Ethics in Nursing Practice

Overview of Ethics

• Definition of Ethics: A systematic process for identifying and synthesizing moral issues, acting as moral agents considering values, principles, and codes in personal and professional decision-making.

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Trust in the Nursing Profession

• Public Trust: For 18 consecutive years, nurses rated as the most trusted profession in the U.S. by Gallup.

  • Statistics: 85% of Americans view nurses' honesty and ethics as "very high" or "high".

Basic Definitions

• Morals: Societal rules of right and wrong.

• Ethics: Formal process for logical decision-making based on moral values.

• Values: Beliefs or qualities prized by individuals or society.

Stages of Moral Development (Kohlberg's Theory)

• Level I: Obedience/Punishment (Infancy)

  • Acting to avoid punishment.

• Level II: Self-Interest (Preschool)

  • Focus on rewards; seek the greatest personal benefit.

• Level III: Interpersonal Accord (School-age)

  • Seek approval; maintain friendly relationships.

• Level IV: Authority/Social Order (School-age)

  • Focus on fixed rules for social order.

• Level V: Social Contract (Teens)

  • Morality is based on mutual benefit and reciprocal relationships.

• Level VI: Universal Principles (Adulthood)

  • Morality transcends self-interest based on ethical principles.

Value Systems in Nursing

• Nurses should:

  • Examine personal value systems and commit to virtuous values.

  • Understanding their worldview affects ethical choices.

Ethical Principles in Nursing

• Purpose: Establish common ground for ethical discussions among patients, families, and healthcare professionals.

Key Ethical Principles

Autonomy

• Ideals of freedom

  • Respect the right to make decisions

  • That does not mean that they can do anything they want

• Informed Consent

  • When are patients competent to make informed consent decisions

  • Questions are raised for minors, confused, mentally ill, imprisoned, inebriated, unconscious, and those in an emergency

  • Nurses must take responsibility for understanding and educating people about advanced directives

• Autonomy is an American Value

Paternalism

• Provider tries to act on behalf of the patient and believes that his or her actions are justified because of a commitment to act in the best interest of the patient

• Interferes with a patients right to self-determination

Beneficience

• Obligation to do Good

• Doing or producing good- especially performing acts of kindness or charity

  • A principle stating that nurses work to give patients the best care possible

  • Promoting the well-being of others

• EX. encouraging a person to quit smoking

• Conflicts

  • An imbalance between the demands of beneficence and those of the health care delivery system

Nonmalficence

• Do No Harm

• An intention to avoid harming or injuring others

• protect and defend the rights of others, prevent harm, remove conditions that will cause harm, help persons with disabilities, and rescue persons in danger

Justice

• Obligation to treat all people the same

• Distributive Justice- Sharing the scarce resources in society in a fair and just manner

Equality vs. Equity

• These terms do NOT mean the same thing

• Equality aims to promote fairness and justice

• Equity means providing resources to people that are proportionate to what they need in order to thrive

Veracity

• Duty to tell the truth

• Not intentionally deceiving or misleading challenges

• Issues of alternative treatments and acknowledgment of uncertainty

Fidelity

• Faithfullness and trust

• Faithful to agreements, commitments, and responsibilities to oneself and others

• Accountability

• Challenges- obligations to work vs family

Confidentiality

• Maintain privacy

• Ethical vs Legal

• Is it acceptable to violate?

Ethical Decision-Making

Philosophical Theories

• Utilitarianism: Taking the consequences of our actions into consideration

  • The view that an action is bad or good in relation to the outcome derived from it

• Deontology: Basing our actions on a set of principles or duties

  • Implies a duty (the view that the rightness or wrongness of an act depends on the nature of the act, not its consequences)

Professional Ethics

• The high standard of moral quality

• Applied to professionals

• Provision of standards of practice and codes

• Process:

  • Not linear; involves time and careful consideration.

  • Steps:

  1. Identify ethical issues and problems.

  2. Analyze available alternatives.

  3. Select and justify one alternative.

• M.O.R.A.L Model:

  • M: Massage the dilemma (relate to context).

  • O: Outline the options.

  • R: Resolve and review ethical principles.

  • A: Act based on decisions and policies.

  • L: Look back to evaluate outcomes.

Common Ethical Dilemmas

• Issues like quality of life, informed consent, and alternative treatments are frequent in healthcare settings.

• The impact of technology complicates decisions around prolonging life and associated costs.

End-of-Life Considerations

• Discussion about physician-assisted dying and the ethical frameworks around it.

• Understanding of patient choices in life-ending scenarios, including legislative context.

Resolving Ethical Conflicts

• Distinguishing personal versus professional ethics is crucial.

• Recognizing potential conflicts in healthcare practice, seeking supervision, and using reflective processes to manage inherent personal values.