ETHICAL ISSUES IN NURSING

NU 204

INTRODUCTION TO ETHICAL ISSUES IN NURSING Since early time we have sought a logical approach to questions of human conduct.
What constitutes good and evil, ethical, unethical? On a day to day basis, nurses are faced with ethical problems in regard to their own actions and those of the health team.

ETHICAL TERMINOLOGY

Ethics: A branch of philosophy referred to as moral philosophy

Morals: Basic standards for what we consider right and wrong Morality: The relationships between human beings

Ethical Dilemma: When an individual must choose between two unfavorable alternatives

ETHICAL TERMINOLOGY (CONT)

Values: Abstract standards that give a person a sense of what is right and wrong. These differ from individual to individual . Values conflict: Occurs when we must choose between two things, both of which are important to us Values Clarification: The process of becoming more conscious of and naming what one values or considers worthy

ETHICAL THEORIES
NATURAL LAW St Thomas Acquinas action right if in accord with our nature

promote good; avoid evil

ethics grounded in concern for human good

ETHICAL THEORIES (cont)

DEONTOLOGY (DUTY-ORIENTED) Immanuel Kant Right and wrong is based on ones duty or obligation to adhere to universal values. abortion/euthanasia wrong as violates duty to respect life lying wrong as violates duty to tell the truth

ETHICAL THEORIES (cont)

TELEOLOGICAL/UTILITARIANISM (CONSEQUENCE-ORIENTED) Jeremy Bentham & John Stuart Mills act is right when it results in a good end end justifies the means abortion is okay because it gets rid of unwanted babies euthanasia is okay because it reduces suffering

ETHICAL THEORIES (cont)

SITUATIONAL Joseph Fletcher no prescribed rules each situation creates its own set of rules and principles love is the only norm

decision in one situation cannot be generalized to another

euthanasia may be an act of love

ETHICAL THEORIES (cont)

SOCIAL EQUITY AND JUSTICE
John Rawls supports justice and equal rights for all veil of ignorance on part of decisionmakers (no specific information) thus most disadvantaged would be supported. all social and economic positions open for results of a decision.

ETHICAL THEORIES (cont)

IDEAL OBSERVER
Raymond Firth Decisions be made from a dispassionate, disinterested, consistent viewpoint with full information about the situation full information about the consequences

Factors That Influence Ethical Decision-Making

Codes for Nurses ANA Code for Nurses

International Code for Nurses

Standards of Practice

ANA Standards of Practice for RNs

The Patient Bill of Rights (AHA) Social and Cultural Attitudes

Factors That Influence Ethical Decision-Making (contd) Science and Technology Legislation Judicial Decisions Funding Personal Religious and Philosophic Viewpoints

Factors in the Work Place That Affect Ethical Decision Making

Status as an Employee Collective Bargaining Contracts Collegial Relationships

Authoritarian and Paternalistic Backgrounds

Ethics Committees in Health Care Consumer Involvement in Health Care

Basic Ethical Concepts

Autonomy: Involves the right of self-determination, independence, and freedom Beneficence: The obligation to do good, not harm Nonmaleficence: The prohibition of intentional harm

Ethical Concepts (contd)

Justice: The obligation to be fair to all people. Fidelity: The obligation to be faithful to agreements, commitments, and responsibilities

Ethical Concepts (contd)

Veracity: Refers to telling the truth or not intentionally deceiving or misleading patients

The Standard of Best Interest: Making a decision for one who is unable to make a decision based on what is best for that individual

FRAMEWORK FOR ETHICAL DECISION-MAKING

Identify and clarify the ethical problem

Gather data

Identify options
Make a decision Act Evaluate the outcomes

BIOETHICAL ISSUES IN HEALTH CARE RELATED TO BEGINNING OF LIFE

Abortion Prenatal testing In vitro fertilization Artificial insemination

Surrogate mothers
Sperm banks

BIOETHICAL ISSUES IN HEALTH CARE (cont) RELATED TO END-OF-LIFE

Death defined Euthanasia Physician-assisted suicide Right-to-die

Withdrawing/withholding treatments

BIOETHICAL ISSUES IN HEALTH CARE (cont) RELATED TO QUALITY OF LIFE ISSUES

Organ transplantation Human genome project Gene therapy Stem cell research

to tell or not to tell (provider truth-telling)

Rationing of health care