1. Chapter 10Ethical Issues in Health Care

2. OBJECTIVES
1. Define the word ethical.
2. Describe what is meant by individual, societal, and situational ethics.
3. Explain why a study of ethics and ethical behavior is important in nursing.
4. State the purposes of a code of ethics.
5. Paraphrase the National Federation for Licensed Practical Nurses (NFLPN) and the National Association for Practical Nurse Education and Service (NAPNES) statements regarding ethical behavior of practical/vocational nurses.
6. Explain personal responsibility and accountability as they relate to ethical behavior.
7. Outline the process for making decisions related to ethical dilemmas.
8. Apply guidelines for ethical decision making in your practice of nursing.
9. Participate in discussions regarding ethical issues in the work environment.

3. Ethics Study of right and wrong related to human conduct
Knowledge of right and wrong related to:
Individual-value system developed early in life, involves beliefs about relationships with and responsibilities to other people; change over a lifetime
Society-may be written as laws, define the rights of society; continually refined
Situation-determining right and wrong behaviors depends on the situation; not always a clear right or wrong action

4. Nursing and Ethics Nurses
Have the ability and obligation to help patients
Internalize the concept of what it means to be a human being
Accept personal responsibility for relationships
Are obligated to do good and not harm
Are committed to providing high quality care to all human beings

5. Nursing and Ethics Code of Ethics NFLPN and NAPNES
Purpose is to provide a list of rules of good conduct
Attempt to describe the ideals of a group
Identify standards of behavior

6. Personal Accountability
Being responsible means to accept being the cause of an action
Being accountable means to accept the consequences of the action
Gives a feeling of personal satisfaction
Provides peers with a excellent role model

7. Unethical Behavior Failure to adhere to a code of ethics
Failure to base practice on high ethical standards
Disregard for basic human rights
Examples: referring to the patient by their diagnosis, ignoring patient requests, documenting procedures not completed, ignoring isolation signs, not washing hands properly….

8. Ethical Dilemmas (box 10-1, page 222)
Conflict or opposition between:
Personal values
Moral principles
Laws
Personal and professional obligations
The rights of individuals and society
No right or wrong answer-varies from situation to situation
Legal versus ethical problems-Ex.: the nurse who is stealing drugs is not only breaking the law but also creating an ethical dilemma for the people with whom he or she works.

9. Ethical Dilemmas General Guidelines for Ethical Decision-Making
Collect the facts-Did you directly observe the behavior? Did the situation happen once or frequently?
Ask questions about behavior-What would happen if everyone acted or behaved in the manner in question?
Discuss concerns with an authority-someone with extensive experience and knowledge.
Understand your motivation and choose course of action-Should you do nothing? Should you pursue your concerns?
Prepare to accept consequences

10. Ethical Issues in Nursing
Dilemmas exists when there is the belief that appropriate and safe care cannot be provided
Choosing between the employer's requirements and what the patient needs
Staffing shortages
Excessive paperwork and administrative tasks
Cost containment measures
Managed care
Mandatory overtime

11. Ethical Issues in Nursing
Risks to personal health and safety
Other issues
Right to refuse to assist with a procedure you believe is morally or ethically wrong
Cannot refuse to provide nursing care for a patient

12. Bioethics Implications of biological research and applications
Bioethics Committees
Bring all available information and points of view to a bioethical dilemma
Task is to make a decision about action to be taken
Committee members may include doctors, clergy, community members, judges, lawyers, nurses, patients and their families, administrators, social workers, philosophers, and ethicists
Ex.: a patient is in a persistent vegetative state. The family wants the doctor to “pull the plug” but she refuses. She also refuses to turn the care over to a physician who will do what the family wants. The family may decide to present their concerns to the health care facility’s ethics committee.

13. Bioethics Contemporary Bioethical Dilemmas Reproductive Issues
Birth control
Abortion
Alternative fertilization
Do individuals have the right to control reproduction, and if so what limitations, if any? What methods are best? What age is appropriate? Should these be available to married and unmarried people, and whether parental consent for minors is needed? Should methods and information be available through schools or public-supported clinics?

14. Bioethics Genetic Issues Stem Cell Research
Profile can lead to discrimination
Human genome project-government funded research project that began in 1990, determine the arrangement of the all the human genes, completed ahead of schedule, 20,000-30,000 genes
Genetic screening-done to confirm a suspected diagnosis, to predict the possibility of future illness, to detect the presence of a carrier state in unaffected individuals, and to predict response to therapy
Stem Cell Research
Embryonic stem cells require destruction of an embryo.

15. Bioethics Organ Transplants Cost for surgery
Cost of lifelong drug therapies
Ethics of sacrificing animals
Religious objections
Buying and selling organs

16. Bioethics Death Criteria for legally declaring one dead
Ability to continue biological functions
Euthanasia
Active
Passive

17. Bioethics Advance Directives
Living will-a document that testifies the patient does not want heroic lifesaving measures, not universally recognized as a legal document
Health care proxy-power of attorney that allows a person to make health care decisions for another
Ulysses Pact-a situation in which the decision a person made in the past might not be the best decision for him or her in the future. There may be new treatments available that might repair the damage or injury. Should the terms of the living will be carried out?

18. Question Is the following statement true or false?
A moral dilemma exists when there is no right or wrong answer.

19. Answer
True
Rationale: The fact that there is no right or wrong answer is what makes it a dilemma.

20. Question General guidelines for ethical decision-making include:
A. Adhere to a code of ethics
B. Be accountable
C. Collect the facts
D. Identify standards of behavior

21. Answer C. Collect the facts
Rationale: Guidelines include collecting all the facts. A code of ethics identifies standards of behavior and personal accountability is one of those behaviors.

22. Question Is the following statement true or false?
Disregard for basic human rights is an ethical dilemma.

23. Answer
False
Rationale: Disregard for basic human rights is unethical behavior. There is no question that this is right or wrong. It is wrong behavior.