Ethics Exam 1

Why are ethical problems called dilemmas?

•Difficult problem seemingly incapable of satisfactory solution

•Choice between equally unsatisfactory alternatives

•Involve conflicting moral claims

•It’s easy to decide between right and wrong– deciding between right and right or wrong and wrong is harder

value

Refers to one’s evaluative judgments about what one believes is good or makes something desirable

-What someone considers as worthwhile, useful, important, etc.

deontology

•Normative theory regarding which choices are morally required, forbidden, or permitted

•Focused on duties and rules to distinguish right from wrong

•Does not weigh the consequences or cost/benefit

“study of duty”

Utilitarianism

Promotes the greatest good and to produce the least amount of harm possible in a situation

•“What would bring about the best consequences?”

•Acts are right or wrong depending on consequences they produce

virtue ethics

“What sort of person must I be to be an excellent person”

Asks “What would a good “nurse” (clinician, teacher, physician, etc.) do in this circumstance?”?

care-based approach

Asks “What would I want done for myself…or family member in a similar circumstance?

•Compassion

•Sympathy

•Concern for well-being

Casuistry Approach

This approach involves analyzing a moral dilemma or case by comparing it to other well-known and ethically scrutinized scenarios, so-called ‘paradigm cases’.

Paradigm cases serve as ethical guideposts
in a sense, similar to precedent cases in the law and classic clinical case presentations.

principilism

Rule-based reasoning, approaches a dilemma by asking:

•“What is the highest principle (rule) that should be followed?”

•“What is the one principle that should never be violated?”

autonomy

•Respect for persons as unique individuals

•Self determination

•Freedom of choice

•Individual liberty 

•We must accept free and informed decisions

beneficence 

“Do good”

•Actions to benefit and promote the welfare of other people

•Promoting good and preventing harm

•Protect and defend the rights of others

•Prevent harm from occurring to others

•Remove conditions that will cause harm to others

•Help persons with disabilities

•Rescue persons in danger

nonmaleficence

“One ought not to inflict evil or harm”

Rule of double effects

•A single act can have two foreseen effects.

•To be justified

•Good effects must be intended

Harmful effects must not be pursued

justice

•Consideration of fair distribution of burdens and benefits, or consideration of what is due or owed others

•Fair/equitable treatment

•Equal share - distributive justice

•Scarcity and competition

•Individual vs. Society

Purpose of the ANA Code

Help nurses act with integrity when faced with ethical challenges (guidelines to help facilitate practice)

KEY: not binding in legal sense

hold people accountable and ensure consistency of behavior

Why are formal codes necessary?

maintenance of competence and continuation of professional growth

- continuation of personal growth

What is provision 5 in the ANA code for nurses?

Obligation to advance health and human rights and reduce disparities

Collaboration for human rights in complex, extreme, or extraordinary practice settings

What is provision 8 in the ANA code for nurses?

autonomy

•State of being self-governing

•Freedom and ability to act in a self-determined manner

Paternalism

Manifests as recommendations or decisions made:

•On behalf of patients that reflect the interests of the clinician/stakeholder

•Without the patient's full consent or knowledge.

_______ implies good intentions on the part of the clinician/stakeholder but undermines the patient’s autonomy claiming that the clinician/stakeholder knows what is best for the patient.

1.Threshold Elements

2.Information Elements

3.Consent Elements

What are the 3 elements of informed consent?

Threshold Elements

•Competence (to understand and decide)

•Voluntariness (choice in deciding)

Information elements

•Disclosure (full explanation of risks/benefits)

•Recommendation (proposed plan)

•Understanding (must be demonstrable)

consent elements

•Decision (in favor of some plan)

•Authorization (approves the chosen plan)

Advance Directives

•Decisions about health care wishes and preferences made while in competent state in “advance of” debilitated condition

•May be formal (written, witnessed or notarized) or informal (discussions with loved ones or health providers)

•May include identification of a surrogate decision maker

•May include statements about the kind of treatments one wishes to have performed in various health states

living will

directives to healthcare providers, surrogates and family members regarding wishes for medical treatments when individuals are no longer able to make the decisions for themselves

Durable Power of Attorney for Health Care

An individual appoints an agent (aka surrogate or proxy) to make health care decisions when individuals are no longer able to make the decisions for themselves

substitute judgement

•A type of surrogate decision making based on what a patient would have wanted were he/ she able to decide for him or herself

•Requires intimate knowledge of the individual’s wishes values, preferences and lifestyle

best interest standard

•A type of surrogate decision making based on what a “reasonable person” would want, given the balance of risks and benefits

•Used when there is insufficient information for a substituted judgment to be made

Competence

legal ability of a person to give valid informed consent

Capacity

the clinical ability of a person to participate in decision making (no standard definition)

moral distress

When one knows the correct action but feels powerless to take it

-This leads nurses to leave jobs and the profession.

•First characterized by Jameton (1984) as when one knows the right thing to do but "institutional constraints" make it impossible.

medical error

Failure of a planned action to be completed as intended

Use of a wrong plan to achieve an aim

adverse event

Injury that results from medical care

Not a part of the natural disease process

Confession

Full disclosure to the patient

Repentance

Apologize

What will be done to prevent recurrence

Forgiveness

Physicians need to forgive themselves so that learning from the incident and healing can begin.

Foundation laid for possible future patient forgiveness of the physician

What are the Western Cultural Expectations in Errors?

second victim phenomenon

the emotional and psychological distress experienced by healthcare professionals after being involved in a medical error or adverse even

Factors that increase the risk for medical errors

Personal life interfering with professional life

To stressed to think clearly

Take on to large of an assignment

Show up to work impaired R/T alcohol or drug use

Understaffed units

Under qualified nurses

Long shift hours

Inadequate time available for proper nursing care

Failure to follow requirements for continuing education

clinical ethics

when ethical problems apply to clinical situations

Doctor Trials and Nuremberg Codes

-WWII docs experimenting on prisoners (ex: make sea water drinkable)

-without consent

-10 Nuremberg Code Principles, the first international code of research ethics.

• Stressed the importance of consent form.

• Voluntary participation without coercion.

• Required standards for research

-Research ethics & human experimentation

First kidney transplantation

-first successful kidney transplantation done on identical twin boys

-donor recipient survived for 8 years after surgery

-Biomedical innovation

Skid Row Cancer Study

-open perineal prostate biopsies on homeless men from skid row

-If cancer was found, the men received radical prostatectomy, orchiectomy, and hormone treatment

-If cancer was not found, the patient’s perineum was stitched back together

-participants were poorly informed and often unaware they were a part of research

Willowbrook State School

Thalidomide

Seattle dialysis selection committee

1st oral contraceptives – Enovid

Milgram Experiment

Declaration of Helsinki

US Public Health Service memo on review

board

Cicely Saunders (1967) and the hospice

movement

Uniform Anatomical Gift Act

Tuskegee study

Roe vs. Wade case (1973); Dobbs v. Jackson Women's Health Organization

Tarasoff case

The Belmont report

Barney Clark (1982) and artificial heart

Baby Doe case

Elizabeth Bouvia

Nancy Cruzan case

Ryan White

Death with Dignity Act in Oregon

Ed Roberts

Jesse Gelsinger case

Peter Singer vs McBryde Johnson debate

Terri Schiavo Case

Marlise Munoz case

Brittany Maynard

First CRISPR babies

RaDonda Vaught