1 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 8 Ethical Issues in Patient Care

2 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Ethics  Science that deals with the principles of right and wrong and of good and bad, and governs our relationships with others  It is based on personal beliefs and values

3 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Bioethics  Ethics specific to health care

4 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Common Ethical Principles and Their Rules

5 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Beneficence  Duty to do good to others.  To maintain a balance between benefits and harm; to provide all patients, including terminally ill, with caring attention; and to treat every patient with respect and courtesy.  Requires that care providers contribute to the health and welfare of the patient and not merely attempt to avoid harm to the patient or client.  An example is carefully adhering to infection control principles for all patients.

6 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Nonmaleficence  Principle of doing no harm  Observe safety rules and precautions and keep skills up to date  Prohibits deliberate harm  Demands weighing risks with the benefits of treatment  Nurses who maintain their skills are practicing the principle of “doing no harm.”

7 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Autonomy  Respect for individual liberty and the person’s right to self-determination.  Informed consent is an example of adherence to the principle of autonomy.

8 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Fidelity  Duty to keep one’s word.  Senior leaders adhering to all contracts is an example of leadership fidelity.

9 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Veracity  Obligation to tell the truth  As a professional, this would be a requirement to admit mistakes promptly or to not lie to a patient about bad news

10 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Respect for Others  Right of people to make their own decisions  Such as not telling a patient what he “should do” but allowing him to make his own decision

11 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Justice  Principle of fairness in which an individual receives what is due, owed, or legitimately claimed  Treat all parties equally, regardless of economic or social background  Requires that individuals be given what they deserve or can legitimately claim  All patients receiving the same level of culturally competent care is an example.

12 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Ethical Dilemma  Ethical decision making is required when there is an ethical dilemma.  Ethical dilemmas occur when there is a conflict between two or more ethical principles.

13 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

14 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. End-Of-Life Issues  Advanced Directive  Living Will  DNR

15 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Organ Donation  A personal choice – can be declared and posted on driver’s license  At the time of death, family members may not be in agreement  There is no cost to the donor family  Many religions have specific views on whether organ donation and transplantation is acceptable

16 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Organ Donation List  Skin  Corneas  Bone  Kidney  Heart  Liver  Pancreas  Lung

17 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Organizational Ethics  Each nursing unit should set an ethical tone and guarantee that all patient rights are respected  Managers must practice ethical leadership  The rights of staff must be protected  There must be a professional work environment  Staff members must be able to work in an environment where they are free to report issues of concern  Hospitals have created departments of corporate compliance to oversee the reporting, documentation, and continued improvement of areas of organizational ethical concern

18 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

19 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

20 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Institutional Review Board (IRB)  A panel that is formally designated to approve, monitor, and review biomedical and behavioral research involving humans in order to protect the rights and welfare of the subjects  Performs oversight for research conducted on human subjects that are scientific and ethical