1. Michael D. Czechowskyj Ferris State University ETHICS IN HEALTH CARE

2. Objectives Discuss different ethical definitions Why do we need ethical education Discuss the main ethical principles Go over the decision tree to support the staff Go over the ethics SBAR form

3. Lets talk about ethics What are ethics? What is the code for ethics for nursing and how is it different? Why are we talking about ethics?

4. Ethics Education What the literature says about current state of ethics and what can be done about it. Why are we here?

5. 6 Ethical Principles Autonomy Beneficence Nonmaleficence Fidelity Justice Paternalism

6. Autonomy Agreement to respect another's right to self- determine a course of action; support of independent decision making. Ms. A. – 34 years old with Hodgkin’s lymphome – She is refusing chemotherapy Mr. J. – 50 year old in failing health following an accident – Wants to be removed from the ventilator knowing it will end his life

7. Beneficence Compassion; taking positive action to help or benefit others; desire to do good; core principle of our patient advocacy. Mrs. B. – Patient declining and needing an intervention – PA doesn’t address the situation – Going up the chain of command to get what the patient needs

8. Nonmaleficence Avoidance of harm or hurt; core of medical oath and nursing ethics. The tricky part about this principle relates to doing no harm unless the benefit is greater than the harm being done. Ms. Q. – 63 year-old stage 4 non-small cell lung cancer – No more treatment options – Care team feels CPR would be harmful for the patient but son refuses to make her a DNR.

9. Fidelity This principle requires loyalty, fairness, truthfulness, advocacy, and dedication to our patients. It involves an agreement to keep our promises. Mr. J. – Wife has stage 4 brain cancer – Husband doesn’t want the physician to tell his wife her prognosis Facebook situation

10. Justice This principle refers to an equal and fair distribution of resources, based on analysis of benefits and burdens of decision. Home care resources – Multiple patients – The company is dictating what supplies you use and how much time you spend based on reimbursement

11. Paternalism The attitude that the physician or caregiver knows better than the patient what is in the patient’s own best interest, typically expressed in the caregiver withholding information from patients or aggressively directing patient care without giving the patient herself the opportunity to consider her values and what treatment options they do or do not support. This principle is heavily laden as an application of power over the patient. Mr. Q. – Jehovah’s witness with large blood loss – Family insist on no blood products even if it results in death

12. Decision Tree To help with the decision making process please use the decision tree as a guide. Also use the SBAR form so the team will have all the information needed when discussing the ethical concern.

13. Ethical Decision Tree An ethical concern is identified by staff Discuss with upline Is this something the Upline can solve? YesNo Continue discussion with upline and develop a plan with all stakeholders Is this a concern that needs to be addressed today Fill out Ethics SBAR form and consult the Medical Director and Administrator NoYes Fill out Ethics SBAR form and consult the Medical Director and Administrator Call the system clinical ethicist hotline# 616-391-1131 At any time during this process you can make a phone call using the ethics hotline# if you feel you are not getting what you need for your patient.

14. Ethics SBAR Form Patients Name:Attending Physician: DOB:Can patient make own decisions: Yes No Unknown Diagnosis:DPOA: Care managers name:Advanced Directives: Yes No Unknown Nurses name:Social Worker: Situation: What is the current ethical problem identified Any pending medical decisions: Psychosocial support/challenges: Background: What is the patients medical historyCode Status: Assessment: What is the patients current condition? Recomendatoin: What are your sugestions for this patients care

15. Conclusion The main ethical principles are? What tool can you use to help guide you to an ethical consult? What form can you use when getting an ethics consult? Thank you for your time. Any Questions?

16. References American Nurses Association. (2015). Code of Ethics for Nursing. Silver Spring, MD: Nursebooks.org. Dierckx de Casterle, B., Izumi, S., Godfrey, N. S., & Denhaerynck, K. (2008). Nurses’ responses to ethical dilemmas in nursing practice: meta-analysis. Journal of Advanced Nursing 63(6), 540-549. dio: 10.1111/j.1365-2648.2008.04702.x. Leuter, C., Petrucci, C., Mattei, A., Tabassi, G., & Lancia, L. (2012). Ethical difficulties in nursing, education needs and attitudes about using ethical resources. Nursing Ethics, 20(3), 348-358. Merriam- Websters. (2014). Ethics. Retrieved from http://www.merriam-webster.com/dictionary/ethicshttp://www.merriam-webster.com/dictionary/ethics Tschudin, V. (2013). Two decades on nursing ethics: Some thoughts on the changes. Nursing Ethics, 20(2), 125- 127. dio: 10.1177/0969733012473013. Vynckier, T., Gastmans, C., Cannaerts, N., & Dierckx de Casterle, B. (2014). Effectiveness of ethics education as perceived by nursing students: Development and testing of a novel assessment instrument. Nursing Ethics. dio: 10.1177/0969733014538888.