Chapter 19
Ethical Issues
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Understanding Ethics
What are your values?
– Clarify your values
Choosing
Prizing
Acting on your value choice
– Values may change over time
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Moral/Ethical Principles
What is the best decision? How will I
know?
– Autonomy
– Beneficence
– Nonmaleficence
– Fidelity
– Justice
– Veracity
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Moral/Ethical Principles
Which principle or rule is most
important?
– Autonomy and nonmaleficence?
– Consider relative benefits and burdens
– Abstract ideas about right and wrong
are not helpful “enough” at the bedside
– Nursing ethicists
Emphasize an ethic of caring—preserve
humanity and dignity and promote wellbeing
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Moral/Ethical Principles
So how do I make an ethical
decision? Many approaches to
decision making
– Deontological—All life is worthy of
respect
– Teleological—That which causes a good
outcome is a good action
– Situational—Decisions made in one
situation cannot be generalized to
another situation
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Moral/Ethical Principles
What other resources are available to
help resolve ethical dilemmas?
– ANA Code of Ethics for Nurses
– ICN Code for Nurses
– Your Rights as a Hospital Patient
– Home Care Bill of Rights for patients
– Nuremberg Code
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Controversial Ethical
Issues Confronting Nursing
Abortion
– When does life begin?
– Does the fetus have rights?
– Do the rights of the fetus take
precedence over the right of the mother
to control her reproductive functions?
– When is abortion morally justified?
– Should minors have the right to
abortion without parental consent or
awareness?
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Controversial Ethical
Issues Confronting Nursing
How does the abortion issue affect
nursing?
– What are your values and beliefs, and how can
you apply these values to your work and
possible political action?
– ANA’s Code of Ethics for Nurses Statement One
outlines your responsibility to care for all
patients
– You do not have to sacrifice your own values
and principles, but you cannot abandon your
patients
– Conscience clauses
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Controversial Ethical
Issues Confronting Nursing
Euthanasia
– “Mercy killing,” “good death,” “right to
die”
– Classified as active, passive, or
voluntary
– Durable Power of Attorney for Health
Care, living wills, Advance Medical
Directives
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Controversial Ethical
Issues Confronting Nursing
Futile care and physician-assisted
suicide
– Futility—medical intervention (beyond
comfort care) without reasonable hope
of benefit to patient
– PAS—AMA opposes (doctors do no
harm)
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Controversial Ethical
Issues Confronting Nursing
The use of reproductive technology
– Artificial insemination
– Surrogate motherhood
– Use of fetal tissue
– In vitro fertilization
– Diagnosis of genetic defects prenatally
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Controversial Ethical
Issues Confronting Nursing
Allocation of scarce resources
– Do all individuals merit the same care?
– Is health care a right or a privilege?
Possible solutions
– Rationing for elderly
– Uninsured children given more equitable
share
– Emphasize preventive care
Health care rationing
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