Fidelity Loyalty Loyalty The promise to fulfill all commitments The promise to fulfill all commitments The basis of accountability The basis of accountability

Confidentiality Anything stated to nurses or health care providers by clients must remain confidential Anything stated to nurses or health care providers by clients must remain confidential The only times this principle may be violated are The only times this principle may be violated are If clients may indicate harm to themselves or others If clients may indicate harm to themselves or others If the client gives permission for the information to be shared If the client gives permission for the information to be shared

Veracity This principle implies “truthfulness” This principle implies “truthfulness” Nurses need to be truthful to their clients Nurses need to be truthful to their clients Veracity is an important component of building trusting relationships Veracity is an important component of building trusting relationships

Accountability Individuals need to be responsible for their own actions Individuals need to be responsible for their own actions Nurses are accountable to themselves and to their colleagues Nurses are accountable to themselves and to their colleagues

Ethical Codes These are formal statements of the rules of behavior for a particular group of individuals These are formal statements of the rules of behavior for a particular group of individuals Ethical codes are dynamic Ethical codes are dynamic Most professions have a “code of ethics” to guide professional behavior Most professions have a “code of ethics” to guide professional behavior

Virtue Ethics Focus on virtues or moral character Focus on virtues or moral character View helping others as charitable or benevolent View helping others as charitable or benevolent

Organizational Ethics Focus on the workplace Focus on the workplace Ethical culture makes a difference Ethical culture makes a difference Senior leadership must promote an ethical culture Senior leadership must promote an ethical culture

Ethical Dilemmas Occur when a problem exists between ethical principles Occur when a problem exists between ethical principles Deciding in favor of one principle usually violates another Deciding in favor of one principle usually violates another Both sides have “goodness” and “badness” associated with them Both sides have “goodness” and “badness” associated with them

Resolving Ethical Dilemmas

Using the Nursing Process Assessment Assessment Planning Planning Implementation Implementation Evaluation Evaluation

Approach to Ethical Dilemmas Approach List and rank the options What values are in conflict? Use of discussion and negotiation Work toward a mutually acceptable decision Implementation Identify decision-makers Determine goals of treatment Planning Am I involved? Collect the facts Re-evaluate as necessary Determine whether desired outcomes have been reached EvaluationAssessment

Current Ethical Issues

Issues to Consider Assisted suicide Assisted suicide Technology issues Technology issues Gene therapies Gene therapies “Designer babies” “Designer babies” Organizational climate Organizational climate

Conclusion An issue is not an ethical issue for the nurse unless he or she has been asked An issue is not an ethical issue for the nurse unless he or she has been asked Always gather the facts prior to decision- making Always gather the facts prior to decision- making Consider your personal beliefs and values Consider your personal beliefs and values