Chapter 24 Ethical Obligations and Accountability Fundamentals of Nursing: Standards & Practices, 2E

 Copyright 2002 by Delmar, a division of Thomson Learning 24-2 Concept of Ethics  Ethics is the study of the rightness of conduct.  Morality is behavior in accordance with custom or tradition and usually reflects personal or religious beliefs.

 Copyright 2002 by Delmar, a division of Thomson Learning 24-3 Relationship Between Legal and Ethical Concepts  Reasons that contribute to the occasional discrepancies between law and ethics Individual differences exist between ethical opinions. Human behavior and motivation are too complex to be accurately reflected in law.

 Copyright 2002 by Delmar, a division of Thomson Learning 24-4 The legal system judges action rather than intent. Laws change according to social and political influences.

 Copyright 2002 by Delmar, a division of Thomson Learning 24-5 Ethics in Health Care  The application of general ethical principles to health care is referred to as bioethics.  There is an emphasis on ethical issues involving life-or-death situations.  Every day nurses encounter challenges about what should be done.

 Copyright 2002 by Delmar, a division of Thomson Learning 24-6  Factors contributing to the need for ethical health care An increasingly technological society The changing fabric of our society Clients who are more knowledgeable about their health Continually decreasing allocation of federal funds for health care

 Copyright 2002 by Delmar, a division of Thomson Learning 24-7 Ethical Theories  Teleology Principle of utility  Deontology Concept of the categorical imperative

 Copyright 2002 by Delmar, a division of Thomson Learning 24-8 Ethical Principles  Autonomy An individual’s right to choose and the ability to act on that choice  Nonmaleficence The duty to cause no harm to others  Beneficence The duty to promote good and to prevent harm

 Copyright 2002 by Delmar, a division of Thomson Learning 24-9  Justice Based on the concept of fairness  Veracity Truthfulness, neither lying nor deceiving others  Fidelity Faithfulness and keeping promises

 Copyright 2002 by Delmar, a division of Thomson Learning Values and Ethics  Values influence the development of beliefs and attitudes.  Almost nothing in life is value-free.  Nurses need to examine their own value systems in order to determine the best approach to managing the care of clients with different values.

 Copyright 2002 by Delmar, a division of Thomson Learning  Values clarification The process of analyzing one’s own values to better understand what is truly important Three step process of valuing  Choosing  Prizing  Acting

 Copyright 2002 by Delmar, a division of Thomson Learning Ethical Codes  International Council of Nurses Code for Nurses  American Nurses Association Code of Ethics  Canadian Nurses Association Code of Ethics for Nursing

 Copyright 2002 by Delmar, a division of Thomson Learning Clients’ Rights  Clients have certain rights including, but not limited to, the right to Make decisions regarding their care Be actively involved in the treatment process Be treated with dignity and respect

 Copyright 2002 by Delmar, a division of Thomson Learning Ethical Dilemmas  An ethical dilemma occurs when there is a conflict between two or more ethical principles.  Ethical dilemmas are situations of conflict, in that there is no right or wrong option.  The nurse must make a choice between two alternatives that may be equally unsatisfactory.

 Copyright 2002 by Delmar, a division of Thomson Learning  The following dilemmas occur frequently Informed consent Refusal of treatment Use of scarce resources Cost-containment initiatives that negatively affect client well-being Incompetent health care providers

 Copyright 2002 by Delmar, a division of Thomson Learning Ethical Decision Making  Ethical reasoning is the process of thinking through what one ought to do in an orderly, systematic manner to provide justification of actions based on principles.  Ethical reasoning is used in situations in which the right decision is not clear or in which there are conflicts of rights and duties.

 Copyright 2002 by Delmar, a division of Thomson Learning  Ethical decision-making process Gather relevant data in order to identify the problem Determine what type of ethical dilemma exists Establish the rights, responsibilities, duties and decision-making abilities of all the people involved

 Copyright 2002 by Delmar, a division of Thomson Learning Identify several possible alternatives and predict the outcome of each, then select a course of action Evaluate the resolution process

 Copyright 2002 by Delmar, a division of Thomson Learning Ethical Issues  Euthanasia Euthanasia refers to mercy killing (deliberate ending of life as a humane action). Active euthanasia refers to taking deliberate action that will hasten the client’s death.

 Copyright 2002 by Delmar, a division of Thomson Learning Passive euthanasia means cooperating with the client’s dying process. Assisted suicide is a form of active euthanasia in which a health care professional provides a client with the means to end his or her own life.

 Copyright 2002 by Delmar, a division of Thomson Learning  Refusal of Treatment The client’s right to refuse treatment is based on the principle of autonomy. A client’s right to refuse treatment and the right to die challenge the values of most health care providers.

 Copyright 2002 by Delmar, a division of Thomson Learning  Scarce Resources The use of expensive services is being examined closely. Availability of goods is also contributing to a scarcity of resources.

 Copyright 2002 by Delmar, a division of Thomson Learning Ethics of Nursing  Ethics committees  The nurse as client advocate  The nurse as whistleblower