Chapter 19 Ethical Issues

Ethical Issues in Nursing Define terminology commonly used in discussions about ethical issues Analyze personal values that influence approaches to ethical issues and decision making Discuss the moral implications of the ANA and ICN codes of ethics Discuss the role of the nurse in ethical health care issues

Understanding Ethics What are your values? Clarify your values Choosing Prizing Acting on your value choice Your values may change over time

Moral/Ethical Principles What is the best decision? How will I know? Pg. 398 Autonomy Beneficence Nonmaleficence Fidelity Justice Veracity

Moral/Ethical Principles (cont’d) Which principle or rule is most important? Autonomy and nonmaleficence? Consider relative benefits and burdens Abstract ideas about right and wrong are not helpful “enough” at the bedside Nursing ethicists Emphasize an ethic of caring—preserve humanity and dignity and promote well-being

Moral/Ethical Principles (cont’d) So how do I make an ethical decision? Many approaches to decision making Pg. 402-03 table 19-1 Deontological—All life is worthy of respect Teleological—That which causes a good outcome is a good action Situational—Decisions made in one situation cannot be generalized to another situation

Moral/Ethical Principles (cont’d) How do I determine who owns the problem? Determine the facts of the situation Identify the ethical issues of the situation Consider the possible input and assistance of an interdisciplinary ethics committee (IEC) Consider possible courses of action and their related outcomes After a course of action has been taken, evaluate the outcome

Moral/Ethical Principles (cont’d) What other resources are available to help resolve ethical dilemmas? ANA Code of Ethics for Nurses ICN Code for Nurses Your Rights as a Hospital Patient Home Care Bill of Rights for Patients Nuremberg Code

Question Identify three resources available to assist nurses in resolving ethical dilemmas in their practice.

Resources available to the nurse faced with an ethical dilemma The Code of Ethics of the American Nurses Association The Code of Ethics of the International Council of Nursing (ICN) The Patient’s Bill of Rights The Nuremberg Code The relevant hospital’s ethical committee

Controversial Ethical Issues Confronting Nursing Abortion When does life begin? Does the fetus have rights? If so, do the rights of the fetus take precedence over the mother’s right to control her own reproductive functions? When, if ever, is abortion morally justified? Should fetal stem cells be used for research that may help cure chronic debilitating diseases? Should minors have the right to abortion without parental consent or awareness?

Controversial Ethical Issues Confronting Nursing (cont’d) How does the abortion issue affect nursing? What are your values and beliefs, and how can you apply these values to your work and possible political action? Statement 1 of ANA’s Code of Ethics for Nurses outlines your responsibility to care for all clients You do not have to sacrifice your own values and principles, but you cannot abandon your clients

Controversial Ethical Issues Confronting Nursing (cont’d) Euthanasia Commonly referred to as “mercy killing,” “good death,” or “right to die” Classified as active, passive, or voluntary Durable power of attorney for health care, living wills, advance medical directives

Consider Your Response, and Reaction What would be possible resources to resolve this conflict The attending physician for a client with terminal AIDS refuses to order increasing doses of pain medication because of her concern that it may cause a repeat episode of respiratory depression. The client’s pain is unrelieved, and he begs your for medication. “Please help me. I know I am dying.”

Controversial Ethical Issues Confronting Nursing (cont’d) Futile care and physician-assisted suicide Futile care—medical intervention (beyond comfort care) without reasonable hope of benefit to patient Physician-assisted suicide (PAS)—AMA opposes (doctors do no harm)

Controversial Ethical Issues Confronting Nursing (cont’d) What are the ethical issues regarding transplantation? On what basis should someone receive an organ? Should severity of illness serve as the primary criteria, or should other factors be taken into consideration? If so, what other factors? Should economic status be used as a contributing factor in the process? How are donors solicited?

Controversial Ethical Issues Confronting Nursing (cont’d) What is the ethical issue regarding the use of fetal tissue? Proponents argue that it is available tissue that can be put to some beneficial use in clients who do not have any other hope of significant improvement or cure Individual states also have the authority to pass laws to permit human embryonic cell research using state funding

Controversial Ethical Issues Confronting Nursing (cont’d) What about in vitro fertilization? Opponents argue it is an unnatural act and removes the biologic act of procreation Cost of procedure Should it be covered by insurance? “Designer Babies”? Should parents be able to pick the sex of the baby? Limit only heterosexual marriages? To whom does the embryo belong, and what are the embryo’s rights?

Controversial Ethical Issues Confronting Nursing (cont’d) How should the ability to diagnose genetic defects prenatally be used? Tay-Sachs disease Cystic fibrosis Should screening remain voluntary or mandatory to detect fetal disorders? Safeguards need to be applied

Controversial Ethical Issues Confronting Nursing (cont’d) Allocation of scarce resources Do all individuals merit the same care? Is health care a right or a privilege? Possible solutions Rationing for elderly Uninsured children given more equitable share Emphasis on preventive care Health care rationing

Visit the American Nurses Association (ANA) Center for Ethics and Human Rights website (www.nursingworld.org/ethics/). Discuss the implications of the ANA position on ethics and how it relates to professional nursing practice.   ■ Human Genome Project & ELSI (ethical, legal, and social implications): www.nhgri.nih.gov/ ■ President's Council on Bioethics: www.bioethics.gov/ ■ Center for Bioethics and Human Dignity: www.cbhd.org/ ■ National Institutes of Health (NIH): http://bioethics.od.nih.gov/