Class 1: Ethics

Ethics

Ethics

Process of critical thoughts and actions which deal with right and wrong.

Morality

Accepted set of social standards

Code of Ethics

A set of guiding principles that all members of a profession accept.

Autonomy

Refers to freedom from external control.

Beneficence

Refers to taking positive actions to help others.

Deontology

Moral duties are self-evident, needing no further justification. Moral action is then based on acting according to a specific duty simply because it is the right thing to do. (Good vs. Bad)

Utilitarianism

A common teleological theory that assumes that a moral action is one that results in the greatest good for the greatest number. (Effect)

True or False: The difference between utilitarianism and deontology is the focus on outcomes. Utilitarianism measures the effect that an act will have, while deontology looks at the act itself and measures it’s “rightness.”

True

Values

Personal beliefs about the truth and worth of behaviors, thoughts, and objects.

Beliefs

Interpretations of conclusions that one accepts as true.

Ethical Decision Making

A method of ensuring that the action we take is well-reasoned and can be justified.

Ethical Dilemma

Involves a problem for which in order to do something right, you have to do something wrong.

Ethical Dilemma Examples

• Abortion

• Assisted reproduction

• Confidentiality

• Genetic testing

• Advance directives

• Organ allocation

• Conflict of interest

• Patient safety

• Use of restraints

• Allocation of research funding

• Medical marijuana

• Drug shortages

• Opioid abuse

Fidelity

Refers to faithfulness or the agreement to keep promises.

Integrity

The quality of being honest and having strong moral principles; the state of being whole and undivided.

Veracity

Concerns truth telling and incorporates the concept that individuals should always tell the truth.

Justice

Refers to fairness and the distribution of resources as well as treating people equitably, fairly, and appropriately.

Nonmaleficence

Refers to the avoidance of harm or hurt.

Respect for Persons

Maintains that human beings have an unconditional moral worth that requires us to treat each individual person with great value, dignity, and respect.

Ethics of Duty

Moral duties are seen as self evident, needing no further justification. Moral action is then based on acting according to a specific action simply because it is the right thing to do.

Ethics of Consequence

Moral actions are defined entirely on the basis of the outcomes or consequences of an action.

True or False: Utilitarianism is a consequences-based theory, while deontology is duty-based theory.

True

Scope of Ethics

The different dimensions of ethics:

• Societal ethics

• Organizational ethics

• Bioethics/clinical ethics

• Professional Ethics

• Personal Ethics

Societal Ethics

• Serves the larger community.

• Laws are the minimum standard of behavior.

Organizational Ethics

• Involves a set of formal and informal principles and values that guide the behavior, decisions, and actions taken by members of an organization.

• Directs all aspects of an organization from its’ mission to how it treats clients.

Professional Ethics

• Refers to the ethical standards and expectations a particular profession.

• Some are held to a higher standard than others.

• Offer general guidelines that are aimed at the highest ideals of practice.

Bioethics

• Deals broadly with ethical questions surrounding the biological sciences, emerging healthcare technologies, and health policy.

Clinical Ethics

• Involved primarily with decision-making at the bedside and other patient-specific issues.

Research Ethics

• A specialized field within bioethics that examines the ethical conduct of research using human subjects and animals.

Personal Ethics

• Describes an individual’s own ethical foundations and practice.

• Continuously intersects with the other categories of ethics, but do not perfectly overlap.

Sources of Ethics

• Family

• Cultural practices

• Education

• Peers

• Religion

• Profession

• Society

• Personal experiences

Informed Consent

The process of obtaining permission from a patient to perform a specific test or procedure after describing all risks, side-effects, and benefits.

Nurses Role in Informed Consent

• Document consent

• Explain nursing procedures

• Ensure patients have their questions answered

Examples of Client Rights Violations

• Telling a patient their med is one thing when it isn’t so they’ll taken it.

• Gossiping about another patient’s diagnosis in the lunchroom.

• Prioritizing an “easy” patient over a more complicated case.

• Prolonging a painful treatment for no medical reason.

ANA Nursing Code of Ethics

1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.

2. The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.

3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.

4. The nurse has authority, accountability, and responsibility for nursing practice; make decisions; and takes action consistent with the obligation to provide optimal patient care.

5. The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.

6. The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.

7. The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.

8. The nurse collaborates with the other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.

9. The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

True or False: Nurses have an obligation first to the client, then others.

True

Strategies to Enhance Ethical Decisions and Practice

• Becoming aware of your own values and ethical aspects of nursing.

• Becoming familiar with the nursing code of ethics.

• Seeking opportunities for education.

• Respecting values, opinions, and responsibilities.

• Participating in or establishing ethics rounds.

• Serving on ethics committees.

Steps in the Resolution of an Ethical Dilemma

1. Is this an ethical problem?

2. Gather info relevant to the case.

3. Identify ethical elements in the situation by clarifying values and recognizing the principals involved. Distinguish between fact, opinion, value.

4. Name the problem.

5. Identify possible courses of action. Access others for their input and be creative.

6. Create/implement an action plan.

7. Evaluate.