chapter four SIS

ethics

• systematic study of what a person’s conduct and actions should be regarding self, others, and the environment

  • what is right vs. wrong or good vs. bad

  • what life should be vs. what it really is

• moral conduct and principles to guide actions

moral indifference

individual questions why morality in practice is even necessary

moral uncertainty

• AKA moral conflict

• individual unsure which more principles or values apply or may not know what moral problem is

moral distress

individual knows the right thing to do but organizational constraints make it difficult to take the right course of action

moral outrage

individual witnesses immoral act of another but feels powerless to stop it

ethical dilemmas

described as being forced to choose between 2 or more undesirable alternatives

utilitarian

• teleologic

• consequentialist theory

• decisions are made with the goal of providing the greatest good for the greatest number of people

• decision making based on what provides greatest good for greatest number of people

  • needs and wants of the individual are diminished

  • OUTCOME determines the morality of the intervention

• end can justify the means

rights based

• deontologic

• individuals have basic inherent rights that should not be interfered with during decision making

• individuals have basic inherent rights that should not be interfered with during decision making

• some things are just a person’s just due

duty based

• deontologic

• decisions are made because one has a duty to do something or to refrain from doing something

• individuals have basic inherent rights that should not be interfered with during decision making

• some decisions must be made because one has a duty

• a ‘duty of care’ is an obligation to avoid doing something, that could possibly lead to the harm of another person

intuitionist

• deontologic

• issues are weighed on a case-by-case basis to determine relative goals, duties, and rights

• decision maker can review each ethical problem or issue on case-by-case basis

  • weigh goals, duties, and rights

  • based on intuition: what decision maker believes is right for that specific situation

ethical relativism

individuals make decisions based only on what seems right or reasonable according to their value system or culture

ethical universalism

• ethical principles are universal and constant

• decision making should not vary based on circumstances or cultural differences

autonomy

• to respect individual freedoms, preferences, and rights

• promotes self-determination and freedom of choice

beneficence

• do good for patients; promote good

• advocate for patient

• coordinate care amongst HCP

nonmaleficence

• prevent harm

• provide high-quality evidence-based care

paternalism

• one individual assumes right to make decisions for another

• limits freedom of choice - only use to prevent harm?

utility

good of many outweighs the wants or needs of the individual

justice

• to be fair, treat people equally

• treat “unequals” according to their differences

• remove barriers to health such as financial status

veracity

• obligation to tell truth

• avoid misleading or deceiving patient

• being transparent

• informed consent

fidelity

• to respect our words and duty to patients; keep our promise

• explicit vs. implicit promises

confidentiality

• keep privileged information private

• health insurance portability and accountability act (HIPAA)

assault and battery

• can involve lack of adequate consent (informed or implied)

• battery - actual touching of person without consent for action

consent for nursing measures

• patient must be informed before making decision

• does not require exhaustive explanation for each situation

• may be verbal or implied

• patient free to refuse any aspect of care offered

• careful documentation required following patient’s refusal of care

consent for medical treatment

• may be verbal or written, but written preferred

• ensure consent was informed

  • doesn’t appear well-informed? RN must notify provider further info is needed

• consent can be withdrawn by patient at ANY time

• emergency? provider can invoke implied consent “for best interest” of patient but should be validated by another provider

code of ethics and professional standards

• set of principles to guide the individual practitioner

  • general values, duties, and responsibilities for role of a nurse

  • highest standards of ethical practice

• first written 1950 by ANA

• revised every 10 years

types of problem-solving processes

• traditional problem-solving process

• nursing process

• moral decision-making model

moral decision-making model

• M: massage the dilemma

• O: outline options

• R: review criteria and resolve

• A: affirm position and act

• L: look back