1. ETHICAL ISSUES IN HEALTH AND NURSING PRACTICE Present by: Dr.Amira Yahia

2. UNDERSTANDING CONCEPTS OF ETHICS  Morals: basic standards for what is considered right and wrong.  Values: ideals, beliefs, custom, mode of conduct, qualities or goals that are highly prized or preferred by individuals, groups or society.  Ethics : specific area of study of morality that concentrates on human conduct and human values.  Ethical dilemma : occurs when an individual must choose between two unfavorable alternatives.

3. BASIC ETHICAL CONCEPTS  Autonomy: right of self-determination or choice, independence, and freedom  Beneficence: obligation to do good, not harm, to other people  Nonmaleficence: prohibition of intentional harm  Justice: fairness, obligation to treat like cases similarly

4.  Fidelity: Obligation to be faithful to the agreements, commitments, and responsibilities that one has made to oneself and others. It is the foundation of the concept of accountability  Veracity: Telling the truth, not intentionally deceiving or misleading patients.  Confidentiality

5. ETHICAL THEORIES 1. Natural Law  Actions are morally right when they are in accord with our nature and end as human beings  Good should be promoted, evil avoided, and ethics grounded in our concern for human good 2. Deontology  Based on moral rules and unchanging principles considered separately from the consequences  Unconditional commands that must be applied in all situations without exception

6. 3. Utilitarianism  An act is right when it is useful in bringing about a desirable or good end  Allows the end to justify the means  Fits well into Western society’s values regarding work ethic and the behavioristic approach to education, philosophy, and life

7. 4. Social Equity and Justice  Allows social and economic positions to be to everyone’s advantage and open to all  Introduces a “veil of ignorance” whereby persons making choices would not have any specific information regarding those involved, thus choosing the alternative that supported the most disadvantaged person  Supports justice and equal rights for everyone

8. EXAMPLES OF ETHICAL PROBLEMS: NURSES & PATIENTS:  Paternalism (acting for patients without their consent to secure good or prevent harm)  Deception  Confidentiality  Allocation of scarce nursing resources, etc.  NURSES & PHYSICIANS:  Disagreements about the proposed medical regimen  Conflicts regarding the scope of Nurse’s role  Unprofessional, incompetent or illegal nurse practice

9. NURSES & OTHER NURSES  Claims of loyalty  Unprofessional, incompetent or illegal nurse practice  NURSES & INSTITUTIONAL AND PUBLIC POLICY  Short staffing and whistle blowing  Healthcare rationing

10.  ETHICAL DECISION MAKING PROCESS: provides a method for nurses to answer KEY QUESTIONS about ethical dilemmas & to organize their thinking in a more logical & sequential manner.  FRAMEWORK FOR ETHICAL DECISION-MAKING  Identifying and clarifying the ethical problem  Gathering data  Identifying options  Making a decision  Acting and assessing

11. FACTORS INFLUENCE ETHICAL DECISION-MAKING 1. Code for nurses 2. The patient’s rights 3. Social and cultural factors 4. Science and technology 5. Legislation 6. Judicial decisions 7. Funding 8. Personal religious & philosophic viewpoints

12. FACTORS IN THE WORK ENVIRONMENT THAT AFFECT ETHICAL DECISION-MAKING 1. Status as an employee 2. Collective bargaining contracts with trade unions 3. Collegial relationships 4. Authoritarian and paternalistic backgrounds 5. Institutional supports for ethical behavior 6. Consumer involvement in health care

13. WHISTLE-BLOWING  Serious situation when using chain of command and there is no response to voiced concerns  Used to bring attention to the circumstances  Should be used as a last resort because of possible ramifications to the individual blowing the whistle

14. BOUNDARY VIOLATIONS  Situation in which the nurse moves beyond a professional relationship and becomes involved with patients and their families  Represents a violation of the trust relationship that exists between the patient and the nurse