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Chapter 9
Ethical Issues
Concept of Ethics
 The study of the rightness of conduct.
 Deals with one’s responsibilities (duties
and obligations).
 Ethical persons put their beliefs into
action.
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Concept of Ethics
 The term morals is often mistakenly used
when ethics is intended.
 Morality is behavior that usually reflects
personal or religious beliefs.
 Ethics is rooted in the legal system.
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Relationship Between Legal
and Ethical Concepts
 There is a connection between acts that
are legal and acts that are ethical.
 The legal system judges action rather
than intention.
 Ethical opinions reflect individual
differences.
 Laws change according to social and
political influences.
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Ethics in Health Care
 Bioethics is the application of ethical
principles to health care.
 Ethics affects every area of health care.
 Ethics helps provide structure by raising
questions that ultimately lead to answers.
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Factors Contributing to the
Need for Ethics in Health Care
 Technological advances
 Changing fabric of our society
 Increased consumer demand for health
care information
 Decreasing allocation of federal funds for
health care
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Examples of Ethical Issues
 Newborns surviving at earlier gestational
ages with serious health problems
 People living longer than ever before
 Organ transplants and the use of bionic
body parts
 Experimental research
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Ethical Theories
 Teleology
• The value of a situation is determined by its
consequences.
• Principle of utility states that an act must
result in the greatest good for the greatest
number.
• “Good” refers to positive benefit.
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Ethical Theories
 Deontology
• The intrinsic significance of the act itself is
the criterion for determination of good.
• Concept of categorical imperative states that
actions should be based on a principle that
is universal.
• The person should never be treated as a
means to an end.
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Ethical Principles
 Autonomy
• The belief that every competent person has
the right to determine his or her own course
of action.
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Autonomy
 Examples of autonomous behavior that
can impair recovery or treatment:
• Smoking
• Refusing to take medication
• Refusing to receive a blood transfusion
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Ethical Principles
 Nonmaleficence
• Duty to cause no harm to others
• Physiological, psychological, social, spiritual
• Helps guide decisions about treatment
approaches
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Ethical Principles
 Beneficence
• Duty to promote good and to prevent harm
• Providing benefit
• Balancing benefits and harm
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Beneficence
 Paternalism is a negative outcome of
beneficence.
 Paternalism occurs when health care
providers decide what is “best” for clients.
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Ethical Principles
 Justice
• Based on concept of fairness
• Equality in treatment and allocation of
resources
 Material Principle of Justice
• Determines when there can be
unequal allocation of scare resources
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Ethical Principles
 Veracity
• Truthfulness, neither lying nor deceiving
others.
• Deception can take the form of intentional
lying, nondisclosure of information, or partial
disclosure.
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Ethical Principles
 Fidelity
• Faithfulness and keeping promises
• Demonstrated by nurses in the role of client
advocate
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Values and Ethics
 Values are individual rather than
universal.
 Individuals often fail to consider the
impact of values on decisions.
 Nurses often care for clients whose value
systems conflict with theirs.
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Values Clarification
 The process of analyzing one’s own
values to better understand what is truly
important
 Three-step process of valuing:
• Choosing
• Prizing
• Acting
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Ethical Codes
 International Council of Nurses Code for
Nurses
 American Nurses Association Code of
Ethics
 Canadian Nurses Association Code of
Ethics for Nursing
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Clients’ Rights
 Clients have certain rights to
• Make decisions regarding their care.
• Be actively involved in the treatment
process.
• Be treated with dignity and respect.
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Clients’ Rights
 Patient Bill of Rights
• Established by the American Hospital
Association.
• Increases awareness of the need to treat
clients in an ethical manner.
• Encourages health care providers to protect
the rights of clients.
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Ethical Dilemmas
 Occur when there is a conflict between
two or more ethical principles.
 The most beneficial decision depends on
the circumstances.
 Ethical analysis is not an exact science.
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Ethical Dilemmas
 Frequently Occurring Ethical Dilemmas
•
•
•
•
Informed Consent
Refusal of Treatment
Use of Scarce Resources
Cost-Containment Initiatives that Negatively
Affect Client Well-Being
• Incompetent Health Care Providers
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Ethical Decision Making
 Ethical Reasoning
• Thinking through what one ought to do in an
orderly, systematic manner
• Justification of actions based on principles
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Ethical Decision Making
 Framework for Ethical Decision Making
•
•
•
•
Which theories are involved?
Which principles are involved?
Who will be affected?
What will be the consequences of the
alternatives?
• What does the client desire?
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Ethical Decision Making
 Steps of Ethical Analysis
• Gathering of relevant data to identify the
problem
• Consideration of all the people involved
• Selection of a course of action
• Evaluation of the resolution process
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Ethical Dilemmas
 Euthanasia
 Refusal of Treatment
 Scarce Resources
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Euthanasia
 “Good or gentle death”
 Mercy killing (deliberate ending of life as
a humane action)
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Euthanasia
 Active euthanasia is taking deliberate
action that will hasten the client’s death.
• Assisted suicide is a form of active
euthanasia.
 Passive euthanasia is the omission of an
action that would prolong dying.
• Discontinuing the client’s tube feedings is a
form of passive euthanasia.
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Refusal of Treatment
 The client’s right to refuse treatment is
based on the principle of autonomy.
 A client’s right to refuse treatment and
the right to die challenge the values of
some health care providers.
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Scarce Resources
 The availability of specialists and organs,
is contributing to a scarcity of resources.
 The use of expensive services is
influenced by social and political forces.
 Health care reform is needed to ensure
services to all.
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Ethics and Nursing
 Professional nurses’ actions are both
legal and ethical.
 Sound nursing practice involves making
ethical decisions.
 Ethics affects nurses in every health care
setting.
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Ethics and Nursing
 Ethics Committees
• One approach for facilitating dialogue
regarding ethical dilemmas
 Nurse as Client Advocate
• Nurses are accountable for protecting the
rights and interests of the client.
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Ethical Decision-Making Model
ANALYSIS
ASSESSMENT
AND DIAGNOSIS
PLANNING
IMPLEMENTATION
EVALUATION
ProblemAssessing
identification:
Consideration
Determination
Carryingthe
outoutcome
Statement
selected
ofofpriorities
claims
of
moral
of
moral
and
of
the
claims;
actions
parties
ethical
actions;dilemma
Generation of“Were
alternatives
the actions
for resolving
ethical?”the dilemma;
Consideration
“Whatofwere
the consequences
the consequences?”
of alternatives
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