Ethical and Bioethical Issues
in Nursing and Health Care
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Key Concepts
• Selected ethical theories and principles
• Relationship between ethics and morality in
relation to nursing practice
• Ethical decision-making model
• Ethical and bioethical dilemmas
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Nursing Ethics
• System of principles concerning the action of the
nurse in relationships with patients, families,
other health care providers, policy makers, and
society
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Code of Ethics
• Implicit values and standards for the profession
• American Nurses Association (ANA)
– ANA Code of Ethics
• International Council of Nurses (ICN)
– ICN Code for Nurses
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Bioethics
• Interdisciplinary field within health care that has
evolved with modern medicine to address
questions created as science and technology
produce new ways of knowing
• Physicians, nurses, social workers, psychiatrists,
clergy, philosophers, and theologians are joining
to address ethical questions in health care
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Dilemmas for Health
Professionals
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Life and death
Quality of life
Right to decide
Informed consent
Alternative treatment issues
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Dilemmas Created by
Technology
• Illnesses once leading to mortality are now
classified as chronic illnesses
• Cost is a consequence of prolonging life with
technology
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Ethical Decision Making
• Answering difficult questions
– What does it mean to be ill or well?
– What is the proper balance between science and
technology and the good of humans?
– Where do we find balance when science allows us to
experiment with the basic origins of life?
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Balancing Science and
Morality
• Nurses must examine life and its origins, as well
as its worth, usefulness, and importance
– What does it mean to be ill or well?
– What is the proper balance between science and
technology and the good of humans?
• Nurses must understand their own values and
seek to understand the values of others
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Health Care Decisions
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Patient
Family
Nurse
Transdisciplinary team
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Values Formation and Moral
Development
• Value: Personal belief about worth that acts as a
guide to behavior
• Value system: Entire framework on which
actions are based
• Values clarification: Process by which people
examine personal values and how the values
function as part of the whole
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Values Formation and Moral
Development—cont’d
• Moral development: Forming a world view and
value system in an evolving, continuous,
dynamic process that moves along a continuum
of development
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Examining Values Systems
• Nurses must examine their own values
• Nurses must commit to a virtuous values system
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World View
• Provides a cohesive model for life
• Encourages personal responsibility for living life
• Prepares one for making ethical choices
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Learning Right and Wrong
• Infants
– No concept of right or wrong
– If basic need for trust is met, will develop foundation
for secure moral thought
• School-age children
– Have learned that good behavior is rewarded and
bad behavior is punished
– Begin to make choices based on an understanding
of good and bad
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Learning Right and Wrong—
cont’d
• Adolescents
– Question moral values and relevance to society
– Become aware of contradictions in adults’ values
systems
• Adults
– Strive to make sense of contradictions
– Develop own morals and values
– Begin to make choices based on internalized set of
principles
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Moral Development Theory
• Kohlberg’s theory
– Most widely accepted
– Cognitive developmental process; sequential in
nature
– Rules imposed by authority
– Conformity to expected social and religious mores
– Autonomous thinker strives for a moral code beyond
the issues of authority and reverence
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Essential Values for the
Professional Nurse
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Altruism
Equality
Esthetics
Freedom
Human dignity
Justice
Truth
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Ethical Theories
• Utilitarianism
– Greatest good for the most people
– Assumes that an action is right if it leads to the
greatest balance of good consequences or to the
fewest possible bad consequences
• Deontology
– Decision is right if it conforms to an overriding moral
duty and wrong if it violates that moral duty
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Purpose of Ethical Principles
• Establish common ground between nurse,
patient, family, other health care professionals,
and society to discuss ethical questions and
make ethical decisions
• Permit people to take a consistent position on
specific or related issues
• Provide an analytical framework by which moral
problems can be evaluated
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Autonomy
• Principle of respect for the person
• Unconditional intrinsic value for all
• People are free to form judgments and actions
as long as they do not infringe on others
• Concepts of freedom and informed consent are
grounded in this principle
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Beneficence
• To promote goodness, kindness, and charity
• To abstain from injuring others and to help
others further their well-being by removing them
from harm
• Common bioethical conflict results from an
imbalance between the demands of beneficence
and those of the health care delivery system
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Nonmaleficence
• Implies a duty:
– Not to inflict harm
– To abstain from injuring others
– To help others further their own well-being by
removing harm
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Veracity
• Principle of truth-telling
• Consumers expect accurate and precise
information
• For trust to develop between providers and
patients, there must be truthful communication
• The challenge is to mesh the need for truthful
communication with the need to protect
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Ethical Decision-Making Model
• Situation assessment procedure:
1. Identify ethical issues and problems
2. Identify and analyze available alternatives
3. Select one alternative
4. Justify the selection
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Identify Ethical Issues and
Problems
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What is the issue?
What are the hidden issues?
What are the complexities of the situation?
Is anything being overlooked?
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Identify and Analyze Available
Alternatives
• What are the reasonable possibilities for
action?
• How do different parties want to resolve the
problem?
• What ethical principles are required for each
alternative?
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Identify and Analyze Available
Alternatives—cont’d
• What assumptions are required, and what
are their implications for future actions?
• What additional ethical problems do
alternatives raise?
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Select One Alternative
• Integration of multiple factors
• Blend ethical theory, principles, and values
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Justify the Selection
• Specify reasons for action
• Clearly present ethical basis for these reasons
• Understand the shortcomings of the
justification
• Anticipate objections to the justification
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Bioethical Dilemmas
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Life
Reproduction
Death
Dilemmas in between
– Injustice and the right to health care
– Organ transplantation and allocation of scarce
resources
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Ethical Challenges
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Veracity
Paternalism
Autonomy
Accountability
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