1. Ethical and Bioethical Issues in Nursing and Health Care

2. 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

3. Nursing Ethics
System of principles concerning the action of the nurse in relationships with patients, families, other health care providers, policy makers, and society

4. 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

5. 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

6. Dilemmas for Health Professionals
Life and death
Quality of life
Right to decide
Informed consent
Alternative treatment issues

7. Dilemmas Created by Technology
Illnesses once leading to mortality are now classified as chronic illnesses
Cost is a consequence of prolonging life with technology

8. 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?

9. 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

10. Health Care Decisions
Patient
Family
Nurse
Transdisciplinary team

11. 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

12. 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

13. Examining Values Systems
Nurses must examine their own values
Nurses must commit to a virtuous values system

14. World View Provides a cohesive model for life
Encourages personal responsibility for living life
Prepares one for making ethical choices

15. 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

16. 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

17. 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

18. Essential Values for the Professional Nurse
Altruism
Equality
Esthetics
Freedom
Human dignity
Justice
Truth

19. 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

20. 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

21. 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

22. 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

23. Nonmaleficence Implies a duty: – Not to inflict harm
– To abstain from injuring others
– To help others further their own well-being by removing harm

24. 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

25. Ethical Decision-Making Model
Situation assessment procedure: Identify ethical issues and problems Identify and analyze available alternatives Select one alternative Justify the selection

26. 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?

27. 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?

28. 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?

29. Select One Alternative
Integration of multiple factors
Blend ethical theory, principles, and values

30. 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

31. Bioethical Dilemmas Life Reproduction Death Dilemmas in between
Injustice and the right to health care
Organ transplantation and allocation of scarce resources

32. Ethical Challenges
Veracity
Paternalism
Autonomy
Accountability