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Ethics
Ethics
• The systematic study of what a person’s
conduct and actions ought to be with regard
to him- or herself, other human beings, and
the environment; it is the justification of what
is right or good and the study of what a
person’s life and relationships ought to be, not
necessarily what they are.
Ethical Issues
• Nurses are often placed in situations where
they are expected to be agents for patients,
physicians, and the organization
simultaneously, all of which may have
conflicting needs, wants, and goals.
Nurses as Agents
• Bruhn
– Bruhn (2005) contends that it is often the
interaction of the culture of the organization and
the character of the leader that creates ethical
failure.
The Management Challenge
• Because personal, organizational, subordinate,
and consumer responsibilities differ, there is
great potential for managers to experience
intrapersonal conflict.
Moral Uncertainty and Moral Conflict
• Moral uncertainty occurs when an individual is
unsure which moral principles or values apply
and may even include uncertainty as to what
the moral problem is.
• Also referred to as moral conflict “when the
duties and obligations of health care providers
or general guiding ethical principles are
unclear” (Jormsri, 2004, p. 217).
Moral Distress and Moral Outrage
• On the other hand, moral distress is the result
of the individual knowing the right thing to do,
but organizational constraints make it difficult
to take the right course of action.
• Moral outrage occurs when an individual
witnesses the immoral act of another but feels
powerless to stop it.
Reminder
• The way managers approach and solve ethical
dilemmas is influenced by their values and
basic beliefs about the rights, duties, and
goals of all human beings.
Ethical Dilemma
• Defined as making a choice between two or
more equally undesirable alternatives.
• The individual who must solve an ethical
dilemma is the only person who can ascertain
if actions taken were congruent with personal
values.
• Self-awareness is vital in ethical decision
making, as it is in other aspects of
management.
Three Characteristics of an Ethical
Dilemma (Leah Curtin, 1982)
1. The problem cannot be solved using only
empirical data.
2. The problem must be so perplexing that it is
difficult to decide what facts and data need to
be used in making the decision.
3. The results of the problem should have farreaching effects.
Three Approaches to Ethical
Decision Making
• Deontological—duty-focused normative
approach centered on rules from which all
action is derived.
• Teleological—outcome-focused approach that
places emphasis on results and protects the
interest of the majority.
• Situational—no prescribed rules, norms, or
majority-focused results that must be
followed.
Frameworks for Ethical
Decision Making
•
•
•
•
Utilitarianism
Duty-based reasoning
Rights-based reasoning
Intuitionism
Principles of Ethical
Decision Making
• Autonomy
–
Promotes self-determination/freedom of choice
• Beneficence
–
The actions one takes should be done in an effort to
promote good.
• Non-malfeasance
– To do no harm
• Paternalism
– One individual assumes the right to make decisions
for another.
•
• Utility
– The good of the many outweighs the wants/needs of
the individual.
• Justice
– Seeks fairness.
– Treats “equals” equally.
– Treats “unequals” according to their differences.
• Veracity
–
The obligation to tell the truth.
• Fidelity
– The need to keep promises.
• Confidentiality
–
Keeping privileged information private.
To Make Appropriate Ethical
Decisions:
• The manager must use a professional
approach that eliminates trial and error and
focuses on proven decision-making models or
problem-solving processes.
The MORAL Decision Making Model
(Crisham, 1985)
•
•
•
•
•
M—Massage the dilemma.
O—Outline options.
R—Review criteria and resolve.
A—Affirm position and act.
L—Look back. Evaluate the decision making.
Error in Ethical Problem Solving
• An error made by managers in ethical problem
solving is using the outcome of the decision as
the sole basis for determining the quality of
the decision making.
Ethics in Action
• In an era of markedly limited physical, human,
and fiscal resources, nearly all decision making
by nurse–managers involves some ethical
component.
• Perhaps the most important thing a manager
can do to create an ethical work environment
is to model ethical behavior.
Structured Approach to Problem
Solving
• “If a structured approach to problem solving is
used, data gathering is adequate, and multiple
alternatives are analyzed, even with a poor
outcome, the manager should accept that the
best possible decision was made at that time
with the information and resources
available.”
Professional Codes of Ethics
• One tool managers can use for guidance in ethical
problem solving is a Professional Code of Ethics.
• A code of ethics is a set of principles, established by a
profession, to guide the individual practitioner.
• The first code of ethics for nurses was adopted by the
American Nurses Association in 1950 and has been
revised five times since then.
• Professional codes of ethics do not have the power of
law. They do, however, function as a guide to the
highest standards of ethical practice for nurses.
Reasons Why Ethics Is Becoming a Greater
Force in Management Decision Making
• Increasing technology, regulatory pressures,
and competitiveness among health care
providers
• National nursing shortages
• Reduced fiscal resources
• Spiraling costs of supplies and salaries
• The public’s increasing distrust of the health
care delivery system and its institutions
Legal and Ethical Are Not the Same!
• Illegal
• Unethical
• Legal
• Unethical
• Illegal
• Ethical
• Legal
• Ethical
Institutional Review Boards (IRB)
• Primarily formed to protect the rights and
welfare of research subjects.