2513 week 2 notes

Textbook- Concepts and Cases in Nursing Ethics

1. BENEFICENCE AND BENEFITING OTHERS

• Beneficence: Derived from the Latin words bene (meaning "well" or "good") and facio (meaning "to do").

• Definition: Signifies promoting someone else’s good or well-being.

• Related Term: The root also forms the word "benefit".

• Principle of Conduct: Beneficence is considered an ideal that obliges individuals to act in ways that benefit others.

• Forms of Benefit:

  • May include preventing or removing harm.

  • Can involve acting directly to produce a good outcome.

• Health Professionals' Role:

  • The knowledge, skills, and powers of health professionals have a dual nature.

  • They can be used to produce benefits but can also produce harm.

• Pharmakon Concept:

  • The Greek term pharmakon signifies both a remedy and a poison.

  • A drug beneficial in one context may be harmful under different circumstances or applications.

  • This principle applies to various health interventions as well.

• Nonmaleficence Principle:

  • Health professionals must consider nonmaleficence, which emphasizes the importance of not doing harm (Beauchamp & Childress, 2012).

  • The principle is encapsulated in the phrase primum non nocere ("first, do no harm").

  • A call to action for health professionals to exert due care and caution while benefiting patients.

  • If they cannot do good, they should ensure they do not make things worse.

• Risks of Harm:

  • Potential harms can arise from simple errors such as:

    • Documentation errors

    • A slip of the hand

    • An unguarded disclosure of information

  • These errors can lead to significant harm to patients.

• Beneficence has always been highly valued in the health professions, particularly in the so-called "caring" professions such as nursing (Lamb & Storch, 2013).

• The first nurses in Canada were associated with religious orders that established hospitals in Quebec City and Montreal in the seventeenth century.

• These nurses included the Augustinian and Ursuline sisters, who provided care to both settlers and Indigenous peoples.

• The circumstances under which they worked were often less than ideal.

• They sometimes risked their health while practicing the tenets of their faith, which focused on doing good and benefiting others.

• Beneficence overlaps with the concept of caring.

• Paley (2002) emphasizes that caring has been central to nursing discourse since the 1970s.

• By the 1980s, the idea of caring as an intrinsic part of nursing gained significance.

• Nursing theorists, such as Benner (2001), Benner & Wrubel (1989), Benner et al. (2009), and Watson (2005), have highlighted the importance of the caring orientation in nursing.

• The works of these theorists have developed in various directions:

  • Bradshaw (2009) discusses the "McDonaldization of care" and initiatives to quantify and measure caring among nurses.

  • Oberle and Bouchal (2009) connect caring to virtue ethics, emphasizing that the virtue of caring considers:

    • Situational context

    • Relationships

    • Patient’s best interests.

• Critique of Caring Discourse: Some nurse philosophers express skepticism regarding the discourse surrounding caring in nursing.

• Rolfe's Analysis (2009):

  • Reviews the usage of the term caring in Corbin's (2008) series on the "lost art of caring".

  • Demonstrates that caring has different and contradictory meanings, including:

    • Caring as a feeling

    • Caring as behaviour

    • Caring as an attitude

    • Caring as an art

    • Caring as a science

  • Skeptical of achieving agreement on a shared definition of caring (Rolfe, 2009, p. 145).

• Paley's Critique:

  • Critiques Finfgeld Connett's (2008) attempt to create a clear concept of caring.

  • Claims this effort is “just an anthology of descriptions” (p. 1669).

  • Argues that causal claims linking caring to health benefit are unfounded and epistemologically confused.

• Critiques of Caring Rhetoric in Nursing:

  • Commentators express concerns that the rhetoric of caring in nursing hinders the development of professional, scientifically informed, and evidence-based nursing practices.

• Dahlke and Stahlke Wall (2017):

  • Argue that the valorization of caring discourse leads to nurses’ reticence in addressing practice challenges.

  • Quote: "It is time for nursing to reflect on our historical thinking and how it has contributed to the persistence of unhelpful ideas. We should shift our focus to a new conception of nursing based on our professional identity of knowledge, skill, and service to humanity."

• Paley (2002):

  • Challenges the “ideology of caring,” equating it to Nietzsche's “slave morality,” which is motivated by resentment.

  • Claims this ideology has been debilitating, preventing nursing from becoming a properly scientific discipline.

• Clarification of Critiques:

  • The critiques do not target the concept of care itself—there is a consensus that nurses should be caring.

  • Focus instead on the meaning and significance of care as expressed in nursing theory.

2. BENEFICENCE, SELF-CONCERN, AND DUTY

• In earlier days, many individuals (almost always women) entered nursing with a strong sense of vocation.

  • Selfless dedication and sacrifice were typically expected from those in the profession.

  • The cultural background combined elements from religious orders and military life.

• As the profession advanced throughout the last century:

  • Significant advances in the status of women occurred in society.

  • Changes in labour and human rights legislation contributed to improving conditions for nurses.

  • Nurses gained a legal right to fair employment conditions.

• In the present day, students, including an increasing number of men (McDonald, 2019), enter nursing for various reasons:

  • Beyond the intrinsic rewards of helping people, nursing is viewed as a desirable career due to factors like salary, benefits, and employment opportunities.

• Intrinsic Motivation: Responsible individuals often desire to benefit others.

• Helping Professions: Caring is a natural inclination for those in professions like nursing.

• Satisfaction in Nursing:

  • Caring for patients can be a joyful fulfillment.

  • It serves as an expression of deep desires and commitments.

  • Positive Self-Impact: Helping others contributes to a sense of personal satisfaction.

  • Many nurses report tremendous job satisfaction from making a positive difference in patients' lives.

• Challenges in Nursing:

  • Meeting patient needs may require hard work, personal risk, or sacrifice (Armstrong & Silas, 2019).

  • Some nursing tasks can be demanding or unpleasant.

  • There may be risks associated with caring for patients with infectious diseases.

  • Overtime Work: Meeting patient needs during emergencies or within short-staffed units can present inconveniences or serious burdens.

• When the nurse finds satisfaction or gratification in caring for the patient, beneficence is easier to exercise.

• Conflicts may arise between the nurse’s own desires or self-concern and what is required to benefit the patient.

  • Example: A nurse may feel reluctant to attend to a homeless man who is lice-ridden and unkempt.

  • Meeting the needs of such patients may be challenging and not aligned with the nurse's personal desires.

• Despite these challenges, such acts of caring are required as a matter of duty.

• It is essential for nurses to recognize and check their first or immediate responses.

• Composing oneself in a professional manner to care for the patient is part of professionalism in nursing.

• Ideally, if what duty requires coincides with what the nurse desires, this situation is favorable.

• However, sometimes duty necessitates actions that are contrary to personal preferences.

• The call of duty can motivate nurses to act even when personal desires lean in another direction.

• Leading a moral life involves:

  • Self-examination

  • Self-sacrifice

  • Effort and striving to meet ethical standards in patient care.

• Duties in Professional Ethics:

  • Duties derive from the phenomenon of promising, linked to the notion of professional promise.

  • Duties emerge from a contract or covenant between:

    • The profession and society.

    • The health professional and the patient.

• Rights and Privileges:

  • Society confers certain rights and privileges on nurses.

  • In return, nurses implicitly promise to uphold certain standards of conduct.

  • Standards are outlined in the profession’s ethical norms and code of ethics.

• Assuming Duties:

  • By entering the nursing profession, individuals assume specific duties.

  • The foremost duty is to act for the benefit of the patient.

• Fiduciary Duty:

  • This duty is referred to as a “fiduciary duty.”

  • It signifies a responsibility derived from trust.

  • Professionals are expected to use their skills and powers in the service of their patients.

• Empowerment of Nurses:

  • Nurses are empowered and entrusted to act for the benefit of patients.

  • Patients have expectations that nurses will fulfill these duties effectively.

• Complexity of Duty:

  • It can be challenging to determine what and how much our duty requires, particularly in relation to beneficence.

• Key Questions:

  • Several important questions arise concerning duty, including:

    • What is entailed by a duty to benefit others?

    • Is it sufficient to only avoid causing harm, or must we also produce positive benefits for others?

    • How much sacrifice, effort, and striving does duty truly necessitate?

• Admiration and Standards:

  • Society tends to admire individuals who passionately commit to serving others.

  • However, the expectations set by self-sacrificing heroes may create unreasonable standards for nursing practice.

• Minimalism in Practice:

  • There is disapproval of nurses who only adhere to the minimum job expectations and fail to make sacrifices for their patients' benefit.

• Finding Balance:

  • An effective approach involves finding a reasonable balance between excessive self-sacrifice and minimal compliance with duty.

• Nurses recognize that they face occupational risks but understand there is a limit to the risks they can reasonably be expected to accept.

• Minimization of Risks: Risks can often be minimized through procedural, structural, or cultural changes in the workplace (Armstrong & Silas, 2019).

• When nurses are placed at serious risk of harm, it is crucial to seek remedies to reduce or eliminate those risks.

• For instance, back injuries are common in nursing and can be diminished by implementing the use of patient lifts.

• Certain risks are more challenging to reduce, and some environments inherently carry greater risks than others.

• Nursing care may be required in contexts where there is a risk of physical and verbal abuse from patients with health problems.

• In such situations, it is essential to utilize assessment and risk protocols.

• Exploitation of Commitment: Nurses must ensure that managers and employers do not exploit their commitment to the well-being of patients.

  • Unsafe Work Conditions: There should be no normalization of unsafe or unduly stressful working situations.

• Historical Context: In the past, nurses were often expected to suffer in silence, relying on their beneficent willingness to make sacrifices.

• Current Protections: Today, nurses are protected by occupational safety laws and policies that aim to create a safe work environment.

  • Managerial Responsibility: Employers and managers are responsible for reducing risks and promoting a healthy workplace for all staff.

• Education and Support:

  • Nurses receive education regarding the management of potentially harmful patients.

  • Security and support staff are available to address potentially dangerous situations.

• Union Support: In unionized settings, nurses can rely on their contracts for guidance in questionable circumstances.

• Workplace Policies: Health agencies implement respectful workplace policies that align with human rights principles.

• Fatigue and Stress: It is recognized that fatigue and stress contribute to increased risks of injuries, errors, and burnout.

  • Many workplaces offer wellness programs for nurses.

• Crisis Situations: During emergencies, such as epidemics, questions arise about when nurses can withdraw their services due to safety concerns.

  • Guidance Documents: Provincial regulations, labour contracts, and the CNA Code of Ethics provide necessary guidance for nurses during crises.

• Duty to Serve: Nurses have a duty to serve during medical emergencies, provided that reasonable steps have been taken to reduce risk.

  • If equipment is inadequate or safety is compromised, nurses are justified in not providing care.

• Reporting Safety Concerns: Nurses should report unsafe conditions if a safe environment is not provided.

• Learning from Harm: When harm occurs to nurses, a systems analysis should take place to improve safety protocols.

• Collaboration: The CNA emphasizes collaboration among professional associations, regulatory bodies, and employers in decision-making processes.

• Resource Management: Nurses need to identify when they require additional resources to fulfill their duty to patients and ensure their own safety.

• Striving for Excellence: Nurses are expected to strive for excellent care even under less conducive conditions.

  • They must also address issues at the root level to ensure quality patient care.

• Advocacy and Ethical Considerations: Advocacy for patients or nurse protection can lead to conflicts. Careful consideration and ethics should guide decisions.

  • Nurses should consult trusted peers or professionals for support in challenging situations.

• Professional Organizations: Nurses can collaborate through professional organizations to ensure environments do not unduly require sacrifice or put patients and nurses at risk (Armstrong & Silas, 2019).

3. CHALLENGES DETERMINING WHAT IS BENEFICIAL

• Willingness to Benefit Others:

  • Represents the desire and intention to help individuals or groups.

  • Important for ethical conduct in caregiving and professional practices.

• Knowing How:

  • Refers to the understanding and knowledge required to effectively help others.

  • Involves skills, training, and experience necessary for beneficial action.

• Ability to Benefit:

  • Highlights the capability of producing positive outcomes.

  • Requires not just intentions but practical methods and interventions.

• Good Intentions:

  • Constitutes a vital component of beneficence.

  • Can be insufficient if not paired with the ability to achieve constructive results.

• Two Aspects of Beneficence:

  • Psychological Aspect:

    • Involves the attitudes or dispositions of caregivers.

    • Includes empathy and concern for others as key components.

  • Consequential Aspect:

    • Concerned with the results and outcomes of actions.

    • Focuses on effectively producing benefits for others.

• Reflection in Care:

  • The notion of care encapsulates both the psychological and consequential forms of beneficence.

  • Points to the importance of combining intentions with effective actions in nourishing relationships and providing care.

• Caring can be viewed from a psychological perspective:

  • Relates to a person's attitudes and dispositions.

  • Focuses on the spirit in which individuals act towards others.

• Praise and Admiration:

  • We often praise individuals for showing concern and empathy towards others.

  • Caring individuals are admired for their good wishes and intentions.

  • Their intentions may still be recognized even if they lead to negative outcomes.

• Therapeutic Value of Caring:

  • The mere knowledge that someone cares can be therapeutically beneficial.

  • However, the benefits derived from caring may be limited.

  • Caring intentions alone may be insufficient for positive outcomes (Rodney, Kadyschuk, et al., 2013).

• Caring Conceptualization: Caring can be seen not solely in terms of people but rather focuses on knowledge, skills, and abilities.

• Evidence-Based Practice: This perspective supports the movement towards evidence-based practice, which:

  • Involves the seeking out and incorporating of the most reliable sources of evidence.

  • Includes knowledge produced by research (Brown, 2014, p. xi).

• Nursing Care: Defined as the various methods through which a nurse, guided by evidence and nursing knowledge, ensures the benefit of the patient.

• Parental Care: Parents typically care for their sick children from a psychological or attitudinal standpoint. However:

  • They may lack the knowledge needed to effectively benefit their child in a practical sense.

• Caring vs. Outcomes: There is a distinction between knowing how to secure a good outcome and having genuine concern:

  • One may possess the skills necessary for positive results without truly caring for the well-being of the other.

• Combining Senses of Caring: Nursing care should ideally integrate both competence and compassion.

  • Competent nurses possess the requisite skills, knowledge, and judgment necessary for effective care.

  • Compassionate nurses genuinely care about their patients, leading to emotionally supportive relationships.

• Effective Actions: Nursing care must be effective and produce benefits for the patient.

• Caring Relationship: According to Benner and Wrubel (1989):

  • A caring relationship establishes conditions of trust.

  • Trust enables the patient to appropriate the help offered and truly feel cared for.

• Trust Components:

  • Includes the belief that the caregiver genuinely cares for the patient.

  • Involves confidence in the caregiver's knowledge and skills to make a positive difference.

• Diminished Caring Relationship: The caring relationship can be weakened if either trust condition (feeling cared for or confidence in knowledge) is not satisfied.

• In some cases, caring individuals with knowledge and skills may:

  • Be unsure about how to best produce benefit for others.

• There may be different or conflicting kinds of benefits to consider, which adds complexity to decision-making.

• Benefits can be mixed with burdens or harms, leading to complicated outcomes.

  • Predicted outcomes may vary, with some being more certain while others may be less probable.

• Judgments about how to best benefit the patient can be complicated by:

  • Considerations of risk and burden weighed against potential benefits.

• Uncertainty and possibly disagreement can arise regarding the benefit of treatment for:

  • Patients who are critically ill.

  • Patients living with chronic health problems.

• Treatment Decisions in the Grey Zone:

  • Involves situations where benefit to the patient is uncertain or disputed.

  • Raises deep and difficult questions about values, goals, and limits of health care.

• Importance of Quality of Life:

  • There is a general agreement on the significance of quality of life.

  • Disagreements may occur regarding:

    • What quality of life precisely means.

    • How to measure quality of life.

  • Health care is valued for its ability to make a difference in one’s quality of life.

• Sanctity of Life:

  • Considered an important value in health care.

  • Respect for patients should be maintained regardless of their health status or quality of life.

  • Example: A low weight neonate should be treated with the same respect as a healthy newborn.

• Quality of Life and Sanctity of Life are critical values in health care.

• Importance for Health Professionals:

  • Health professionals must consider the impact of their interventions on the patient's quality of life.

  • Respecting human life is essential, regardless of its quality.

• Variability of Interpretation:

  • Different individuals interpret and prioritize these values based on specific contexts.

• Concept of Sanctity of Life:

  • Some health professionals view the sanctity of life as the belief that life should be preserved regardless of its quality.

  • Conversely, others argue that when quality of life falls below a certain threshold, it is pointless or wrong to preserve life.

• Faith Perspectives:

  • Certain faith groups may prioritize sanctity of life above quality of life.

  • However, they may agree that if death is imminent and quality of life has significantly diminished, allowing comfort measures is an acceptable approach.

• The difficulties in determining what is beneficial are compounded by the fact that:

  • The concept of beneficence can be understood in broad or narrow terms.

  • The interpretation of what constitutes a benefit to others varies significantly.

• The patient is placed under the nurse’s responsibility based on:

  • An expectation that the nurse will act on behalf of the patient’s health interests.

  • A trust relationship between the patient and the nurse.

• It is reasonable to define nursing care primarily in terms of health, given the professional context:

  • Nurses’ actions and decisions should be focused on promoting the patient’s physical and mental well-being.

• In comparison to other professions,

  • Different professionals may demonstrate beneficence in various forms:

    • An accountant caring for a client’s financial well-being.

    • A chaplain attending to a person’s spiritual well-being.

• The fundamental focus of a nurse’s care is aligned with ensuring the health and well-being of patients, which is:

  • A direct result of the knowledge and experience gained through nursing education.

• Restriction of Beneficence: Focus on acting on behalf of the patient’s good.

  • This good is primarily identified with health.

• Complexity of Health: The concept of health can be subject to different interpretations.

  • Definitions of health encompass a wide range of meanings.

• Narrow vs. Broad Conception of Health:

  • Narrow Conception: Defined as the absence of disease or infirmity; restricts health to biological or medical levels.

  • Broad Conception: Extends to include aspects of lifestyle, psychosocial factors, and environmental considerations.

• World Health Organization (WHO) Definition:

  • Influential Definition: “A state of complete physical, mental, and social well-being.”

  • Initial Publication: First principle in the WHO’s founding constitution (1948).

  • Current Reaffirmation: This definition remains largely unchanged in WHO’s current constitution (2014).

• Health Promotion Perspective:

  • WHO documents expand on the concept of health promotion.

  • Ottawa Charter for Health Promotion:

    • Defines health as a resource for everyday living.

    • Emphasizes the need to identify and realize aspirations, satisfy needs, and cope with the environment.

    • Recognizes health as a positive concept with a focus on social and personal resources as well as physical capacities.

    • Lists fundamental conditions for health: peace, shelter, education, food, income, stable eco-system, sustainable resources, and social justice and equity.

• Implications for Health Promotion:

  • Promoting health based on the broad definition involves a fundamental shift away from simply promoting health as defined by biomedical standards.

• Cultural Factors: Influence conceptions of health and related health practices.

• Research Overview: Levesque reviews studies that explore these influences.

• Canadian Context: Levesque describes similarities and differences in health conceptualization among:

  • Francophones

  • Anglophones

  • First Nations peoples (Levesque, 2011; Levesque & Li, 2014; Levesque et al., 2013).

• Multidimensional Health Models:

  • Provided by WHO.

  • Aim for a comprehensive view of health.

  • May not reflect views of members of cultural minority groups.

  • Developed primarily from studies on Caucasian, English-speaking populations (Levesque et al

• Differences in Understanding of Health:

  • Variations in how health is understood and maintained impact beneficence in health care.

• Cultural Implications:

  • Levesque and Li (2014) discuss two significant implications of cultural differences concerning health:

    • Health Policy Makers:

      • Must consider the cultural role in conceptualizing health.

      • Health policies and programs should reflect the particular beliefs and needs of targeted populations.

    • Health-Care Professionals:

      • Should recognize and respect the diverse views of their patients.

      • Aims to provide culturally appropriate care.

• Cultural Diversity in Canada:

  • The growing cultural diversity in Canada has highlighted the importance of understanding the needs and rights of First Nations people.

  • Nursing plays a leading role in advocating for the development of cultural competence among health professionals.

  • There is a focus on integrating cultural safety into healthcare education and practice (Hart-Wasekeesikaw & Gregory, 2009; Laws & Chilton, 2013; Racine, 2014).

• Complexity of Beneficence: Beneficence becomes more complicated when we question its restriction to health-related matters.

  • Health as a Value: Health is just one good among others but holds significant importance.

  • Prioritization of Values: Many individuals value other things above health, such as:

    • Devotion to political or religious causes

    • Personal ambition

    • Acquisition of wealth

  • Willingness to Sacrifice: People may be willing to sacrifice their health for these alternative values.

• Assessing Health Value: This raises the question of how to assess the value of health relative to other values.

• Broader Interpretation of Beneficence: Beneficence may be interpreted to encompass the good of others beyond just health.

• Nurse's Responsibilities: Nurses care about:

  • Patients' ability to act according to their own values.

  • The right of patients to be informed truthfully.

• Scope of Beneficence: Commonly, the scope of beneficence is limited to the good of the patient, particularly in terms of health.

• Conflict with Other Values: When viewed in this manner, beneficence can conflict with other key values, especially:

  • Autonomy

  • Truthfulness

• Paternalism: These conflicts often prompt discussions about paternalism in health care practice.

4. PATERNALISM

• Paternalism: Emerges as a critical issue when the focus shifts from defining standards of benefit for others to determining authority regarding such decisions.

• Key Question: Who has the right to decide what is considered good for an individual?

• Patient Rights vs. Autonomy: How much importance should be placed on the patient's rights or autonomy?

  • Example: Conflicts may arise when patient desires are incompatible with their health interests as perceived by the nurse or health team.

• Implications: The balance of power and decision-making in the context of healthcare can lead to ethical challenges regarding autonomy and beneficence.

• Classic Scenario for Paternalism:

  • Paternalism is defined as the interference with a person's liberty of action.

  • Justification for this interference relates exclusively to the following aspects of the person being coerced:

    • Welfare

    • Good

    • Happiness

    • Needs

    • Interests

    • Values

  • Source: Gerald Dworkin’s (1971) definition (p. 108).

• Jameton's Definition (1984):

  • Paternalism involves:

    • Making people do what is good for them

    • Preventing people from doing what is bad for them

• The paternalistic person acts in the name of beneficence:

  • Takes steps believed to promote the good of others.

  • Actions may occur even if the affected person disagrees or protests.

• Paternalism in Healthcare:

  • Historically, healthcare professionals have a strong inclination toward benefiting the patient, leading to paternalism.

  • Such paternalism was more widely accepted in the past.

• Historical Context:

  • A generation ago, health professionals frequently made treatment decisions based on their belief in what was best for the patient.

  • Patients’ informed consent was often not fully obtained.

  • Information deemed potentially harmful was frequently withheld from patients.

• Contemporary Changes:

  • There has been a significant shift in healthcare, moving decision-making from health professionals to the patients themselves.

  • Increasing emphasis on patient autonomy and the right to know the truth is a key development.

• Nurse’s Role:

  • When a nurse believes that a patient’s wishes may not be in their best interest, it is acceptable to seek clarification.

  • The nurse must ensure that the patient understands relevant information and is making a free decision.

  • If the patient demonstrates understanding and freedom in their decision-making, the nurse has a duty to respect and act according to the patient's wishes, even in disagreement.

• Paternalism: A term that has acquired a negative connotation in health care, signaling a shift towards autonomy over beneficence.

• Commentators like Pellegrino & Thomasma (1988) argue that the shift may have gone too far from beneficence to autonomy.

• Justification for Paternalism: Even advocates for autonomy acknowledge that paternalism can be valid when individuals lack the capacity to make informed decisions.

• Parent-Child Relationship: This relationship exemplifies paternalism, as the term itself derives from the Latin word for father (pater), reflecting how adults make decisions on behalf of children.

• Decision-Making Context: Whether paternalism is justified can depend on several factors:

  • Type of Decision: Simple choices (e.g., choosing between a hamburger and a sandwich) can be made by young children, while complex health decisions (e.g., immunizations) may surpass their maturity level.

  • Child's Experience: The appropriateness of paternalistic interventions can vary based on the experience and development of the child in reasoning.

• Doctrine of the Mature Minor:

  • Holds across Canada as a matter of common law.

  • Enshrined in statutory law in several provinces, including British Columbia and Ontario.

• Definition of Mature Minors:

  • Mature minors are individuals under the age of majority who can:

    • Understand and appreciate the consequences of accepting or refusing medical treatment (Guichon et al., 2017, p. 787).

• Consent to Medical Treatment:

  • Consent is not based solely on a set age.

  • Focus on the child’s capacity to understand and appreciate the information necessary for an informed decision.

• Case Example:

  • In instances where adolescents refuse aggressive treatment for cancer, while parents wish for treatment to continue:

    • Nurses and colleagues assess if the patient meets criteria for a mature minor.

    • If criteria are met, the child can make the treatment decision.

• Support Needs:

  • Recognize the difficulty of these situations.

  • Provide psychological and ethical support for all involved, including:

    • Children

    • Parents

    • Family members

    • Health team members

• Interference with Adult Liberty:

  • Questionable to interfere with the liberty of adults for their own good.

  • Adults typically have sufficient maturity and competence to make their own decisions based on their values.

  • Laws restricting adult freedom (e.g., seatbelt or helmet laws) can be viewed as problematic, despite their benefits in preventing injury.

• Cognitive Impairment and Paternalism:

  • Adults may sometimes lack the ability to understand relevant information, and paternalistic intervention may be justified.

  • If adults lack the capacity to make decisions, it's generally accepted that others can decide on their behalf.

• Challenges in Capacity Determination:

  • Determining the capacity of anyone—adult, adolescent, or child—to make specific choices can be challenging.

5. BENEFICENCE: CARING FOR INDIVIDUALS IN CONTEXT

• Principal Focus: Traditionally, the focal point of beneficence in health care has been the individual patient.

• Neglect of Broader Links: This focus often leads to neglecting the myriad ways that individual health is linked to:

  • Other people

  • The community

  • The environment

• Scope of Beneficence: There is no reason to restrict beneficence to individuals; it should be extended more broadly.

• Codes of Ethics: Various health professions express a broader commitment to do good, exemplified in the CNA Code of Ethics (2017, pp. 18-19), which includes:

  • Ethical Endeavours related to Broad Societal Issues.

• Nursing Perspective: In nursing, this broader understanding of beneficence is reflected in:

  • A strong health promotion and public health orientation.

  • A holistic concern with health in the context of:

    • Family

    • Community

    • Environment.

• Extending the scope of benefit beyond an individual’s well-being introduces new complexities.

  • Important questions arise regarding how to weigh the benefit owed to one individual against possible benefits and harms to others.

  • This question can occur in various contexts.

  • For instance, nurses may need to balance the patient’s good with the interests of the patient’s family or community.

    • Nurses have obligations to both patients and their families.

    • The primary obligation remains with the patient, but family obligations may also exist.

  • Nurses practicing in the community may refer to concepts like the “nursing of families” or the “family as patient.”

  • Nursing practice should emphasize “person- and family-centered care” as recommended by the Registered Nurses’ Association of Ontario (RNAO, 2015).

  • Managing conflicts among family members, patients, and nurses is essential.

    • Clarity at the beginning of the professional relationship regarding roles is crucial.

    • Identifying the family decision-maker and determining who receives information can help mitigate potential issues.

  • Transparency in care evaluations and ongoing assessments can further reduce the risk of conflicts.

• Considerations of Justice: Increasingly relevant in the health care system.

• Nursing Challenges: How to proceed when the good of an individual patient or group of patients competes with that of others.

• Time Allocation: In a busy hospital unit, excessive time spent with one patient can lead to not enough time for others.

• Distribution of Benefits: Important to consider how benefits should be distributed among patients in such situations.

• Need Ranking: Nurses should rank needs and allocate time accordingly.

• Workload Measurement Tools: These tools can assist nurses in prioritizing patient needs and revealing insufficient staffing levels (Armstrong & Silas, 2019).

• Ethical Decision-Making: Decisions about prioritization are fundamentally ethical.

• Principles and Theories: Relevant principles and theories for carrying out ethical decisions will be discussed in Chapter 6 on justice.

• Beneficence dictates that nurses utilize their knowledge, skill, and judgment not only for individual patient care but also for population health.

• Growing recognition emphasizes that individual health is impacted by broader determinants such as:

  • Inequality

  • Income

  • Employment

  • Culture

  • Environment

• Clinical interventions performed by nurses and health professionals often lack the capacity to influence these broader population health determinants.

• Addressing these determinants requires actions at the levels of law and public policy.

• Nurses, along with nursing associations, have the ability to act and advocate in numerous ways to influence public policy related to health.

6. CONCLUSION

• The good related to the health and well-being of patients is recognized as a primary concern for healthcare providers.

• Those entrusted with the duty to promote health and provide care are expected to prioritize this good.

• Caring for others presents considerable challenges for nurses, emphasizing the complexity of their roles.

• There may be uncertainty about how much giving and caring is required for beneficence by the nurse.

• In some situations, there may be disagreement about which course of action will yield the most beneficial outcomes for patients.

• The commitment to the good of an individual patient may sometimes conflict with the commitment to the good of others.

• This conflict is especially pronounced during a shortage of health care resources, where prioritization is crucial.

• Clear Requirements of Beneficence:

  • Even when the requirements of beneficence are clear to the nurse,

  • Other ethical issues may arise involving additional values.

• Incompatibility of Values:

  • The patient's values and wishes may conflict with the nurse's values.

  • They may also contradict the plan of care that the nurse believes is beneficial.

• Weighing Concerns:

  • The nurse must carefully balance concern for the patient’s health with respect for the patient’s autonomy.

  • Autonomy signifies the patient's right to choose their treatment path.

• Risks of Paternalism:

  • The nurse's positive desire to help can lead to paternalism if it goes unchecked.

  • Paternalism involves making decisions for the patient under the belief it is in their best interest.

• Ethical Justification:

  • While ethics does not outright forbid paternalism, it necessitates justification.

  • Nurses must be ready to explain decisions that prioritize beneficial actions over the patient's autonomy.

• Doing good and benefiting others extends beyond mere good intentions.

• The concept of beneficence may appear simple at first glance.

• Upon deeper scrutiny, this simplicity reveals its deceptive nature.

• Each case presented highlights distinct features of beneficence.

• These cases also emphasize various issues that impact ethical nursing practice.