1. If ‘Ethics’ Stresses You Out… Grab Some Colors

2. Ethical Decision Making for Nurses: Case Studies Janie Butts, Ph.D., RN Professor Elizabeth Tinnon, Ph.D., RN, CNE Assistant Professor

3. Our Belief “Many people argue that we are living in a time when society is moving away from the moral absolutes that have guided right and wrong behaviors to an era of making decisions derived from ethical relativism. This means actions right for one person are not necessarily right for others and different cultures believe in and practice different moral codes.” continue to next page

4. cont’d. “If this is accurate, can nurses, when making an ethical decision, maintain some sense of assurance that they chose a right action?” “Although we believe nurses cannot always have an absolute assurance that they made right ethical choices, they do have the Code of Ethics and other books to guide them in making difficult decisions. Given our current moral landscape, nurses must now, more than ever, be sensitive to ethical issues in their surroundings and be able to analyze them within a decision-making framework.” Dr. Janie Butts and Dr. Elizabeth Tinnon

5. Presentation Content A case study on violation of humanity lost. A case study on right to refuse treatment.

6. Case Study of Humanity Lost A male, Mr. C., age 42, has a lung cancer from smoking, which is now metastasized to the brain and is in and out of the hospital regularly. Recently, he was admitted again for treatment. He is liked by the staff nurses, but as the tumor progressed, he displayed combative and hostile treatment, such as attacking a nurse with an I.V. pole. Pharmacological management did not help him calm down. Then, he was placed in 4-point restraints according to policy. (continue to next page)

7. cont’d. The nurses called for an ethics consult because “When we walk into his room what we see is an animal tethered to a bed. His patient gown is often awry because of his restlessness, and he lies there in glorious nakedness. His condom catheter often comes off, and his sheets are urine soaked. He moans….it’s hard to think of him as a person. Somehow we lost the man we knew and love.”

8. Question What do you see as the top two central ethical issues?

9. Question Why do you agree or disagree with the following statement: The more vulnerable people are because of illness or marginalizing factors, the more they command my compassion and respect.

10. Question Why do you agree or disagree with the following statement: I need to be compassionate and respectful to those innocently affected by disease or injury— so long as abusive behaviors did not cause the disease or infirmity.

11. Broken colors still color. The same can be said of nurses.

13. Patient’s Right to Refuse Treatment Mrs. Smith is admitted to your home health agency with a diagnosis of multiple diabetic ulcers. Upon admission you are aghast at the condition of her ulcers and overall general health. As you progress through the admission Mrs. Smith insists that she is unwilling to follow a diabetic diet or take her medication as ordered. When the physician returns your call for orders she asks about the patient’s willingness to follow the plan of care. You inform the physician that the patient is willing to allow dressing changes but is unwilling to follow any other part of the plan. continue to next page

14. cont’d. Then, the physician states that she is unable to continue to provide medical care to the patient and Mrs. Smith is not admitted. Mrs. Smith tells you that she will contact her daughter and they will find another physician. One month later Mrs. Smith’s daughter calls you very upset stating that her mother is in very bad shape and asks that you come to the home. Upon entering the home you observe what appears to be gangrene on both feet and Mrs. Smith is very lethargic. You arrange for the patient to be taken to the hospital where upon Mrs. Smith undergoes a bilateral below the knee amputation.

16. What is the First Ethical Issue You See in This Scenario?

17. What Are The Ethical Principles At Stake?

18. Do You Think the Doctor Had the Right to Dismiss the Patient?

19. Do You Think Mrs. Smith had the Right to Refuse Treatment?

20. So, Again… If ‘Ethics’ Stresses You Out… Grab Some Colors

21. References Beauchamp, T., & Childress, J. (2013). Principles of biomedical ethics. New York: Oxford University Press. Butts, J., & Rich, K. (2016). Nursing ethics: Across the curriculum and into practice (4 th ed.). Burlington, MA: Jones & Bartlett Learning. American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. ANA: MD: Silver Spring, MD. Fry, S., Veatch, R., & Taylor, C. (2011). Case studies in nursing ethics (4 th ed.). Sudbury, MA: Jones & Bartlett. Jonsen, A., Siegler, M., & Winslade, W. (2015). A practical approach to ethical decisions in clinical medicine (8 th ed.). Boston: McGraw-Hill Education.