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Ethical and Bioethical Issues in Nursing and Health Care Mosby items and derived items copyright © 2002 by Mosby, Inc. Key Concepts • Selected ethical theories and principles • Relationship between ethics and morality in relation to nursing practice • Ethical decision-making model • Ethical and bioethical dilemmas Mosby items and derived items copyright © 2002 by Mosby, Inc. Nursing Ethics • System of principles concerning the action of the nurse in relationships with patients, families, other health care providers, policy makers, and society Mosby items and derived items copyright © 2002 by Mosby, Inc. Code of Ethics • Implicit values and standards for the profession • American Nurses Association (ANA) – ANA Code of Ethics • International Council of Nurses (ICN) – ICN Code for Nurses Mosby items and derived items copyright © 2002 by Mosby, Inc. Bioethics • Interdisciplinary field within health care that has evolved with modern medicine to address questions created as science and technology produce new ways of knowing • Physicians, nurses, social workers, psychiatrists, clergy, philosophers, and theologians are joining to address ethical questions in health care Mosby items and derived items copyright © 2002 by Mosby, Inc. Dilemmas for Health Professionals • • • • • Life and death Quality of life Right to decide Informed consent Alternative treatment issues Mosby items and derived items copyright © 2002 by Mosby, Inc. Dilemmas Created by Technology • Illnesses once leading to mortality are now classified as chronic illnesses • Cost is a consequence of prolonging life with technology Mosby items and derived items copyright © 2002 by Mosby, Inc. Ethical Decision Making • Answering difficult questions – What does it mean to be ill or well? – What is the proper balance between science and technology and the good of humans? – Where do we find balance when science allows us to experiment with the basic origins of life? Mosby items and derived items copyright © 2002 by Mosby, Inc. Balancing Science and Morality • Nurses must examine life and its origins, as well as its worth, usefulness, and importance – What does it mean to be ill or well? – What is the proper balance between science and technology and the good of humans? • Nurses must understand their own values and seek to understand the values of others Mosby items and derived items copyright © 2002 by Mosby, Inc. Health Care Decisions • • • • Patient Family Nurse Transdisciplinary team Mosby items and derived items copyright © 2002 by Mosby, Inc. Values Formation and Moral Development • Value: Personal belief about worth that acts as a guide to behavior • Value system: Entire framework on which actions are based • Values clarification: Process by which people examine personal values and how the values function as part of the whole Mosby items and derived items copyright © 2002 by Mosby, Inc. Values Formation and Moral Development—cont’d • Moral development: Forming a world view and value system in an evolving, continuous, dynamic process that moves along a continuum of development Mosby items and derived items copyright © 2002 by Mosby, Inc. Examining Values Systems • Nurses must examine their own values • Nurses must commit to a virtuous values system Mosby items and derived items copyright © 2002 by Mosby, Inc. World View • Provides a cohesive model for life • Encourages personal responsibility for living life • Prepares one for making ethical choices Mosby items and derived items copyright © 2002 by Mosby, Inc. Learning Right and Wrong • Infants – No concept of right or wrong – If basic need for trust is met, will develop foundation for secure moral thought • School-age children – Have learned that good behavior is rewarded and bad behavior is punished – Begin to make choices based on an understanding of good and bad Mosby items and derived items copyright © 2002 by Mosby, Inc. Learning Right and Wrong— cont’d • Adolescents – Question moral values and relevance to society – Become aware of contradictions in adults’ values systems • Adults – Strive to make sense of contradictions – Develop own morals and values – Begin to make choices based on internalized set of principles Mosby items and derived items copyright © 2002 by Mosby, Inc. Moral Development Theory • Kohlberg’s theory – Most widely accepted – Cognitive developmental process; sequential in nature – Rules imposed by authority – Conformity to expected social and religious mores – Autonomous thinker strives for a moral code beyond the issues of authority and reverence Mosby items and derived items copyright © 2002 by Mosby, Inc. Essential Values for the Professional Nurse • • • • • • • Altruism Equality Esthetics Freedom Human dignity Justice Truth Mosby items and derived items copyright © 2002 by Mosby, Inc. Ethical Theories • Utilitarianism – Greatest good for the most people – Assumes that an action is right if it leads to the greatest balance of good consequences or to the fewest possible bad consequences • Deontology – Decision is right if it conforms to an overriding moral duty and wrong if it violates that moral duty Mosby items and derived items copyright © 2002 by Mosby, Inc. Purpose of Ethical Principles • Establish common ground between nurse, patient, family, other health care professionals, and society to discuss ethical questions and make ethical decisions • Permit people to take a consistent position on specific or related issues • Provide an analytical framework by which moral problems can be evaluated Mosby items and derived items copyright © 2002 by Mosby, Inc. Autonomy • Principle of respect for the person • Unconditional intrinsic value for all • People are free to form judgments and actions as long as they do not infringe on others • Concepts of freedom and informed consent are grounded in this principle Mosby items and derived items copyright © 2002 by Mosby, Inc. Beneficence • To promote goodness, kindness, and charity • To abstain from injuring others and to help others further their well-being by removing them from harm • Common bioethical conflict results from an imbalance between the demands of beneficence and those of the health care delivery system Mosby items and derived items copyright © 2002 by Mosby, Inc. Nonmaleficence • Implies a duty: – Not to inflict harm – To abstain from injuring others – To help others further their own well-being by removing harm Mosby items and derived items copyright © 2002 by Mosby, Inc. Veracity • Principle of truth-telling • Consumers expect accurate and precise information • For trust to develop between providers and patients, there must be truthful communication • The challenge is to mesh the need for truthful communication with the need to protect Mosby items and derived items copyright © 2002 by Mosby, Inc. Ethical Decision-Making Model • Situation assessment procedure: 1. Identify ethical issues and problems 2. Identify and analyze available alternatives 3. Select one alternative 4. Justify the selection Mosby items and derived items copyright © 2002 by Mosby, Inc. Identify Ethical Issues and Problems • • • • What is the issue? What are the hidden issues? What are the complexities of the situation? Is anything being overlooked? Mosby items and derived items copyright © 2002 by Mosby, Inc. Identify and Analyze Available Alternatives • What are the reasonable possibilities for action? • How do different parties want to resolve the problem? • What ethical principles are required for each alternative? Mosby items and derived items copyright © 2002 by Mosby, Inc. Identify and Analyze Available Alternatives—cont’d • What assumptions are required, and what are their implications for future actions? • What additional ethical problems do alternatives raise? Mosby items and derived items copyright © 2002 by Mosby, Inc. Select One Alternative • Integration of multiple factors • Blend ethical theory, principles, and values Mosby items and derived items copyright © 2002 by Mosby, Inc. Justify the Selection • Specify reasons for action • Clearly present ethical basis for these reasons • Understand the shortcomings of the justification • Anticipate objections to the justification Mosby items and derived items copyright © 2002 by Mosby, Inc. Bioethical Dilemmas • • • • Life Reproduction Death Dilemmas in between – Injustice and the right to health care – Organ transplantation and allocation of scarce resources Mosby items and derived items copyright © 2002 by Mosby, Inc. Ethical Challenges • • • • Veracity Paternalism Autonomy Accountability Mosby items and derived items copyright © 2002 by Mosby, Inc.