Reading Notes, Chapter 4, Chinn and Kramer Ethical Knowledge Dev’t BNURS 501, Prof. Andrea Kovalesky Note: All language is from text; Later in the MN program (year 2 or 3) BNURS 508, Ethics, Aesthetics, will provide a solid review of ethics. So if you have not had an ethics course before, just focus on this chapter as an introduction/FYI; If you have had such a course before, you will find that this chapter provides both review and new information.

Introduction (pp 87-89) Read Isabel Stewart quote Core questions in ethical knowledge: Is this right? Is this responsible? What the “right” decision is may not be clear when 2 or more morally acceptable choices are present An ethical decision is the best decision one can make given the circumstances

Ethics, Morality, and Nursing (pp. 89-93) Are all nursing actions moral statements? The terms Ethics and Morality are often used interchangeably “Ethics” is usually considered the cognitive part (the epistomological part, how do we know what is right?) Descriptive ethics – describes what people believe or do about ethical issues Prescriptive ethics, aka normative ethics – what we should do Nursing codes and standards give us some guidance

Morality Morality is the ontological part – what we do; how we behave; grounded in our values Moral integrity – when our actions and values are aligned Moral distress –what we feel when our value-based desired actions are blocked by situational factors Legal requirements are one example that can create moral distress Morality is largely determined by situational and background experiences; filtered through family, friends, religion, gender, culture, society, and developmental stage

Overview of ethical perspectives (pp 93-95) Teleology – What is right produces good The greatest good for the greatest number Sometimes known as utilitarianism Deontology – Duty the end does NOT justify the means external rules and codes determine what is right, regardless of the outcome Relativism no ethical viewpoint is privileged over any other; universal generalities about what constitutes moral action cannot be made; one standard of morality is as good as any other 4. Virtue ethics – the character of a person is important

Nursing’s Focus on Ethics and Morality (pp. 95-97) Ethics of caring and ethics of justice have been historically intrinsic to nursing a problem in nursing if only FEMININE (versus FEMINIST) virtues are expected or promoted Feminist ethics are associated with critically understanding related sociopolitical contexts

Dimensions of Ethical Knowledge Development (pp. 97-98) Need to focus on nurses’ every day activities Use a pluralistic approach, as Carper proposed Increase reflective practice in nursing The field of bioethics deflects attention from socio-political organizations of care and away from day to day nursing

Critical Questions (pp. 98-99) Is this right? Is this responsible? Nurse’s moral selves are challenged every day, in big AND small ethical situations

Creative Processes (pp. 99 –102) Values Clarification Deliberatively question and raise awareness of the personal values that undergird action An attempt to emotionally understand, clarify, embrace, and perhaps change individually held values Often hidden and emotionally charged as r/t to our deep personal beliefs Journaling about our values can help us become more aware of them

Creative Processes cont. Exploration of Alternatives More objectively understand and analyze the values inherent in a certain situation and the various actions that flow from those values How do different courses of actions flow from or challenge your values? Possibly begin to see alternative actions

Some general questions for value clarification from 6th ed. (1999, p What outcome would I like to see? What would I do? How do I feel about this? How strongly do I feel? What is guiding my potential actions? My feelings? What would need to change about the context for me to act or feel differently? Are there any alternatives in this situation? How viable are they? How proud do I feel about my choices? Would I affirm them to others? Does there seem to be a hierarchy of choices?

Some general questions for value analysis, also from 6th ed. (1999, p What are the ethical/moral issues? What ethical/moral decisions are being made? What ethical/moral bases are operating to guide those decisions? How strong are the arguments? The counterarguments? Is more evidence needed to justify a decision? What sort? Are there any inconsistencies r/t ethical decisions being made? What evidence do we need to know whether the decisions are moral/ethical? What is the social and political contexts of the decision, and how are those affecting outcomes?

Creative Processes cont. 3. Using an ethical decision tree Flow charts with a series of ordered questions Most useful when time permits such analysis and as a learning tool In the Puget Sound area the Jonsen Model (aka The Four Box Model) is often used medical indications, patient/family preferences, quality of life, and contextual issues

Formal Expressions of Ethical Knowing (p. 103) Ethical knowledge can be: Principles and codes, like the Code of ethics for nurses with interpretive statements published by the ANA Sets of rules Statements of duties, rights, or obligations Theory Laws Nightingale Pledge and Hippocratic Oath

Integrated Expression in Practice (p. 103) Moral/ethical comportment Comportment means how people behave All others patterns of knowing must be included in our moral/ethical behavior

Authentication processes (p. 103-106) One ethical standard of validity, internal logic, is insufficient for nursing Dialogue – the community of those challenged by an ethical problem examine established ethical perspectives, principles and codes They strive to more fully understand alternative points of view This dialogue can occur face to face, online, or through the published literature

Authentication processes cont. 2. Justification Dialogue involving multiple voices over time becomes integrated into justification processes Some ways it can occur Appealing to authority of historical values associated with nursing, like caring Existing moral/ethical knowledge Currently held values Values and moral knowing consistent with an envisioned future See example on Page 105, Box 4-1