Ethical Concerns in Nursing Practice

Learning Objectives: 1. Discuss the concepts of ethics and morality and how they are applied in the healthcare field. 2. Describe ethical decision making 3. Explain the Codes for Nurses, and documents addressing patients’ rights are used as a basis for ethical decision making. 4. Outline a framework for ethical decision making.

Introduction Have you ever overheard a physician discussing with a patient’s family whether to start an elderly comatose patient on a series of antibiotics to treat pneumonia? Or perhaps you have observed a staff nurse leaving the unit after completing the shift with a pocket full of pens, Band-Aids, or tape. These are examples of situations that involve moral and ethical judgments. Judgments as to what is right, what is wrong, and what one ought to do in a given situation.

Terminology Related to Ethics Ethics: Specific area of study of morality that concentrates on human values. Ethics of care: Focuses on those traits valued in intimate personal relationships, such as compassion, love, sympathy, and trust. Moral: Generally accepted as dealing with what is good and what is bad, what is right and what is wrong

Ethical vs. Unethical Decisions Ethical decision – reasonable and acceptable because it aids stakeholders, organization, and society. Unethical decision- decision that a manager would prefer to hide from other people because of individual gain is placed above others needs.

Ethical Perspectives for Evaluating Behavior Societal Organizational Legal Individual

BASIC ETHICAL CONCEPTS

1. Autonomy Autonomy involves the right of self-determination or choice, independence, and freedom. As with most other rights, there may be restrictions on the right to choose, autonomy does not mean that individuals can do anything they want. So what happens when the family decision is not what health providers think is best for the patient?

1. Autonomy Individual rights Privacy Freedom of choice Examples: informed consent. Patient has right to know procedure, complications, other options.

2. Beneficence and Nonmaleficence Beneficence: means “doing good” Nurses should implement actions that benefit clients and their support persons. Such as nursing care. Nonmaleficence: Harm can mean deliberate harm, risk of harm, and unintentional harm. In nursing, intentional harm is always unacceptable. Such as injection. Duty: NOT TO CAUSE harm Duty: PREVENT harm Duty: REMOVE harm

3. Justice Justice and fairness in nursing care is often related to the delivery of services E.g. busy unit, new admission

4.Fidelity Fidelity refers to the obligation to be faithful to the agreements, commitments, and responsibilities that one has made to oneself and others, both implicitly and explicitly. Fidelity is the foundation of the concept of accountability that we hear about so often in nursing today. Implicit – those promises that are implied, not verbally communicated. Like when patient comes into the hospital, they expect to be cared. Explicit – those that we verbally communicate Like if you tell patient you’ll be back with pain meds, you’d better come back.

5. Veracity Refers to telling the truth As a nurse should I tell the truth when it is known that doing so will cause harm? Does tell a lie when it is known that the lie will relieve anxiety and fear? Should I lie to dying people? The obligation to tell the truth and not to lie or deceive others.

6. Paternalism When one individual assumes the right to make decisions for another Limits freedom of choice Examples: Parents making decisions for children Terminal cancer patient

Nursing Codes of Ethics A code of ethics is a formal statement of a group’s ideals and values. It is a set of ethical principles that is shared by members of the group, reflects their moral judgments over time and serves as a standard for their professional actions. International, national, state nursing associations have established codes of ethics

Nursing Codes of Ethics (purposes) To inform the public about the minimum standards of the profession. To provide a sign of the profession’s commitment to the public it serves. To outline the major ethical considerations of the profession To guide the profession in self-regulation To remind nurses of the special responsibility they assume when caring for clients.

Nursing Codes of Ethics (elements) Nurses and people Nurses and practice Nurses and the profession Nurses and the co-workers

American Nurses Association (ANA) Code of Ethics Applies to all nurses in all healthcare settings Ethical principles agreed upon by members of the nursing profession Sets standards of conduct and behaviors for nurses http://www.nursingworld.org/mainmenucategories/ethicsstandards/codeofethicsfornurses

ANA Code of Ethics – Key Points Primary commitment is to patient (individual, family or community) Demonstrates compassion and respect for all patients regardless of patient status Promotes the health and welfare of patients. Accountable for individual practice. Maintains and increases own knowledge base. Works to improve healthcare environment for providers and patients.

ICN Code of Ethics International Council of Nurses Code of Ethics 4 fundamental responsibilities of Nurses Promote health Prevent illness Restore health Alleviate suffering http://www.icn.ch/icncode.pdf

Nursing Code of Ethics: General Nursing Administration, MOH-KSA Code of Ethics: a branch of philosophy dealing with standard of conduct and moral judgments Purpose: To provide basis for interpreting and analyzing clinical situations in decision making. https://www.iau.edu.sa/sites/default/files/resources/5039864724.pdf Nursing Directorate, MOH-KSA,

Patient’s Bill of Rights Affirms the basic human rights of all clients who seek health care services to: Receive considerate and respectful care Obtain complete medical information Receive information necessary for giving informed consent Refuse treatment Request services Refuse participation in research projects Expect reasonable continuity of care Be informed of institutional regulations Have privacy Have personal information and medical records treated confidentially Be provided with information on other institutions and individuals related to care and treatment Examine and obtain explanations of financial charges .library.armstrong.edu

Ethical decision-making refers to the process of evaluating and choosing among alternatives in a manner consistent with ethical principles. In making ethical decisions, it is necessary to perceive and eliminate unethical options and select the best ethical alternative.

How to make an ethical decision 1. Identify the problem 2. Gather additional information 3. Identify all options open to the decision maker. 4. Think the situation through. 5. Make the decision 6. Act and assess the decision and its outcomes .library.armstrong.edu

Factors that influence EDM Codes for Nurses The patient’s rights Social and cultural attitudes Science and technology Legislation Funding Personal religious and philosophic viewpoint

Ethical Dilemmas An ethical dilemma is a decision-making problem between two possible moral imperatives.

How to manage an Ethical Conflict Discuss the client care situation with the following: Another nurse Nursing leadership A representative from the Ethics Committee The patient or the patient’s family The patient’s physician A religious counselor

Ethics Committees With the increasing complexity of ethical issues in health care, ethics committees have been created to assist in making ethical decisions in clinical settings. Ethical committees can: 1. Provide structure and guidelines for potential problems. 2. Serve as an open forum for discussion and debate. 3. Function as a patient advocate by placing the patient at the core of the committee’s deliberations.

Examples Euthanasia Greek words meaning “easy death”. Euthanasia is an act by which the causative agent of death is administered by another with the intent to end life. Assisted Suicide Patient actively seeks physician/nurse to “help” them commit suicide

References Ethics in Community-Oriented Nursing Practice. Chap 6. http://www.library.armstrong.edu/eres/docs/eres/NURS4005- 1_MAHAN/500006dunCh6.pdf International Council of Nurses [ICN] (2012). The ICN Code of Ethics for Nurses. Geneva, Switzerland. Code of Ethics for Healthcare Practitioners https://www.iau.edu.sa/sites/default/files/resources/5039864724.pdf MOH-KSA, General Directorate of Nursing. (2011). Manual of Nursing Policies and Procedures (2nd ed.).