Ethical Issues
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
Ethics
 Principles of right and wrong behaviours, beliefs and
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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
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
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
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
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
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
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
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
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
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
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
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
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
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
Principle CONT’D
 Rationalism-basis for how things or conditions
appear for decision making
 Focuses on logical sequencing
Principle CONT’D
 Pragmatism-process of clarifying ideas objectively
through problem solving
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
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
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
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
Principle CONT’D
 Responsibility- execution of duties associated with
the nurse’s particular role.
Principle CONT’D
 Accountability- being answerable for one’s own actions
Professional accountability serve the following purposes:
1.
Evaluate new professional practices and reassess
existing ones
2.
Maintain standards of health care
3.
Facilitate personal reflection, ethical thought and
personal growth
4. Provide a basis for ethical decision making
Moral Reasoning
 Different approaches to moral reasoning
Factors that affect our moral reasoning :
 Emotions
 Legal considerations
 Personal held religious or spiritual convictions
Ethical Decision Making
Three models that are commonly applied are:
 Deantological -moral
 Teleological- utilitarianism
 Situational
Deantological - Moral
 System of ethical decision making that is based on
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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
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
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
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
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
Read on the Following
 Institutional Ethics Committees and their functions
 Role of the nurse in such committees
 Questions
 Summary
 Thank you