Ethics

ETHICS Overview

• Presenter: Andi Jefferis, MSN, RN, MEDSURG-BC

LEARNING OBJECTIVES

• Values and Ethics: Clarify the relationship between values and ethics in nursing.

• Ethical Decision Making: Identify principles guiding ethical decision making.

• ANA Code of Ethics: Explain the American Nurses Association (ANA) Code of Ethics.

• Personal Values: Describe how personal values intersect with individual patient care.

• Client Rights: Discuss the rights of clients within the healthcare system.

• Resolving Dilemmas: Apply nursing ethical principles to tackle ethical and moral dilemmas.

CONCEPT DEFINITION

• Ethics: A systematic study of principles of right and wrong conduct, virtue and vice, and good and evil as they relate to human behavior (Taylor et al., 2023).

ETHICS, MORALS, AND VALUES

• Ethics: A systematic framework for standards of character and behavior pertaining to a group, such as the ANA Ethics and Code of Conduct.

• Values: Personal beliefs that shape standards of behavior (e.g., patient safety).

• Morals: Community standards of right and wrong based on values.

SOURCES OF ETHICS

• Personal experiences

• Family

• Peers

• Religion

• Culture

• Society

• Professional environment

BIOETHICS

• A branch of philosophy studying the ethical implications of human actions within healthcare, focusing on issues like organ donation, reproductive rights, abortion, and euthanasia.

• Nursing Ethics: A subset of bioethics that deals specifically with ethical issues in nursing practice.

ETHICAL PRACTICE IN NURSING

• Nurses should be prepared to make ethical decisions and respond to ethical challenges daily.

• Common ethical issues: Cost containment affecting patient care, end-of-life decisions, confidentiality, and addressing unethical practices of colleagues.

THEORIES OF ETHICS

• Utilitarianism: The moral rightness of an action depends on its consequences.

• Deontology: Actions are right or wrong based on rules, independent of consequences.

BASIC ETHICAL PRINCIPLES

• Advocacy: Defend client rights and welfare.

• Responsibility: Uphold obligations and fulfill promises.

• Accountability: Answer for one's actions.

• Confidentiality: Safeguard privacy without compromising care quality.

ETHICAL PRINCIPLES IN NURSING

• Autonomy: Right of patients to make their own healthcare decisions.

• Beneficence: Actions taken to benefit others without self-interest.

• Fidelity: Keeping commitments and promises.

• Justice: Providing equal care and resources to all patients.

• Nonmaleficence: Commitment to avoid harm.

• Veracity: The obligation to be truthful.

AUTONOMY

• Patients have the right to decide their treatment options and informed consent is a nurse's advocacy responsibility.

BENEFICENCE vs. NONMALEFICENCE

• Example of Beneficence: Encouraging a patient to get fresh air.

• Example of Nonmaleficence: Carefully checking medication labels before administration.

FIDELITY vs. VERACITY

• Example of Fidelity: Commitment to check on a patient in 30 minutes.

• Example of Veracity: Disclosing side effects of chemotherapy honestly.

JUSTICE

• Care should be provided fairly and equally to all patients, regardless of personal identity factors.

ETHICAL PRINCIPLES: PRACTICE QUESTION

• Case: A nurse caring for a client in a research study needs to understand which ethical principle is demonstrated by stopping an experimental medication due to kidney failure.

ETHICAL DILEMMAS

• Arise from conflicting choices and values in decision makers.

• Example: Withholding medical information from a patient against their wishes.

CARE-BASED APPROACH TO BIOETHICS

• Emphasizes dignity, respect, individual response, professionalism, compassion, and attentiveness in nursing care.

MORAL AGENCY

• Defined as the capacity to act ethically and fulfill expectations from the populations served by nurses.

VIRTUES IN NURSING

• Virtues include courage, integrity, trustworthiness, intelligence, and humility that enhance patient care.

CIVILITY IN NURSING

• Importance of respectful behavior in team dynamics to promote collaboration and reduce incivility through positive interactions and support.

AMERICAN NURSES' ASSOCIATION (ANA) CODE OF ETHICS

• Compassion and respect for every person's dignity and worth.

• Primary commitment to the patient.

• Advocacy for patients' rights and well-being.

• Accountability for nursing practice and decisions.

• Importance of ethical environment and collaboration with other health professionals to uphold social justice.

CONFLICTS OF COMMITMENT

• Balancing primary commitments to patients with personal well-being is crucial for effective nursing practice.

BILL OF RIGHTS FOR RNs

• Empower nurses in practice and workplace conditions to ensure safe, respectful patient care.

• Key points include autonomy in practice, professional growth access, equitable treatment environments, and support for advocacy.

NURSING PRACTICE COMMITMENTS

• Commitment to lifelong learning, adherence to policies, advocacy for the profession, and involvement at the unit level are essential.

MORAL DISTRESS AND RESILIENCY

• Moral Distress: Recognizing the right course of action but facing constraints.

• Moral Resilience: Ability to handle morally distressing situations effectively.

COMPASSION FATIGUE

• Stress from wanting to help suffering patients but feeling unable to relieve their distress; proactive strategies include journaling and meditation.

ETHICAL DECISION MAKING

• A systematic approach includes diagnosing the ethical problem, assessing the situation, planning alternatives, implementing and evaluating decisions.

ETHICAL CONSIDERATIONS

• Includes deliberation of benefits vs. harms, client choice, cultural considerations, and the integrity of healthcare providers.

INFORMED CONSENT AND REFUSAL

• Ethical/legal standards require full transparency and patient comprehension concerning procedures and treatment options, including conditions under which consent is valid.

EXAMPLES OF ETHICAL PROBLEMS

• Include paternalism, deception, confidentiality concerns, and ethical dilemmas concerning new technologies and staffing issues.

ETHICS COMMITTEES

• Multidisciplinary bodies addressing complex ethical issues in healthcare settings, ensuring nurses contribute their unique perspectives to ethical discussions.

PATIENTS’ RIGHTS

• Rights include high-quality care, privacy protection, involvement in care decisions, and understanding healthcare processes during their stay.

CASE STUDY: THINK-PAIR-SHARE

• Ethical dilemma case involving the patient’s wishes for feeding options raises issues of nonmaleficence and the nurse's advocacy role. Engage the ethics committee to resolve differing family opinions.