N470: Ethics (exam 4)

The study of ideal human behavior and ideal ways of being; an active process (of moral deliberation) rather than a static condition

ethics

Specific beliefs, behaviors, and ways of being; what you deem "right & wrong"

morals

something of worth, something that is highly regarded

values

rule-based criteria for conduct that naturally flow from the identification of obligations and duties; example- ANA code of ethics

principles

specific domain of ethics that is focused on moral issues in the field of health care; evolved in the 70's

Bioethics

Why do we need bioethical principles?

-Advancements in technology and medicine (20th century)

-Risk vs. benefit

-Allocation of resources

-Research boundaries (animal testing, pregnant women)

Four bioethical principles (Beauchamp and Childress)

-Autonomy

-Nonmaleficence

-Beneficence

-Justice

Freedom and ability to act in a self-determined manner

Autonomy

what does informed consent require?

- Competency

- Disclosure, recommendation, understanding

- VOLUNTARY authorization

Patient Self-Determination Act gives patient's....

Right to refuse

Principle used to communicate the obligation to do no harm.

Nonmaleficence

Beneficence vs nonmaleficence

Beneficence involves action to help someone and nonmaleficence requires “intentional avoidance of actions that cause harm”

the absence of due care; imposing a risk of harm = imposing an unintended careless risk of harm OR imposing an intentional reckless risk of harm

Negligence

Intended effects and merely foreseen effects; ex- giving higher doses of morphine at the end of life

Rule of double effect

actions to benefit and promote the welfare of other people

Beneficence

making choices for patients based on your personal beliefs (ex- repositioning Q2H) and not their wishes (ex-pt refuses to be turned); instead, provide pt with all information including risks and benefits, but do not force them beyond that

Paternalism

a principle in healthcare ethics, refers to fairness.

- treating people equally and without prejudice

- equitable distribution of benefits and burdens

- assuring fairness in biomedical research

Justice

Nurses try to identify unmet patient needs and then follow up to address the needs appropriately

Patient Advocacy

ANA Code of Ethics outlines nine provisions to guide ethical decisions (do not have to memorize)

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; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal 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 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.

a globally accepted document for ethical practice in nursing

International Council of Nurses Code of Ethics

ICN action-based standard of conduct four key elements

1)nurses and people

2)nurses and practice

3)nurses and the profession

4)nurses and coworkers

Many states encourage health care professionals to stop and render aid in non-employment related emergencies; offer immunity from lawsuit for bystanders who offer aid in emergencies; if you assume care, you must remain with patient until trained responders take over

"Good Samaritan" statutes

limits that protect the space between the nurse's professional power and the patient's vulnerabilities

Professional boundaries

Concepts underlying nurse-patient boundaries include... (3)

power, choice, and trust

A situation in which an individual is compelled to choose between two actions that will impact the well-being of a sentient being

Ethical Dilemmas

Three possibilities of ethical dilemmas

- Both actions can be reasonably justified as being good

- Neither action is readily justifiable as good

- The "goodness" of the actions is uncertain

Four Topics Approach to Ethical Decision Making

1. Medical Indications

2. Patient Preferences

3. Quality of Life

4. Contextual Features

Who serves on the ethics committee?

1) physicians

2) nurses

3) on-staff chaplain

4) social worker

5) administrator, 6) possibly a legal representative

6) local community representatives

who is the primary person who guards a patient's dignity during medical procedures?

the nurse

Where does scope of practice come from?

- the board of nursing's legal regulations and standards for practice in his or her state of residence

- Facility policies and procedures (maybe more restrictive than state)

action involving stopping to think about what one is choosing and doing before and during one's actions

Reflecting

Goals of ethics committee

-provide support by providing guidance to patients, families, and decision makers

-review cases when there are conflicts in basic values

-assist in clarifying ethical, legal, or religious situations that are beyond the scope of practice

-clarify issues, discuss alternatives, and suggest compromises

-promote rights of patient

-when appropriate, assist patient and family in making decisions about the best course of action

-promote policies and procedures that will maximize the likelihood of achieving good, pt centered outcomes

-enhance ethical standing of professionals and organizations

stereotyping and discrimination against older adults based on age

Ageism

active vs passive vs voluntary euthanasia

1) Active = involves a deliberate ACTION which intentionally causes death

2) Passive = involves WITHOLDING or withdrawing life-sustaining or life-prolonging measures in order to allow death

3) voluntary= physician assisted suicide

the unacceptably low chance of achieving a therapeutic benefit for the patient

Medical Futility

written expression of patient wishes for medical care, especially in the case of terminal illness; include what is refused and okay the time it takes effect, may specify hospitals/physicians

advanced directive

two types of advanced directives

living will and durable power of attorney

written directions about medical care provided in specific circumstances; legal document

living will

written directive that designates another person to act on the behalf of the patient if they become incapable; medical or financial

Durable Power of Attorney

proxy who acts on behalf of the patient; may be chosen or court appointed; first spouse, then adult child, parent, domestic partner, sibling, close friend, then neighbor, the two physicians

Surrogate Decision Maker

aspects of modified codes

- Medications

- Compressions

- Defibrillation

- Bag/mask

- Intubation