1. Ethical Principles (Ch 3) Feb 21, 2013 Dr Fatmeh Alzoubi
{وَإِنَّكَ لَعَلى خُلُقٍ عَظِيمٍ}
(4) سورة القلم

2. Ethical principles Purpose
At the end of this lecture the student will be able to :
-Define ethics
-Discuss the principle of autonomy and related issues (informed consent, paternalism ,& noncompliance)
-Discuss the principle of nonmaleficence
-Relate the principle of veracity to nursing
-Discuss the principle of confidentiality ,limitation to confidentiality
-Discuss the principle of justice
-Discuss the principle of fidelity .

3. Ethics in Nursing Ethics
a branch of philosophy dealing with standards of conduct and moral judgment.
Morals
standards of right and wrong

4. Why we study ethics?
*Ethics provide basis for making a logical & consistent decisions in the practice of our profession.
*Study of ethics make you more rational, responsible &effective.
*Unlike other empirical sciences like mathematics, there are no absolute rules governing ethics

5. Ethical principles
- Ethical principles are basic and obvious moral truths that guide deliberation and action
-The cornerstone of any caring profession is respect for person
-It is vital for nurses to understand the dominant ethical principles and be adapt at applying them in meaningful manner
-Adherence to these principles is an important basis for ethical practice in nursing

6. Respect for person
-Nurses have respect for the value and uniqueness of person -Implies one considers others to be worthy of high regard

7. Ethical principles Autonomy (Informed consent ,noncompliance)
Beneficence
Nonmaleficence
Veracity
Confidentiality
Justice
Fidelity

8. Autonomy
-Having the freedom to make choices about issues that affect one’s life, personal goals
-Free to choose and implement our own decision without restriction, lies, restraints, or coercion
-Right of self-determination, independence, and freedom
-No absolute
-Self-governing
-We should understand this concept and be advocates to ensure the maintenance of autonomy for all patients
-We should respect the autonomy of patients, but are given little guidance in understanding the meaning of the concept

9. Basic elements (autonomy)
-Autonomous person is respected: logically nursing profession value and respect the uniqueness of humanity of others
-Autonomous person must be able to determine personal goals
-Autonomous person has the capacity to decide on plan of action (understand the meaning of choices, possible outcomes). E.g., restaurant menu

10. -Incompetent to make decisions or lack of decision making capacity group: children, fetuses, mentally retarded.
-Autonomous person has the freedom to act upon the choices (implementation)
-Limited or absent autonomy e.g.: poor pt who do not have access to health care insurance
-Important in cultures where all individuals are considered unique and valuable members
-It is meaningless in societies: salivary, subservient women, unrespected minorities, exploited children

11. Intrinsic factors that might violate pts’ autonomy:
-Patient’s role (dependent)
-Health care professional’s role (power based on knowledge and authority and is inherent in the role)
-Hospital routine (eat at certain time, medication, bathe).Following the plan—otherwise labeled difficult patient or noncompliant

12. Nurses and other HCP’s usually fail to recognize subtle violations of patient autonomy Why???????

13. Violation of patients autonomy (factors)
-Nurses may falsely assume that patients have the same values and goals as themselves (nurses believe that the only reasonable course of action is the one that is consistent with their value)
(elderly sick pt ask to stay at home-incompetent)
-Our failure to recognize that individuals thought process different background and style of thinking )
-Our assumption about patients knowledge base
The “work” of nursing becomes the major focus-habit

14. Autonomy-other related issues
Informed consent Paternalism Compliance Self-determination

15. Informed consent
A process by which patients are informed of the possible outcomes, alternative and risk of treatment and are required to give their consent freely It assure the legal protection of patient’s right to personal autonomy to specific treatment and procedures

16. Paternalism
Paternalism is a gender biased that literally means acting as fatherly manner, role behavior as leadership Parentalism non-gender term that parallels the meaning of paternalism while avoiding gender bias

17. Paternalism: professionals who restrict others’ autonomy, usually to protect the person from perceived or anticipated harm
Appropriate: incompetent pt’s, diminished decision making capacity

18. Noncompliance
Is generally thought of as denoting an unwillingness of the pt to participate in health care Lack of participation in health-planned regimen that should be carried out by patient (meds, wt. loss, exercising)

19. Important factors when dealing with noncompliant patient:
Autonomous participation of pt in health care plan is essential to success (awareness, consequences of non-treatment) Nurses must assess pt’s ability to follow plans of care (lack of knowledge, lack of family support, resources, psychological factors, cultural beliefs )

20. Self-determination
- Means the freedom of adults to make decisions for themselves in all areas of their lives
-All adults are presumed to have decision-making capacity and are therefore afforded the right to self-determination.
- The concept of autonomy reinforces this right to be free from unwanted interference, which means that there must be legal justification for any violation of autonomy

21. Beneficence -Doing good
-Nurses should act in ways that benefit patients
-Very complex principle ( What is good for you is not
good for others)
-Major component:
1)Do or promote good
2)Prevent harm
3)Remove evil or harm

22. Nonmaleficence -Do no harm either intentionally or unintentionally
-Protect those from harm who cannot protect themselves
- Three different types of harm
1)Deliberate harm
2)Risk of harm
3)Harm that occurs during the performance of beneficial acts (immunization)

23. Veracity
-Truthfulness -not to deceive or mislead clients intentionally -Primary limitation, telling truth when it would seriously harm client -Truthfulness is widely accepted as universal virtue -Truth telling is taught during childhood -Openness and honesty

24. -Nursing literature promotes honesty as a virtue and truth telling as an important function of nurses…….however -Bioethicists disagree on the absolute necessity of truth telling in all instances

25. Veracity….Ask yourself
1)Is telling the truth always beneficent ? 2)How do you feel about giving placebos? 3)If your goal is to be beneficent and if the patient would be beneficent, is deception justifiable if it will help the patient? 4)Is the truth sometimes harmful? 5)Do you think it is acceptable to deceive (mislead) a patient in order to prevent unnecessary suffering?

26. Veracity…consequences of lying
Creates barriers between people and prohibits both meaningful communication and the building of relationships (destroyed)
-Violation the principle of veracity shows lack of respect
-When bad consequences occur after deception
-When bad consequences occur after reporting the truth

27. Medical perspective of veracity
-Patient do not want to know the bad news
-Trustful information has the potential to harm patients
-Patients do not have sufficient information about how their bodies function to interpret medical information
-Hope and positive outlook may promote healing and help prolong life
-There is an absolute duty to avoid lying to patients but there is no duty not to deceive

28. Confidentiality
-Ethical principle that requires nondisclosure of private or secret information with which one is entrusted
- Requirement of nursing codes of ethics
- Maintaining confidentiality of patient is an expression of respect of persons and essential to nurse-patient relationship
-The individual’s right to control personal information- right to privacy

29. -Place to share information with other nurses----breach of confidentiality -Who have legal access to patient records? -Which information should be recorded in the file?

30. Arguments in maintaining confidentiality
-Individual’s right to control personal information
-It is important when revealing sensitive information has the potential to harm the patient; this harm could have different forms.
- Should the principle of confidentiality be honored in all instances????

31. Limits of confidentiality
The argument include theories related to principle of harm and vulnerability

32. When the nurse should not maintain confidentiality?
If maintaining confidentiality will result in preventable wrongful harm to innocent others (e.g. mandatory premarital testing for syphilis)
Foreseeability: The nurse should be able to predict harm or injury to an innocent other in order to violate principle of confidentiality in favor of a duty to warn

33. Justice -Obligation to be fair -Distributive Justice:
The right to be treated equally regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious belief.
-Equal access to health care for all

34. Relates to fair, equitable, and appropriate treatment in light of what is due or owed to persons, recognizing that giving to some will deny receipt to others who might otherwise have received these things

35. -Distribution of goods and services (Disruptive justice)-this is made on a variety of levels.
e.g. immunization (government), concern on who will occupy ICU beds, ER patients (hospitals), time allocation with patients (nurses)

36. Fidelity -Faithful to commitments and practice to keep promises
-Nurses should be faithful to the society that grants the right to practice nursing through licensure and certification
-It means to keep the promise of upholding the profession's code of ethics, to remain competent in practice

37. -The principle of fidelity relates to Loyalty within the nurse-patient relationship
-Though fidelity is the cornerstone of a trusting nurse-patient relationship
-No absolute duty to keep promise (Harmful consequences of the promised action should be weighed against the benefits of keeping promise)

38. Vulnerability Principle
The duty to protect others from harm is stronger when third party is dependent on others in some way especially vulnerable
E.g., nurse have an absolute duty to report child abuse because children are dependent and vulnerable

39. The End