Class1 history, code of ethic, cultural safety

history1 : 460-370

revolutionized medcine by establish medcine practice, do not harm

history 1750 bc sode of hammurubi

briong rule pf rightness destory devil, include how dr should treat pt

hx 304 322 aristotle

virtue central to leding to good life-basic of virtue ethic

hx 1748 heremy and utilirianism

operate under that the right pr ethic choice lead to greatest happiness for greatest number of pp,

hx 1785 immnueal kant denotlogy

dentology does not look at consequence of action, but more at action

hx1914 schloendorff

earlier nyc case of informed consent, scholednroff not giving consent to amputate arm, adult have right to determine what should be done to their own body

hx 1976 tarasoff regent usc

mental health profession have duty to warn individual who are being thrated with body harm

1979 biomedical ethic principle and beauchamp

first bioemdical ethic : autonomy,benficience, non maleficence and justic

1980 chambliss nursing stufy

nurse ethical dimelmma cause by rganization and nurse central place, heirachy of ;ower and slow pace of system change

concept of relationality

 relationality posits that individuals do not exist as isolated, autonomous units

identity, health, and healing are co-created through an ongoing web of relationships: person-to-person, person-to-community, and person-to-environment.

Relation to the "Other":

pt not as objective/case/problem to be solved

• equires ethical attunement, active listening, and recognizing the shared humanity and agency of the other person.

Relational Accountability

• morally accountable not just for outcomes, but to the relationships they cultivate with patients, families, and communities.

6r framework

Kirkness & Barnhardt)

Indigenous and relational care models, the Six Rs govern ethical practice and community engagemen

respect

relevance

responsibility

reciprocity

represenation

relationship

6r respect

• Upholding the inherent dignity, autonomy, cultural integrity, and worldview of the other person.

• Refusing paternalistic approaches by honoring the individual's lived experience and self-determination.

6r relevance

• Ensuring care plans, interventions, and research align with the real-life priorities, needs, and cultural context of the person and their community.

• Avoiding generic, externally imposed solutions that do not fit the patient’s lived reality.

6r responsility

• Ethical accountability for the trust and stories shared by the patient or community.

• Recognizing the practitioner's duty to advocate, prevent harm, and follow through on commitments.

6r reciprocity

• Rejecting one-way, transactional interactions in favor of bidirectional learning and exchange.

• Acknowledging that both caregiver and patient contribute valuable knowledge, insights, and gifts to the healing process.

6r represenational

• Ensuring the patient's voice, values, and community context are authentically integrated into decision-making and systemic policies.

• Preventing stereotyping, erasure, or speaking over the person.

6r relationship

• on binding all principles together.

• Building an authentic therapeutic alliance grounded in continuity, sustained trust, presence, and mutual safety.

nursing ehtic central purpose

navigate the moral and legal landscape of practice

understand core theoretical frameworks

build the moral courage required to address ethical dilemmas in complex clinical environments.

situating ethics

• Nursing is fundamentally a moral endeavour; nurses occupy unique "in-between" positions where systemic demands conflict with bedside patient needs.

Ethical Theories & Principlism

• Contrasts duty-based ethics (deontology) with outcome-based ethics (utilitarianism/consequentialism), bridging them through the four principles: autonomy, beneficence, nonmaleficence, and justice.

Professional Codes of Ethics

• CNA) Code of Ethics outlines professional values and duties.

• not enforced by public courts

• it sets enforceable standards of conduct governed by provincial regulation.

Ethics vs. The Law

• Institutional constraints, understaffing, and power imbalances produce moral distress (knowing the right action but being unable to act)

• and cumulative moral residue (long-term harm from chronic compromises).

What is meant by nurses occupying "in-between" spaces?

sit directly between patients/families, physicians, interprofessional colleagues, and institutional management.

Constant proximity: Because nurses remain at the bedside around the clock, they witness everything

Competing demands: caught between institutional efficiency and their fundamental duty to advocate for the individual patient's dignity, comfort, and safety.

How can you describe your nursing practice as a moral endeavour?

• Inherent vulnerability:involves intimate bodily contact, human suffering, and profound power differentials, meaning technical actions are never purely mechanical

• Everyday ethical choices: Everyday nursing decisions carry moral weight, such as prioritizing , maintaining physical privacy during procedures, or validating

• Commitment to human good: Practice is driven by core values—human dignity, equity, relational trust, and advocacy—rather than institutional convenience.

dentology-duy based core premise

Actions are intrinsically right or wrong based on duties, rules, and universal moral obligations, regardless of consequences.

denotolgy guiding rule

Act only according to rules you would want universalized; treat individuals as ends in themselves, never merely as means.

dentology clinical application

Truth-telling and upholding informed consent are absolute duties, even if disclosing a diagnosis causes emotional distress.

dentology critique

• Rigid and inflexible when duties conflict

• Often discounts the emotional, relational, and contextual reality of complex human scenarios.

Consequentialism / Utilitarianism core premise

Actions are judged morally right or wrong entirely by their outcomes or consequences.

Consequentialism / Utilitarianism guiding urle

Maximize the greatest good, benefit, or happiness for the greatest number of people (utility).

Consequentialism / Utilitarianism; clinical application

Triaging limited emergency resources or ICU beds during a pandemic crisis to save the maximum number of life-years.

Consequentialism / Utilitarianism crtiqiue

• Can justify violating individual rights, autonomy, or minority interests to serve the benefit of the majority.

• Predicting all short- and long-term consequences in unpredictable clinical situations is practically impossible.

crtique of principlism

• Although designed to bridge these theories using four principles (autonomy, beneficence, nonmaleficence, justice), learners often apply it mechanistically and rigidly.

• It reflects a heavily Westernized bioethics perspective and can fall short when applied to collectivist or Indigenous relational worldviews.

law

• The external, enforceable baseline of acceptable conduct required by society.

• Focuses on minimum standards, liability, and regulatory compliance, enforced by courts and legal statutes.

• What is legal may not be ethical

• What is illegal may be ethically defensible in emergencies

• Creates legal reporting duties that can conflict with therapeutic trust and confidentiality.

ethics

• Represents an internal commitment to doing what is right, just, and good.

• Operates well above the legal floor, guiding clinical advocacy, relationship building, and compassionate care.

• Professional Codes of Ethics are enforced through internal regulatory discipline committees rather than public courts.

what does moral integrity look like in a nursing workplace?

1. Moral Autonomy: Developing, owning, and critically examining one's authentic values rather than passively adopting institutional norms.

2. Fidelity to Promise: Making commitments to patients and colleagues and reliably following through, establishing trust.

3. Steadfastness: Standing firm for ethical values in the face of pressure, institutional pushback, or personal risk

4. Wholeness: Maintaining moral consistency across all personal and professional roles, avoiding hypocrisy.

• actively addressing the sources of moral distress and preventing the accumulation of moral residue.

How personal values align with ethical leadership and moral integrity:

• Ethical Leadership as a Moral Compass: leaders use their position and knowledge as a positive force to create safe, open practice environments where staff do not feel silenced.

• Cultivating Moral Courage: willingness to advocate for what is right despite fear, adversity, and institutional pressure. It bridges the gap between moral intent and clinical action.

• Practical Alignment: Aligning personal values requires active reflection, knowing personal limits, speaking up when safety or dignity is compromised, and fostering a workplace culture grounded in safety and mutual respect.

What a Code of Ethics Typically Contains

• Core Values & Ethical Responsibilities: Fundamental commitments of the profession

• Standards of Professional Conduct: Clear guidelines governing therapeutic boundaries, conflicts of interest, competence, and accountability.

• Relations with the Public, Clients, and Colleagues: Obligations regarding interprofessional collaboration, reporting unsafe practice, and maintaining the public trust.

• Framework for Ethical Decision-Making: Guidance for resolving conflicts, navigating moral distress, and balancing competing priorities

Relationship Between Professional Codes of Ethics and the Law

• The Law as the Floor: The law establishes the minimum standard of acceptable societal conduct. Violations can lead to civil, criminal, or regulatory prosecution.

• Ethics as the Professional Standard: Codes of ethics articulated by professional bodies set higher moral ideals, guiding clinicians toward optimal care.

• Legal Weight of the Code (Quebec Context): The OIIQ official provincial regulation under the Professional Code. A breach of the code is not merely a theoretical failure; it constitutes professional misconduct subject to formal disciplinary action

How the Codes Inform Daily Practice & Bedside Experience

• Promoting Safe, Competent, and Ethical Care:

  • Identifying personal practice boundaries and refusing tasks all outside authorization.

  • Ensuring medication reconciliation, double-checking , and speaking up about near-misses.

• Promoting and Respecting Informed Decision-Making:

  • Ensuring the patient clearly understands procedures before proceeding.

  • Respecting a capable adult's right to refuse treatment

• Honoring Dignity and Privacy:

  • Pulling curtains, keeping bodies covered e, and maintaining professional decorum at all times.

  • Guarding personal health information by not discussing patient cases in public

• Maintaining Professional Integrity & Boundaries:

  • Declining personal gifts

  • Refusing dual relationships or personal social media interactions with current or recent patients.

Clinical Competence and Unsafe Assignments

• OIIQ Code (Article 44 / 45): A nurse must not demonstrate negligence in care and treatments, must perform required clinical evaluation, and must maintain clinical competence.
  OIIQ

• CNA Value (Providing Safe, Compassionate, Competent, and Ethical Care): Mandates that the nurse practice within the boundaries of their individual competence. The nurse has an ethical and legal obligation to formally inform the charge nurse of their lack of certification, negotiate a safe realignment of duties, document the staffing concern objectively, and refuse interventions that risk direct harm.

Respecting Autonomy and Free, Informed Consent

• IIQ Code (Article 41.1): When obtaining or verifying free and informed consent, the nurse must provide all necessary information, ensure consent remains informed, and respect the client’s right to withdraw or refuse consent at any time.
  OIIQ

• CNA Value (Promoting and Respecting Informed Decision-Making): Prohibits coercion or paternalism. The nurse explores the patient's concerns, explains the risks and benefits objectively, respects their refusal, and collaborates with the team to develop an alternative, comfort-focused plan.
  CNO

• Incidents, Transparency, and Truth-Telling

• OIIQ Code (Article 12): The nurse has a strict legal obligation to promptly disclose any incident or accident resulting from their action or omission, must never attempt to conceal it, and must take immediate steps to mitigate any consequences.
  Gouvernement du Québec

• CNA Value (Being Accountable & Preserving Dignity): Demands honest self-reporting, transparency with the patient and attending team, and using the event to identify systemic unit vulnerabilities rather than hiding an error out of fear of blame.

•  Patient Confidentiality and Professional Boundaries

• OIIQ Code (Articles 34, 38): Upholds strict professional secrecy (secret professionnel) and establishes boundaries regarding personal relationships.
  Gouvernement du Québec

• CNA Value (Maintaining Privacy and Confidentiality): Directs the nurse to redirect family inquiries appropriately, obtain proper consent prior to disclosure, and actively intervene to stop careless hallway or elevator discussions that violate patient privacy.