1. Mosby items and derived items copyright © 2002 by Mosby, Inc. Ethical and Bioethical Issues in Nursing and Health Care

2. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. Dilemmas for Health Professionals Life and death Quality of life Right to decide Informed consent Alternative treatment issues

7. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. Health Care Decisions Patient Family Nurse Transdisciplinary team

11. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. Examining Values Systems Nurses must examine their own values Nurses must commit to a virtuous values system

14. Mosby items and derived items copyright © 2002 by Mosby, Inc. World View Provides a cohesive model for life Encourages personal responsibility for living life Prepares one for making ethical choices

15. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. Essential Values for the Professional Nurse Altruism Equality Esthetics Freedom Human dignity Justice Truth

19. Mosby items and derived items copyright © 2002 by Mosby, Inc. Ethical Theories Utilitarianism –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. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. Ethical Decision-Making Model Situation assessment procedure: 1. Identify ethical issues and problems 2. Identify and analyze available alternatives 3. Select one alternative 4. Justify the selection

26. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. What assumptions are required, and what are their implications for future actions? What additional ethical problems do alternatives raise? Identify and Analyze Available Alternatives—cont’d

29. Mosby items and derived items copyright © 2002 by Mosby, Inc. Select One Alternative Integration of multiple factors Blend ethical theory, principles, and values

30. Mosby items and derived items copyright © 2002 by Mosby, Inc. 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. Mosby items and derived items copyright © 2002 by Mosby, Inc. Bioethical Dilemmas Life Reproduction Death Dilemmas in between –Injustice and the right to health care –Organ transplantation and allocation of scarce resources

32. Mosby items and derived items copyright © 2002 by Mosby, Inc. Ethical Challenges Veracity Paternalism Autonomy Accountability