NURS 47- Ethics - Introduction to Bioethics and Ethical Decision Making

What is bioethics?

A concept brought on by medical advances which focuses on decisions about resource allocation

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Consider Organ Transports:

• Who gets the organ?

• Will a provider give up on a organ donor in the hopes of retrieving organs for another patient?

What are the three principles of the Belmont report?

• Respect for persons

• Beneficence

• Justice

What are the four principles of biomedical ethics?

• Autonomy → Acting in self-determined manner

• Beneficence → Doing good

• Nonmaleficence → Intentionally avoiding doing harm

• Justice → Treating people equally

What is autonomy?

• Freedom and ability to act in self-directed manner → Inclusive of patient autonomy and nurses professional autonomy

• Central in Western healthcare ethics

• Not emphasized in ethic of care

What is informed consent?

• Person must receive information, consent for treatment must be voluntary

• Person MUST be competent

What is implied consent?

Consent that is not directly stated but is implied.

What are examples of intentional nondisclosure?

• Near misses → Catch a error before it is made

• Emergency situations → Do not have the time to explain side effects of meds or benefit of treatment

• Therapeutic privilege → With holding information from a client with the belief that it will cause more harm than good.

• Placebos → With holding information from a client about wether the treatment they are receiving is legit or a placebo for the benefit of the clinical trial

When was the patient self-determination act passed?

• Passed by congress in 1990

What is the purpose of the patient self-determination act?

• Designed to facilitate patient autonomy; focused on advance directives

What is nonmaleficence?

Intentional avoidance of harm

What are futile treatments?

Treatments a client are receiving that won’t provide benefit to the patient but may do more harm.

Futile treatments are apart of which concept?

Nonmaleficence

What is the rule of double effect?

The concept that an act can have two effects; usually the intended effect and an unintended effect (double edged sword)

Ex: Morphine relieves pain however causes respiratory depression

What is the concept of slippery slope argument?

• May move toward illogical extremes; can become alarmist

  Example: Oregon death with dignity act → Patient assisted suicide lead to questions of “how do we know everyone’s not going to off themselves?” “How do we know those with mental illness won’t have access to it?”

What is beneficence?

• Actions to benefit and promote welfare; this is the legal responsibility of the nurse

What is paternalism?

• Acting beneficently without respecting autonomy

  Types:

  • Soft paternalism When people are told what to do whilst not having the capacity to make their own decisions. Ex: Altered patient fighting healthcare providers and subsequently being restrained.

  • Hard paternalism → When people are told what to do despite having the competency to make their own decisions. Ex: Law enforcement of wearing a seatbelt

• This concept is becoming less common today

What is the concept of the second victim phenomenon?

• Concept that the first victim in a healthcare error is the patient and the second is the healthcare provider.

  • Second victim phenomenon can cause emotional stress and grief

What is justice?

• Justice refers to fairness and the equal treatment of everyone without prejudice

  • This also includes the allocation of resources

What is distributive justice?

• Fair allocation of resources

What is social justice?

• Fair distribution of benefits and burdens

What is the veil of ignorance?

• Attempts to remove bias

What is libertarianism?

• A concept where individuals who contribute to the system are rewarded

What is moral suffering/distress?

• Being in morally unsatisfactory situations where taking action is not morally commendable

What are topics used in ethical decision making?

• Medical indications

• Patient preferences

• Quality of life

• Contextual features