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Ethical and Bioethical Issues in Nursing and Health Care
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Key Concepts Selected ethical theories and principles
Relationship between ethics and morality in relation to nursing practice Ethical decision-making model Ethical and bioethical dilemmas
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Nursing Ethics System of principles concerning the action of the nurse in relationships with patients, families, other health care providers, policy makers, and society
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Code of Ethics Implicit values and standards for the profession
American Nurses Association (ANA) ANA Code of Ethics International Council of Nurses (ICN) ICN Code for Nurses
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Bioethics Interdisciplinary field within health care that has evolved with modern medicine to address questions created as science and technology produce new ways of knowing Physicians, nurses, social workers, psychiatrists, clergy, philosophers, and theologians are joining to address ethical questions in health care
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Dilemmas for Health Professionals
Life and death Quality of life Right to decide Informed consent Alternative treatment issues
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Dilemmas Created by Technology
Illnesses once leading to mortality are now classified as chronic illnesses Cost is a consequence of prolonging life with technology
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Ethical Decision Making
Answering difficult questions What does it mean to be ill or well? What is the proper balance between science and technology and the good of humans? Where do we find balance when science allows us to experiment with the basic origins of life?
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Balancing Science and Morality
Nurses must examine life and its origins, as well as its worth, usefulness, and importance What does it mean to be ill or well? What is the proper balance between science and technology and the good of humans? Nurses must understand their own values and seek to understand the values of others
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Health Care Decisions Patient Family Nurse Transdisciplinary team
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Values Formation and Moral Development
Value: Personal belief about worth that acts as a guide to behavior Value system: Entire framework on which actions are based Values clarification: Process by which people examine personal values and how the values function as part of the whole
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Values Formation and Moral Development—cont’d
Moral development: Forming a world view and value system in an evolving, continuous, dynamic process that moves along a continuum of development
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Examining Values Systems
Nurses must examine their own values Nurses must commit to a virtuous values system
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World View Provides a cohesive model for life
Encourages personal responsibility for living life Prepares one for making ethical choices
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Learning Right and Wrong
Infants No concept of right or wrong If basic need for trust is met, will develop foundation for secure moral thought School-age children Have learned that good behavior is rewarded and bad behavior is punished Begin to make choices based on an understanding of good and bad
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Learning Right and Wrong—cont’d
Adolescents Question moral values and relevance to society Become aware of contradictions in adults’ values systems Adults Strive to make sense of contradictions Develop own morals and values Begin to make choices based on internalized set of principles
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Moral Development Theory
Kohlberg’s theory Most widely accepted Cognitive developmental process; sequential in nature Rules imposed by authority Conformity to expected social and religious mores Autonomous thinker strives for a moral code beyond the issues of authority and reverence
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Essential Values for the Professional Nurse
Altruism Equality Esthetics Freedom Human dignity Justice Truth
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Ethical Theories Utilitarianism Deontology
Greatest good for the most people Assumes that an action is right if it leads to the greatest balance of good consequences or to the fewest possible bad consequences Deontology Decision is right if it conforms to an overriding moral duty and wrong if it violates that moral duty
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Purpose of Ethical Principles
Establish common ground between nurse, patient, family, other health care professionals, and society to discuss ethical questions and make ethical decisions Permit people to take a consistent position on specific or related issues Provide an analytical framework by which moral problems can be evaluated
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Autonomy Principle of respect for the person
Unconditional intrinsic value for all People are free to form judgments and actions as long as they do not infringe on others Concepts of freedom and informed consent are grounded in this principle
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Beneficence To promote goodness, kindness, and charity
To abstain from injuring others and to help others further their well-being by removing them from harm Common bioethical conflict results from an imbalance between the demands of beneficence and those of the health care delivery system
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Nonmaleficence Implies a duty: – Not to inflict harm
– To abstain from injuring others – To help others further their own well-being by removing harm
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Veracity Principle of truth-telling
Consumers expect accurate and precise information For trust to develop between providers and patients, there must be truthful communication The challenge is to mesh the need for truthful communication with the need to protect
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Ethical Decision-Making Model
Situation assessment procedure: Identify ethical issues and problems Identify and analyze available alternatives Select one alternative Justify the selection
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Identify Ethical Issues and Problems
What is the issue? What are the hidden issues? What are the complexities of the situation? Is anything being overlooked?
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Identify and Analyze Available Alternatives
What are the reasonable possibilities for action? How do different parties want to resolve the problem? What ethical principles are required for each alternative?
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Identify and Analyze Available Alternatives—cont’d
What assumptions are required, and what are their implications for future actions? What additional ethical problems do alternatives raise?
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Select One Alternative
Integration of multiple factors Blend ethical theory, principles, and values
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Justify the Selection Specify reasons for action
Clearly present ethical basis for these reasons Understand the shortcomings of the justification Anticipate objections to the justification
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Bioethical Dilemmas Life Reproduction Death Dilemmas in between
Injustice and the right to health care Organ transplantation and allocation of scarce resources
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Ethical Challenges Veracity Paternalism Autonomy Accountability
