Basic Nursing: Foundations of Skills & Concepts Chapter 7 ETHICAL RESPONSIBILITIES

Ethics The branch of philosophy concerned with the distinction of right from wrong on the basis of a body of knowledge rather than on just opinions. Ethics looks at human behavior - things people do under different types of circumstances.

Bioethics The application of ethical principles of health care.

Why is Ethics an Increasing Issue for Health Care? an increasingly technological society with complicated issues that never had to be considered before. the changing fabric of society, particularly in terms of family structure. health-care has become a consumer-driven system based on clients becoming more knowledgeable.

Ethical Principles Codes that direct or govern actions.

Basic Ethical Principles Autonomy - The respect for individual liberty Justice - The equitable distribution of potential benefits and risks Fidelity - The duty to do what one has promised Nonmaleficence - The obligation to do or cause no harm to another Beneficence - The duty to do good to others Veracity - The obligation to tell the truth

Ethical Theories Teleology - the value of a situation is determined by its consequences. Deontology - the intrinsic significance of an act itself as the criterion for the determination of good. Situational Theory - holds that there are no set rules or norms. Each situation must be considered individually. Caring-Based Theory - focuses on emotions, feelings, and attitudes.

Values Values are different from principles, in that they influence the development of beliefs and attitudes, rather than behaviors. They may, however, indirectly influence behaviors.

Value System An individual’s collection of inner beliefs that guides the way the person acts and helps determine the choices made in life.

Value Clarification The process of analyzing one’s own values to better understand those things that are truly important in life.

Value Clarification The process of analyzing one’s own values to better understand those things that are truly important in life.

Self-Reflection Because ethics and values are so closely associated, nurses must explore their own values in order to acknowledge the value systems of their clients.

Ethical Codes Codes are used to help nurses act ethically. These have been developed by nursing organizations such as the NFLPN, the ICN and the ANA.

The Patient’s Bill of Rights A document designed to guarantee ethical care of clients in terms of their decision making about treatment choices and other aspects of their care.

Ethical Dilemma A conflict between two or more ethical principles. In an ethical dilemma, there is no “correct” decision.

Major Types of Ethical Dilemma Euthanasia. Refusal of Treatment. Scarcity of Resources.

Euthanasia Intentional action or lack of action that causes the merciful death of someone suffering from a terminal illness or incurable condition.

Refusal of Treatment Based on the principle of autonomy. A client’s rights to refuse treatment and to die often challenge the values of most health care providers.

Scarcity of Resources The allocation of scarce resources (e.g. organs, specialists) is emerging as a major medical dilemma.

Ethical Decision Making

Ethics Committees Many health care agencies now recognize the need for a systematic manner whereby to discuss ethical concerns. Multidisciplinary committees offer dialogue regarding ethical dilemmas. Ethics committees can lead to the establishment of policies and procedures for the prevention and resolution of dilemmas.

Nurse as Client Advocate When acting as client advocate, the nurse’s first step is to develop a meaningful relationship with the client. The nurse is then able to make decisions with the client based on the strength of the relationship.

Nurse as Whistleblower Whistleblowing refers to calling attention to unethical, illegal, or incompetent actions of others. Whistleblowing is based on the ethical principles of veracity and nonmaleficence. Federal and state laws (to varying degrees) provide protection, such as privacy, to whistleblowers.

Questions for Whistleblowers Whose problem is this? Must I do anything about it? Is it my fault? Who am I to judge? Do I have the facts straight?