1. Ethical Issues

2. Objectives By the end of the lecture students should be able to:
Define common ethical terminologies
Analyze personal values that influence the approach to ethical issues
Discuss moral implications of N/M and ICN codes of ethics
Discuss the role of the nurse in ethical health care issue

3. Ethics
Principles of right and wrong behaviours, beliefs and values(Thompson et al (2007)
Ethics is essentially concerned with our life as members of a community and how we behave and function in society
Discipline that deals with the rightness or wrongness of actions
Ethics is the study of conduct and character
Law and ethics overlap in so many areas

4. Definition of Terms
Values- Ideals or concepts that give meaning to an individual’s life. Mostly derived from social norms, religion and family orientation
Ideas and beliefs that you hold in highest regard

5. Activity List ten values that guide your daily interactions
Discuss with your partner each of the values you listed and how they guide your interactions
Compare your list of values with your partner and discuss similarities and differences
Prioritize your list and discuss why you think some are more important than others

6. Definition CONT’D
Advance directives- written statement of a person’s wishes about how he/she would like his health care decisions to be made if he or she loses the ability to make such decisions independently
Bioethics-Ethics concerning life (euthanasia ,abortion)
Durable power of attorney for health care- spoke person

7. Definitions CONT’D
Ethical dilemma-situation involving competing rules or principles that appears to have no satisfactory solution
Choice between two or more equally undesirable alternatives
Morals- fundamental standard of right and wrong that an individual learns and internalizes

8. Definitions CONT’D
Moral and ethical principles- fundamental values and assumptions about the way humans should be treated and cared for
Moral reasoning-A process of considering and selecting approaches to resolve ethical issues
Moral uncertainty-situation that exist when the individual is unsure which moral principles or values apply in a given situation

9. Definitions CONT’D
Code of ethics-written list of a profession’s values and standards of conduct
It provides a frame work for decision making for a profession
Needs to be oriented to the day to day decisions made by members of the profession

10. Moral/Ethical Principles
Autonomy: Patient’s right to self determination without outside control
Implies freedom to make choices and decisions about one’s own care without interference even if the health care team does not agree
Or the decisions may not be in the client’s best interest

11. Principle CONT’D
Justice- The duty to treat all patients fairly, without regard to age, socioeconomic status or other variables
obligation to be fair to all people
Allocation of scarce and expensive health care resources
All patient with the same diagnosis should receive the same level of care

12. Principle CONT’D Fidelity-Duty to be faithful to commitments
Individuals obligation to be faithful to commitments made to self and others
Professional faithfulness and loyalty
Keeping information confidential and maintaining trust and privacy
Agreement to keep one’s promise to the client about care that was offered

13. Principle CONT’D Beneficence-Duty to actively do good to patients
Doing good for patients under your care
Good- holistic
Agreement that the care given is in the best interest of the client
Taking positive actions to help the client

14. Principle CONT’D
Non-maleficence- Duty to prevent or avoid doing harm, whether intentional or unintentional
Health care providers do no harm to their patients either intentionally or unintentionally
Protect from harm those who cannot protect themselves
Avoidance of pain or harm as much as possible when giving treatments

15. Principle CONT’D Veracity- The duty to tell the truth
Requires that health care providers tell the truth and not intentionally deceive or mislead patients

16. Principle CONT’D Paternalism- practices that limit the liberty
of individuals without their consent
Knowing better what is good for the patient
Takes away autonomy

17. Principle CONT’D
Rationalism-basis for how things or conditions appear for decision making
Focuses on logical sequencing

18. Principle CONT’D
Pragmatism-process of clarifying ideas objectively through problem solving

19. Principle CONT’D
Standard of best interest-decision made about individual patient’s health care when they are unable to make informed decisions for their own care
Based on what the family and health care providers agree upon
Respect the individuals expressed wishes either written or unwritten

20. Principle CONT’D
Obligations-demands made on individuals, professions, society or government to fulfill and honor the rights of others
Two Categories
Legal- formal statements of Law and are enforced under the law
Moral- based on moral and or ethical principles but not enforce under the law

21. Principle CONT’D
Rights- defined as just claims or titles or as something that is owed to an individual according to just claims, legal guarantees or moral and ethical principles
Types
Welfare/legal: legal entitlement to some good or benefit
Ethical/moral: moral or ethical principles

22. Rights CONT’D
Option –based on fundamental belief in the dignity and freedom of human beings
Freedom of choice and the right to live as you choose

23. Principle CONT’D
Responsibility- execution of duties associated with the nurse’s particular role.

24. Principle CONT’D
Accountability- being answerable for one’s own actions
Professional accountability serve the following purposes:
Evaluate new professional practices and reassess
existing ones
Maintain standards of health care
Facilitate personal reflection, ethical thought and
personal growth
4. Provide a basis for ethical decision making

25. Moral Reasoning Different approaches to moral reasoning
Factors that affect our moral reasoning :
Emotions
Legal considerations
Personal held religious or spiritual convictions

26. Ethical Decision Making
Three models that are commonly applied are:
Deantological -moral
Teleological- utilitarianism
Situational

27. Deantological - Moral
System of ethical decision making that is based on moral rules and unchanging principles
Formalistic principles, principle system or duty based ethics
Ethical absoluteness of the principle regardless of the consequences of the decision
Derived fro Judeo-Christian origins
Intrinsic good that are absolutes revealed from God
All person are worthy of respect

28. Teleological- utilitarianism
Ethical system of utility
Outcome focus and place emphasis on results
Based on two underlying principles:
Greatest good for the greater number
End justifies the means

29. Situational
There are no prescribe rules, norms or majority results that must be followed
Situations creates its own set of rules and principles that should be considered in that particular situation

30. Ethical Decision Making Process I
Collect, analyze and interpret data
State the dilemma
Consider the choices of action
Analyze the advantages and disadvantages of each Course of action
Make a decision

31. Ethical Decision Making Process II
Presume good will- wanting to find the good
Identify all important persons
Gather relevant information
Identify important ethical principles
Propose alternative course of action
Take action

32. Read on the Following
Institutional Ethics Committees and their functions
Role of the nurse in such committees

33. Questions
Summary
Thank you