Chapter 9 - Ethical and Bioethical Issues in (notes)

Chapter 9: Ethical and Bioethical Issues in Nursing and Health Care

Objectives

• Integrate Basic Concepts: Understand essential human values such as respect, compassion, and integrity that are crucial for ethical decision-making in nursing practice.

• Analyze Ethical Theories: Examine the foundational ethical theories—deontological, consequentialist, virtue ethics—that inform nursing ethics and their application to real-life situations.

• Ethics, Morality, and Mortality: Explore the complex relationships between ethics, morality, and mortality and their implications for nursing practice, especially in end-of-life care.

• Use an Ethical Decision-Making Framework: Implement a structured ethical decision-making framework to effectively resolve ethical dilemmas and problems in healthcare settings.

• Apply Ethical Decision-Making: Utilize ethical principles to address and resolve specific clinical ethical issues, ensuring alignment with patient care and institutional policies.

Defining Ethics in Nursing

• Choices Available: Ethics in nursing can be defined as:

  • Care based on client values, which is the correct response, emphasizing patient-centered care.

• Key Themes: Major themes in nursing ethics include:

  • Care: The fundamental commitment to patient welfare.

  • Good decision-making: Utilizing ethical principles to inform choices.

  • Best outcomes for patients: Aiming to enhance overall patient well-being through ethical practice.

Ethical Dilemmas in Nursing

• Main Reasons for Ethical Dilemmas:

  • Life or death decisions may present moral conflicts.

  • Patient refusal of treatment highlights the tension between autonomy and professional responsibility.

  • Conflicts with cultural/religious beliefs necessitate sensitivity and understanding.

  • Incompetence among peers can compromise patient safety and raise ethical concerns.

  • Inadequate staffing increases risks and moral distress for nurses.

• Common Ethical Dilemmas include:

  • Pro-Life vs. Pro-choice debates challenge personal and professional beliefs.

  • Privacy rights of adolescents raise issues of confidentiality and consent.

  • Parental vaccination refusal brings public health and individual rights into conflict.

  • Boundaries in social media use need clear guidelines for professional conduct.

  • Informed consent issues emphasize the need for transparent and thorough communication.

  • Addictions in treatment contexts complicate the administration of controlled substances, requiring careful ethical considerations.

Nursing Ethics

• Definition: Nursing ethics comprises the principles governing nurses' actions and decisions in relation to patients, families, and society at large.

• Codes of Ethics:

  • Implicit professional standards guide ethical behavior in nursing practice.

  • The American Nurses Association (ANA) Code of Ethics articulates ethical obligations for nurses in practice, emphasizing:

    • Practicing with compassion and respect for all individuals.

    • Commitment to patient welfare, health, and rights.

    • Promoting a safe and ethical work environment.

    • Engaging in continuous personal and professional growth through education and practice.

    • Involvement in research and policy development influencing nursing standards and patient care.

International Council of Nurses Code of Ethics

• Responsibilities to Individuals: Nurses must:

  • Show respect for human rights, dignity, and autonomy in patient care.

  • Ensure culturally appropriate communication that respects diverse backgrounds.

  • Advocate for equity and justice in healthcare access, contributing to reducing disparities.

• Professional Responsibilities include:

  • Maintaining health, competencies, and adhering to standards of practice throughout one’s career.

  • Creating a collaborative, supportive work environment that enhances team effectiveness and patient care quality.

Bioethics

• Field Overview: Bioethics adopts an interdisciplinary approach to address ethical questions arising in modern medicine and healthcare, involving debates among philosophers, legal experts, and medical professionals.

• Common Dilemmas include:

  • Addressing life and death decisions, informed consent complexities, and the balance of risks and benefits of alternative treatments.

  • Dealing with the implications of technology in healthcare, particularly regarding chronic illnesses and the economic aspects of life prolongation.

Ethics of Care

• Provider Obligations: Nurses fulfill caring responsibilities rooted in moral imperatives that aim to alleviate suffering and enhance patient welfare, reflecting the core ethical duty of care.

Ethical Decision Making

• Challenges: Key challenges in ethical decision-making in nursing encompass:

  • Defining safe care practices amidst varying interpretations of safety standards.

  • Managing inadequate staffing levels while ensuring quality care.

  • Navigating conflicts between personal values and institutional policies or regulations.

• Creating a Thought Process: Effective ethical decision-making requires:

  • Engaging in thoughtful dialogue with patients, families, and members of the healthcare team to gather diverse perspectives and foster understanding.

Values Formation and Moral Development

• Key Definitions: It is important to understand:

  • Value: Personal beliefs that guide behavior and ethical considerations in clinical practice.

  • Moral Development: The continuous growth of a person’s ethical perspectives and decision-making capabilities, influenced by experiences and education.

• Stages of Development: Different age groups exhibit unique understandings of right and wrong, affecting how ethical decisions are approached during growth.

Moral Development Theory (Lawrence Kohlberg)

• Levels of moral reasoning include:

  • Preconventional: Individuals obey rules imposed by authority figures to avoid punishment.

  • Conventional: Individuals internalize moral standards based on social expectations and relationships with others.

  • Postconventional: Individuals develop autonomous moral codes that transcend established authority, emphasizing principles such as justice and equality.

Ethical Principles in Nursing

• Autonomy: Respecting individual rights and informed consent is paramount in fostering patient empowerment.

• Beneficence and Nonmaleficence: Nurses promote patient well-being while preventing harm by balancing benefits and risks associated with interventions.

• Veracity: The ethical principle of truth-telling strengthens trust and ensures effective communication with patients, essential for informed decision-making.

Ethical Decision-Making Model

• Approach: A systematic approach involves:

  • Identifying ethical issues present in a situation.

  • Analyzing possible alternatives and consequences.

  • Selecting and justifying the preferred action based on ethical principles.

• Application: This model can be applied to contentious issues like abortion, euthanasia, and resource allocation strategies to ensure ethical integrity in nursing practice.

Summary

• Professional Commitment: Nurses are tasked with upholding the ethics of care in all aspects of practice, recognizing the individuality and unique needs of each situation.

• Relationships: Building relationships is fundamental to ethical practice; thus, ethical decision-making must prioritize patient empowerment, advocacy, and collaborative care to enhance outcomes.