Chapter 9 Ethical Aspects of Gerontological Nursing

Terms to Know Autonomy: to respect individual freedoms, preferences, and rights Beneficence: to do good for patients Confidentiality: to respect the privacy Ethics: a system of moral principles that guides behaviors Fidelity: to respect our words and duty to patients Justice: to be fair, treat people equally Nonmaleficence: to prevent harm to patients Veracity: truthfulness

Introduction Professional ethics: principles guiding right and wrong conduct Must understand ethics of nursing profession and own personal ethics Many ethical dilemmas facing gerontological nurses today

Philosophies Guiding Ethical Thinking Utilitarianism: good acts benefitting greatest number of people Egoism: morally acceptable benefit for oneself Relativism: right and wrong relative to situation Absolutism: specific truths to guide actions

Question Which statement best describes relativism? Good for the greatest number of people Greatest benefit to oneself Situational ethics Specific truths

Answer C. Situational ethics Rationale: Relativism can be referred to as situational ethics, in that right and wrong are relative to the situation.

Ethics in Nursing Internal ethical standards: ANA code of ethics External ethical standards Federal, state, and local standards: regulations Joint commission: standards Agency specific: philosophy, goals, and objectives Individual nurses: values for ethical thinking

Ethical Principles Beneficence: do good Nonmaleficence: prevent harm Justice: fair, treat equally Fidelity: respect and duty Veracity: truthful Autonomy: respect freedom, preferences, and rights Confidentiality: to respect the privacy

Question Which actions best describes the ethical principle of veracity? Preventing a medication error from occurring Telling a patient bad news in a honest and truthful manner Making a health-related decision for an older adult Treating each patient equally while providing care

Answer B. Telling a patient bad news in a honest and truthful manner Rationale: Veracity is truthfulness. This principle is central to all nurse–patient interactions because the quality of the relationship depends on trust and integrity.

Ethical Dilemmas Facing Gerontological Nurses Most clinical situations not simple, clear-cut ethical decisions Conflicts with nurses’ values External systems affecting decisions Conflicts with rights of patient and nurses’ responsibility

Question Is the following statement true or false? Increasing ethical dilemmas for nurses often occur as there is a wider scope of nursing practice, combined with higher salaries and greater status that has increased the accountability and responsibility of nurses for the care of patients.

Answer True Rationale: The expanded role of nurses has introduced new areas of ethical dilemmas to nursing practice as nurses now perform sophisticated assessments, diagnose nursing problems, monitor and give complicated treatments, and increasingly make independent judgments about patients’ clinical conditions.

Changes Increasing Ethical Dilemmas for Nurses Expanded role of nurses Medical technology New fiscal constraints Conflicts of interest Greater numbers of older adults Assisted suicide

Measures to Help Nurses Make Ethical Decisions Encourage patients’ expression of desires Identify significant others who impact and are impacted Know yourself Read and discuss Form an ethics committee Consult experts Share and evaluate decisions