1. Chapter 9
Ethical Issues

2. Concept of Ethics The study of the rightness of conduct.
Deals with one’s responsibilities (duties and obligations).
Ethical persons put their beliefs into action.
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3. Concept of Ethics
The term morals is often mistakenly used when ethics is intended.
Morality is behavior that usually reflects personal or religious beliefs.
Ethics is rooted in the legal system.
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4. Relationship Between Legal and Ethical Concepts
There is a connection between acts that are legal and acts that are ethical.
The legal system judges action rather than intention.
Ethical opinions reflect individual differences.
Laws change according to social and political influences.
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5. Ethics in Health Care
Bioethics is the application of ethical principles to health care.
Ethics affects every area of health care.
Ethics helps provide structure by raising questions that ultimately lead to answers.
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6. Factors Contributing to the Need for Ethics in Health Care
Technological advances
Changing fabric of our society
Increased consumer demand for health care information
Decreasing allocation of federal funds for health care
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7. Examples of Ethical Issues
Newborns surviving at earlier gestational ages with serious health problems
People living longer than ever before
Organ transplants and the use of bionic body parts
Experimental research
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8. Ethical Theories Teleology
The value of a situation is determined by its consequences.
Principle of utility states that an act must result in the greatest good for the greatest number.
“Good” refers to positive benefit.
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9. Ethical Theories Deontology
The intrinsic significance of the act itself is the criterion for determination of good.
Concept of categorical imperative states that actions should be based on a principle that is universal.
The person should never be treated as a means to an end.
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10. Ethical Principles Autonomy
The belief that every competent person has the right to determine his or her own course of action.
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11. Autonomy
Examples of autonomous behavior that can impair recovery or treatment:
Smoking
Refusing to take medication
Refusing to receive a blood transfusion
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12. Ethical Principles Nonmaleficence Duty to cause no harm to others
Physiological, psychological, social, spiritual
Helps guide decisions about treatment approaches
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13. Ethical Principles Beneficence
Duty to promote good and to prevent harm
Providing benefit
Balancing benefits and harm
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14. Beneficence Paternalism is a negative outcome of beneficence.
Paternalism occurs when health care providers decide what is “best” for clients.
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15. Ethical Principles Justice Based on concept of fairness
Equality in treatment and allocation of resources
Material Principle of Justice
Determines when there can be unequal allocation of scare resources
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16. Ethical Principles Veracity
Truthfulness, neither lying nor deceiving others.
Deception can take the form of intentional lying, nondisclosure of information, or partial disclosure.
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17. Ethical Principles Fidelity Faithfulness and keeping promises
Demonstrated by nurses in the role of client advocate
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18. Values and Ethics Values are individual rather than universal.
Individuals often fail to consider the impact of values on decisions.
Nurses often care for clients whose value systems conflict with theirs.
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19. 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
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20. Ethical Codes International Council of Nurses Code for Nurses
American Nurses Association Code of Ethics
Canadian Nurses Association Code of Ethics for Nursing
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21. Clients’ Rights Clients have certain rights to
Make decisions regarding their care.
Be actively involved in the treatment process.
Be treated with dignity and respect.
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22. Clients’ Rights Patient Bill of Rights
Established by the American Hospital Association.
Increases awareness of the need to treat clients in an ethical manner.
Encourages health care providers to protect the rights of clients.
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23. Ethical Dilemmas
Occur when there is a conflict between two or more ethical principles.
The most beneficial decision depends on the circumstances.
Ethical analysis is not an exact science.
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24. Ethical Dilemmas Frequently Occurring Ethical Dilemmas
Informed Consent
Refusal of Treatment
Use of Scarce Resources
Cost-Containment Initiatives that Negatively Affect Client Well-Being
Incompetent Health Care Providers
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25. Ethical Decision Making
Ethical Reasoning
Thinking through what one ought to do in an orderly, systematic manner
Justification of actions based on principles
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26. Ethical Decision Making
Framework for Ethical Decision Making
Which theories are involved?
Which principles are involved?
Who will be affected?
What will be the consequences of the alternatives?
What does the client desire?
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27. Ethical Decision Making
Steps of Ethical Analysis
Gathering of relevant data to identify the problem
Consideration of all the people involved
Selection of a course of action
Evaluation of the resolution process
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28. Ethical Dilemmas Euthanasia Refusal of Treatment Scarce Resources
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29. Euthanasia “Good or gentle death”
Mercy killing (deliberate ending of life as a humane action)
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30. Euthanasia
Active euthanasia is taking deliberate action that will hasten the client’s death.
Assisted suicide is a form of active euthanasia.
Passive euthanasia is the omission of an action that would prolong dying.
Discontinuing the client’s tube feedings is a form of passive euthanasia.
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31. 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 some health care providers.
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32. Scarce Resources
The availability of specialists and organs, is contributing to a scarcity of resources.
The use of expensive services is influenced by social and political forces.
Health care reform is needed to ensure services to all.
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33. Ethics and Nursing
Professional nurses’ actions are both legal and ethical.
Sound nursing practice involves making ethical decisions.
Ethics affects nurses in every health care setting.
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34. Ethics and Nursing Ethics Committees Nurse as Client Advocate
One approach for facilitating dialogue regarding ethical dilemmas
Nurse as Client Advocate
Nurses are accountable for protecting the rights and interests of the client.
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35. Ethical Decision-Making Model
ANALYSIS AND DIAGNOSIS
Problem identification: Statement of the ethical dilemma
ASSESSMENT
Determination of claims and parties
Consideration of priorities of claims;
Generation of alternatives for resolving the dilemma;
Consideration of the consequences of alternatives
PLANNING
Carrying out selected moral actions
IMPLEMENTATION
Assessing the outcome of moral actions;
“Were the actions ethical?”
“What were the consequences?”
EVALUATION
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