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ETHICAL THEORIES AND BIOETHICS N243-NURSING ADMINISTRATION IV Krizzia Eve Mamuad Ariani Arista Pertiwi JAN. 9, 2009 OBJECTIVES Identify core bioethics terms and basic ethical principles for the nurse administration in health care agencies Explain relevant concepts and theories of ethics Define critical aspects of an ethics committee and the role of the nurse administrator Identify major ethical dilemmas as they relate to managing health care services Evaluate common ethical conflicts associated with the current practice environment Create an understanding of laws influencing care management Discuss the Ethical decision-making models Create a dialogue about values and ethical conflicts in nursing Discussion • What is your opinion about the video? • What are ethical principles have been violated? • What will you do if you were one of the team? ETHICAL KEY TERMS • ETHICS – the discipline in the judgment of rightness or wrongness, unfairness or fairness, virtue or vice - Formal study of ways of conceptualizing and understanding the moral life •NORMATIVE ETHICS - area of inquiry that seeks to determine which approach or action is the most ethically desirable in a given situation •HEALTH CARE ETHICS – biomedical / bioethics VALUE -any object or quality that is found to be desirable or worthwhile ; beliefs, purposes and attitudes that are freely chosen, prized and acted on RULE -a specific prescriptive action guide, expressed as an imperative PRINICPLE -an action guide that is more universal and general than a rule or value -Framework; skeleton of ethical decision making -Provides boundaries that should not be exceeded without justified reasons THEORY -an organized explanation of a particular phenomena; with principles as its basic components; basic assumptions believed to be true based on evidence ETHICAL PRINCIPLES AUTONOMY -quality or state of being self governing ; the capacity of an agent to determine its own actions through independent choice within a system of principles and laws to which one is dedicated (Ballou, 1998) -authority, accountability and liability for one’s decisions and actions BENEFICENCE -An obligation to positively benefit another balanced against risk - “promote good” -viewing person as autonomous NON MALEFICENCE -avoidance of intentional harm or the risk of inflicting harm on someone -an obligation to “do no harm” JUSTICE -Giving people what is owed, deserved or legitimately claimed -Norm of being fair to all, giving equal treatment -An obligation to distribute benefits (goods), and burdens (risks or harms) and cost equally FIDELITY -Being loyal and faithful to commitments and accountable for responsibilities VERACITY -Norm of telling the truth and not intentionally deceiving or misleading clients ETHICAL PRINCIPLES AND CORRESPONDING RULES AUTONOMY BENEFICENCE keep promises, mainatain confidentiality, be truthful, avoid coercion, preserve dignity, provide informed consent - be kind, merciful, competent, safe and helpful (prompt treatment of pain, non abandonment, promotion of health and well being) NONMALEFICENCE JUSTICE – refrain from inflicting harm of any type especially in the form of suffering, death or disability -provide indicated treatment regardless of differences; allocate resources according to a logical, fair and objective method ETHICAL THEORIES UTILITARIANISM of Jeremy Bentham And John Stuart Mill -normative ethical theory that advocates bringing about the greatest good for the greatest number of people. -an act is right if it produces the greatest possible value over disvalue; -theory CONSEQUENTIALISM consequences of the act are of primary concern An act is ethical if it produces desired outcomes ; the right act is the one that produces the best overall outcome KANTIAN DEONTOLOGY -proposed by a German philosopher, Immanuel Kant in 1781 an act is right when the agent behaves according to prescribed duties and obligations that preserve the dignity of each person (“DEONTO” = DUTY) REJECTED UTILITY as a primary moral principle AUTONOMY both is the supreme value the intent and how people achieve the end result are important rightness and wrongness of human actions is totally independent of the goodness or badness of consequences MAXIMS OF KANT an act is morally right if and only if it is universalizable. an act is morally right if and only if the agent performing it refrains from treating any person solely as mean to an end. TELEOLOGIC STYLE comes from the Greek root meaning “knowledge of the end” -assigns duty and obligations based on the consequences of the act (extrinsic nature) CONTRACTARIAN THEORY -morality involves a social contract, which provides the principle of what an individual can and cannot do “MORAL GUIDANCE IS MOST NEEDED WHEN TIMES ARE HARDEST AND TEMPTATION IS THE GREATEST” (RACHELS 1995) Ethical Decision Making Models Aiken (1994) Five Step Ethical Decision-Making Process First step: Second Step: Collect, analyze, and interpret as much information as possible about the dilemma State the dilemma as clearly as is possible Third Step: List and consider all possible courses of action to choose among Fourth step: Analyze the advantages and disadvantages of each course of action Final step: Make a decision Crisham (1985) MORAL model Linking judgment Choice Action considering alternatives in view of moral principles • Massaging the dilemma by defining and describing conflicts and interests • Outlining options by brainstorming to discover alternative solutions • Reviewing criteria and resolving the dilemma • Affirming a position and acting on the judgment • Looking back to evaluate the effectiveness of the process MORAL model Research Based Tool Framework for Bioethical Decision Making • Relevant patient and family demographics, including pertinent social data • Medical facts, including course of illness, diagnosis, prognosis, quality of life information, and a statement as to patient’s or family’s understanding of these data • Name of the legally designated decision maker • Persons who should be present for the discussion of options • How the available options are justified ethically: the specifications of the ethical norms involved and the pros and cons associated with each option • The most ethically sound option and justification for it Nursing process as a framework for Ethical Decision Making (Reigle, 1996) • Assessment: composed of problem identification and information gathering • Plan: selection of strategy for resolution • Implementation: putting the agreedon moral plan into effect • Evaluation: analysis of the process and the efficacy of the plan Values clarification Approach to Problem Resolution (Fry, 1994) • What is the story behind the values conflict? • What is the significance of the values involved? • What is the significance of the conflict to the parties involved? • What should be done? Task of Mediators in Resolving Bioethical Disputes Assessment phase investigate and characterize the conflict, identify the parties, and reach agreement on medical fact. Development Phase Distinguish and clarify the relevant legal and ethical principles and make sure that all parties understand the facts and the rights of parties in the same way Resolution Phase Help patient and family think through the options, articulate values to caregivers, and ensure that agreedon solution is carried out accordingly. Factors influence nurse decision making • Time • Resources • Values – Personal • Personal value related to caring in nursing care – Professional • ANA’s Code for Nurses – Organizational • Cost containment, making profit Developing a Health Care Ethics Program • Education • Consultation • Policy development Thank You