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Chapter 22 Ethics and Values Copyright © 2017, Elsevier Inc. All Rights Reserved. Basic Terms in Health Ethics Autonomy Commitment to include patients in decisions Beneficence Taking positive actions to help others Nonmaleficence Avoidance of harm or hurt Justice Being fair Fidelity Agreement to keep promises Copyright © 2017, Elsevier Inc. All Rights Reserved. 2 Professional Nursing Code of Ethics Code of nursing ethics A set of guiding principles that all members of a profession accept Helps professional groups settle questions about practice or behavior Includes advocacy, responsibility, accountability, and confidentiality Social networking Presents ethical challenges for nurses Copyright © 2017, Elsevier Inc. All Rights Reserved. 3 Principles of ANA Code of Ethics Advocacy Responsibility Refers to a willingness to respect one’s professional obligation and follow through on promises. Nurses are responsible for their actions and actions of those to whom you delegate Accountability Support of a particular cause. Ex: As a nurse, you advocate for clients’ health, safety, rights, including privacy Refers to ability to answer for one’s own actions. Confidentiality HIPPA mandates the protection of patient’s personal health information. Copyright © 2017, Elsevier Inc. All Rights Reserved. 4 Case Study Anna Moreno is an 82-year-old African-American widow and retired schoolteacher. She lives with her 55-yearold daughter and three teenage grandchildren. Her daughter, Lucille, is a single mother and a full-time nurse. Anna assists with the care of her grandchildren when her daughter is at work. She also volunteers at the library and at her church. She has diabetes and high blood pressure, both controlled with diet and medication. Copyright © 2017, Elsevier Inc. All Rights Reserved. 5 Quick Quiz! 1. Your patient is about to undergo a controversial orthopedic procedure. The procedure may cause periods of pain. Although nurses agree to do no harm, this procedure may be the patient’s only treatment choice. Which ethical principle does this situation describes? A. Autonomy. B. Fidelity. C. Justice. D. Nonmaleficence. Copyright © 2017, Elsevier Inc. All Rights Reserved. 6 Values Value A value is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior. Values clarification Ethical dilemmas almost always occur in the presence of conflicting values. To resolve ethical dilemmas, one needs to distinguish among values, facts, and opinion. Copyright © 2017, Elsevier Inc. All Rights Reserved. 7 Ethics and Philosophy Deontology Defines actions as right or wrong Utilitarianism Proposes that the value of something is determined by its usefulness Feminist Ethics Focuses on the inequality between people Ethics of Care Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives Casuistry Copyright © 2017, Elsevier Inc. All Rights Reserved. Case-based reasoning 8 Case Study (Cont.) Lucille accompanies her mother to the physician’s office for a routine visit. When her mother steps out to have some lab work done, Lucille asks to speak privately to the nurse, Mary Ann, and reveals some serious concerns. Lucille had received a call from the manager of the library where her mother volunteers. The manager described finding Ms. Moreno in the janitor's closet one day, confused and tearful. Copyright © 2017, Elsevier Inc. All Rights Reserved. 9 Case Study (Cont.) The manager expressed growing concern about Ms. Moreno’s ability to finish tasks, such as reshelving books and taking phone messages. She recommended that Lucille get an evaluation of her mother’s mental status. Lucille tells the nurse that she is not at all convinced that her mother is having mental problems. Copyright © 2017, Elsevier Inc. All Rights Reserved. 10 Nursing Point of View Nurses generally engage with patients over longer periods of time than other disciplines. Patients may feel more comfortable revealing information to nurses. Copyright © 2017, Elsevier Inc. All Rights Reserved. 11 Processing an Ethical Dilemma Step 1: Ask if this is an ethical dilemma. Step 2: Gather all relevant information. Step 3: Clarify values. Step 4: Verbalize the problem. Step 5: Identify possible courses of action. Step 6: Negotiate the outcome. Step 7: Evaluate the action. Copyright © 2017, Elsevier Inc. All Rights Reserved. 12 Institutional Resources Ethics committees are usually multidisciplinary and serve several purposes: education, policy recommendation, and case consultation. Any person involved in an ethical dilemma, including nurses, physicians, health care providers, patients, and family members, can request access to an ethics committee. Copyright © 2017, Elsevier Inc. All Rights Reserved. 13 Issues in Health Care Ethics Quality of life: Central to discussions about endof-life care, cancer therapy, physician-assisted suicide, and Do Not Resuscitate (DNR) Disabilities: Antidiscrimination laws enhance the economic security of people with physical, mental, or emotional challenges Care at the end of life: Interventions unlikely to produce benefit for the patient Health Care Reform: Facilitated access to care for millions of uninsured Americans Copyright © 2017, Elsevier Inc. All Rights Reserved. 14 Ethics and Access to Care The number of uninsured in the united states grew from 39 million people in 2000 to more than 46.3 million people by 2008—more than 15% of the total population. Many of the uninsured are women and children. Although two thirds of the uninsured are poor, nearly 80% come from working families. Ethical Issues on Aging Older people usually are not as familiar with the concept of autonomy as are people from younger generations. As people age, they develop clinical conditions that affect the communication process. Some patients become incapacitated by stroke or disease. Most older adults take multiple medications, some of which affect cognitive skills in subtle ways. Consensus about medical goals for the older adult is hard to achieve. Copyright © 2017, Elsevier Inc. All Rights Reserved. 16 Quick Quiz! 2. If a nurse decides to withhold a medication because it might further lower the patient’s blood pressure, which principle will the nurse will be practicing? A. Responsibility. B. Accountability. C. Competency. D. Moral behavior. Copyright © 2017, Elsevier Inc. All Rights Reserved. 17 22 - 17 Case Study (Cont.) From Mary Ann’s perspective, Lucille seems angry and defensive about the manager’s report. She even accuses the manager of discrimination against older adults. She adamantly refuses offers of a physical or mental evaluation for her mother, or even to discuss the issues with her mother. Instead, she requests that the nurse write a letter that validates her mother’s good health. What do you think about Lucille’s reaction? Do you agree with Mary ANN? What do you think Mary ANN will do? Copyright © 2017, Elsevier Inc. All Rights Reserved. 18 Case Study (Cont.) After all, Lucille argues, her mother’s blood pressure is normal, and her blood glucose levels are within normal limits. Mary Ann realizes that this situation is complex. She will need to get the help of others to sort out the best response to Lucille’s request. Is this an ethical dilemma for Mary Ann? Copyright © 2017, Elsevier Inc. All Rights Reserved. 19 Case Study (Cont.) Mary Anne has determined that the situation is an ethical dilemma. Now she must: Step 2: Gather all information relevant to the case. Step 3: Examine and determine her own values and opinions about the issues. Copyright © 2017, Elsevier Inc. All Rights Reserved. 20 Case Study (Cont.) Step 4: State the problem clearly. Step 5: Consider possible courses of action. Step 6: Negotiate the outcome. Step 7: Evaluate the action. Copyright © 2017, Elsevier Inc. All Rights Reserved. 21 Who is most likely to encounter an ethical dilemma? Copyright © 2017, Elsevier Inc. All Rights Reserved. 22 Question Which of the following provides a foundation for professional nursing? A. American Nursing Association Code of Ethics. B. The institutional Ethics Committee. C. The nurse’s values clarification. D. The hospital’s policy and procedure manual. Copyright © 2017, Elsevier Inc. All Rights Reserved. 23 Group Activity Defined and provide an example of each principles of the ANA Code of Ethics: Accountability, Responsibility, Advocacy, and Confidentiality Describe each of the following philosophies and provide an example each: Deontology, Utilitarianism, Feminist Ethics, Ethics of Care, and Cauistry. Describe and provide an example of autonomy, beneficence, nonmaleficence, justice, and fidelity. Provide examples of how culture can cause an ethical dilemma. Copyright © 2017, Elsevier Inc. All Rights Reserved. 24