Ethics 312

ETHICAL DIMENSIONS OF NURSING & HEALTHCARE

Overview

  • Presenter: Heather Patterson, MSN, RN, CNE

  • Reference Text: F & S Ch. 12

Page 2: Ethics & Nursing

  • Nursing Standards & Scope of Practice

    • Involves theoretical and practical knowledge.

    • Practice Knowledge:

    • Development of clinical judgment focused on appropriate therapeutic and ethical (morally sound) actions.

  • Ethical Dilemmas in Healthcare:

    • Common occurrences in the nursing field.

    • Guidelines:

    • The American Nurses Association (ANA) outlines a code of ethics to provide nurses with guidelines for safe, compassionate care.

    • Nurses must be morally accountable.

  • Foundation of Ethical Principles:

    • Crucial for considering patient rights and needs.

Page 3: Definitions of Ethics

  • Ethics:

    • Study of philosophical ideals regarding right and wrong behavior of individuals or groups.

    • Refers to expected standards or behaviors of a group.

    • A mode of inquiry to understand moral dimensions of human conduct.

    • Moral vs. Ethical:

    • Terms often used interchangeably.

Page 4: Bioethics

  • Changing Ethical Considerations:

    • Ethical considerations in healthcare have evolved dramatically over the past two decades.

  • Philosophical Constructs (Beliefs):

    • Deontology:

    • Duty-based ethics, focused on adherence to rules.

    • Utilitarianism:

    • Outcome-based ethics, focused on maximizing overall happiness.

  • Definition of Bioethics:

    • The application of ethical principles to guide conversations about difficult issues in healthcare.

    • Encourages respect for diverse viewpoints while striving for consensus in dilemmas.

    • Nurses' perspectives are essential due to close interactions with clients.

Page 5: Values in Nursing

  • Definition of Values:

    • Desirable standards or qualities expressed through language, behaviors, and conduct expected from individuals.

    • Represents belief systems influenced by cultural, social relationships, and personal needs.

  • Value Formation:

    • Acquired through parenting, culture, religion, and experiences.

    • Evolve as individuals mature or encounter new experiences.

Page 6: Personal Values and Cultural Values

  • Personal Values:

    • Individual beliefs that form the basis for behavior.

    • Vary widely among individuals and can be prioritized differently.

    • Caution:

    • Avoid assuming others share the same values.

  • Cultural Values:

    • Values specific to a culture or group influencing health and illness beliefs.

    • Nurses must recognize cultural differences for effective communication.

Page 7: Professional Values

  • Definition:

    • General attributes valued by a professional group and promoted by professional codes and practice standards (ANA).

  • Learned Values:

    • Through formal education and informal observation of practicing nurses.

    • Traditional Nursing Etiquette/Values:

    • Efficiency, organization, cleanliness, competence, compassion, honesty.

  • Value Conflicts:

    • Conflicts can arise between professional values and personal values or those of other cultures.

Page 8: Ethical Principles

  • Purpose of Ethical Principles:

    • Serve as starting points for moral reasoning and decision-making.

    • No single principle guarantees the right action in every circumstance.

  • Main Ethical Principles:

    • Beneficence:

    • Obligation to do good and prevent harm, ensuring a positive benefit for clients.

    • Goals of nursing include the prevention of illness, alleviation of suffering, and promotion of health.

    • Paternalism:

    • Overriding a client’s choices, thinking it’s in their best interest.

    • Rarely justified unless significant unforeseen benefits are present.

Page 9: Autonomy

  • Definition:

    • The concept that individuals' wishes should be respected, allowing personal liberty, agency, and understanding in decision-making.

  • Implications:

    • Individuals should determine their course of action, symbolized by informed consent.

    • Example: A Jehovah’s Witness refusing a blood transfusion despite potential fatality.

    • Constraints may hinder autonomy related to age, mental ability, consciousness, and disease states.

Page 10: Nonmaleficence and Justice

  • Nonmaleficence:

    • The obligation to avoid causing harm; foundational to the Hippocratic Oath in medicine.

    • Necessitates weighing risks/benefits of actions.

  • Justice:

    • Principles of fairness, dictating equal treatment for all individuals regardless of circumstances.

    • Nurses have dual responsibilities—practice level and social activism— to advocate for equitable healthcare distribution.

Page 11: Veracity

  • Definition:

    • The obligation to tell the truth and not deceive others.

    • Essential for building trust in healthcare, connected to informed consent arrangements.

Page 12: Fidelity

  • Definition:

    • The obligation of individuals to others or organizations; critical in maintaining nurse-client trust.

    • Breaking confidentiality may be morally permissible in some situations, particularly when third-party welfare is at stake.

Page 13: Moral Distress

  • Definition:

    • Occurs when clinicians feel unable to act according to their ethical beliefs due to external constraints, leading to feelings of complicity in unethical actions.

  • Constituents:

    • Initial Moral Distress:

    • Experienced in real-time as unethical actions unfold.

    • Moral Residue:

    • Residual feelings of distress that linger after the ethical situation resolves.

Page 14: Sanctity of Human Life

  • Obligation:

    • Respecting human life as sacred; significant moral obligations exist toward preserving life.

  • Challenges:

    • Dealing with medical futility and ethical dilemmas surrounding end-of-life care.

  • Legal Considerations:

    • Active euthanasia is legal in select states, but not supported by the ANA.

Page 15: Moral Concepts in Nursing Practice

  • Advocacy:

    • Fundamental aspect involving speaking on behalf of clients and protecting their rights.

  • Accountability:

    • Involves responsibility for one's actions to clients, profession, and society.

Page 16: Cooperation and Caring

  • Cooperation:

    • Active participation for client quality care through teamwork and collaboration.

  • Caring:

    • The moral obligation in nursing anchored in concern for patient welfare and experience.

Page 19: Nursing Code of Ethics

  • Definition:

    • A collective statement that encompasses ethical principles expected of nurses.

    • The ANA established the first Code of Ethics in 1897 and a written version in 1950.

Page 20: 2025 Nursing Code of Ethics

  • Purpose:

    • Serves as a foundational framework for ethical nursing practice; guides decision-making that upholds patient care and professional integrity.

Page 21: Ethical Dilemmas

  • Nature:

    • Sources of conflict in healthcare often involving complex technologies.

  • Decision-Making Frameworks:

    • Involves critical thinking and understanding various values at stake.

Page 22: Managing an Ethical Dilemma

  • Seven Steps:

    1. Determine if an ethical dilemma exists.

    2. Gather relevant information.

    3. Examine and clarify own values.

    4. Verbalize the problem.

    5. Consider all possible actions.

    6. Negotiate the outcome.

    7. Evaluate the action taken.

Page 23: Important Considerations in Ethical Dilemmas

  • Reflect on ethical principles applicable to the scenario and evaluate relevant power dynamics.

    • Assess who is directly affected by the decisions made.

    • Ensure actions taken are beneficial and minimally harmful.

Page 24: Ethical Decision-Making Structures

  • TJC Recommendations:

    • Hospitals should have ethics committees that facilitate resolution of ethical dilemmas.

    • Typically composed of diverse professionals, fostering systematic approaches to ethical issues.

Page 25: Ethical Issues in Healthcare

  • Quality of Life (QOL):

    • Significant concern in dilemmas ranging from end-of-life care to experimental therapies.

    • Allocation of Scarce Resources:

    • Critical discussions around healthcare resource distribution, affected by rising costs and staffing shortages.

Page 26: Autonomy & Patient Self-Determination Act (PSDA) (1991)

  • Rights Granting:

    • Patients can determine their treatment levels, with PSDA mandating documentation of advance directives in healthcare facilities.

  • Key Issue:

    • Treatment decision-making after loss of decisional capacity, defined by the ability to comprehend and communicate decisions.

Page 28: Key Terms in Genetics and Genomics

  • Genetics:

    • The study of individual genes and inherited traits.

  • Genomics:

    • Comprehensive exploration of the entire genome.

Page 29: Nurse’s Role in Genetics & Genomics

  • Background:

    • First human genome was mapped in 2003, revealing linkages between genes and health.

  • Advocacy:

    • Nurses should advocate for patients’ access to genomic services and resources.

Page 30: Precision Health

  • Concept:

    • Customizing healthcare based on individual genomic data combined with environmental and behavioral factors, leading to targeted treatments.

Page 31: Other Related Developments

  • Genetic Testing and Carrier Testing:

    • Expanding field aiming to identify hereditary conditions and genetic susceptibilities.

Page 32: Ethical Issues in Genetics

  • Concerns:

    • Accessibility, informed decision-making, privacy, and potential discrimination following genetic testing.

  • The Code of Ethics serves as a guide against these possible ethical challenges.

Page 33: Ethics Project Presentations

  • Schedule:

    • Group presentations on ethics case studies scheduled for specific dates.

  • Students must check the schedule for assigned group participation details.