Objectives After completing this lecture, you should be able to: 1. Discuss the concepts of ethics and morality and how they are applied in the healthcare field. 2. Understanding of the basic ethical principles in health care providing facilities 3. Analyze the four ethical theories that may be used to guide ethical decision making 4. Discuss the main factors that influence ethical decision making. Objectives 5. Understanding the code of ethics for nursing , and discuss ANA code of ethics for nursing. 6. Understanding the Jordanian nursing code of ethics. 7. Outline a framework for ethical decision making. 8. Explain the ethical consequences for boundary violations in nursing. Have you ever overheard a physician discussing with a patient’s family whether to start an elderly comatose patient on a series of antibiotics to treat pneumonia? Or have you been present at a discussion in order to stop enteral therapy on a patient who has shown no response to stimuli? These are examples of situations that involve moral and ethical judgments—judgments as to what is right, what is wrong, and what one ought to do in a given situation. When we talk about morals, we are referring to the basic standards for what we consider right and wrong, that typically are based on religious beliefs, social influences (including education),group norms, culture, and life experiences If we are of good moral character, we would not steal from a neighbor or cheat on an examination. This word, derived from the Latin mores, means custom or habit. Ethics is a branch of philosophy offers a formal process for answering the question about what one ought to do in a given situation. Understanding some of the basic ethical principles and guidelines assists us in making logical and appropriate decisions. It helps us identify the motives for action and define relationships between human beings. The word ethics is derived from the Greek term ethos, which means customs, habitual usage, conduct, and character. As we work at sorting out those behaviors that we typically describe as good, right, desirable, fitting, or proper , we are dealing with values. values are important and enduring beliefs or ideals shared by the members of a culture about what is good or desirable and what is not. In general; values, believes, moral and ethics are closely related to each others in meaning and common use. Is it involves choosing between two unfavorable alternatives??? Or Is it requires choosing from among two or more morally accepted courses of action when one choice prevents selecting the other???? Ethical dilemma broadly defined as : any situation in which guiding moral principles cannot determine which course of action is right or wrong. Examples : Who should receive a needed heart transplant—a young 34-year-old male with a wife and two children or a 78-year old gentleman who also has diabetes? ?? Should abortion be an alternative for a 14-year-old impregnated as the result of rape??? Having a good understanding of yourself will be helpful when you are faced with an Ethical dilemma. Ethical dilemmas usually have no perfect solution, and those making decisions may find themselves in direct conflict with another. Remember : when you face Ethical dilemma; you should respect cultural differences . Explain the context of your point of view and try to picture the other person’s perspective of what you are saying. Autonomy/ Freedom. Beneficence/ Non maleficience Justice Veracity Fidelity. Privacy/ Confidentiality. The standard of best interest. Autonomy involves self-determination or choice, independence, and freedom. In healthcare delivery system, it is important to respect patients’ rights to make decisions about and for themselves, even when we do not agree with those decisions It is closely tied to informed consent because it requires that clients be provided clear and sufficient information to make good decisions for themselves. As with most other rights, there may be restrictions on the right to choose—autonomy does not mean that individuals can do anything they want. When one person’s autonomy interferes with another individual’s rights, health, or well-being, limitations may be imposed. For example, a client generally can use his or her right to autonomy by refusing any or all treatments. However, in the case of contagious diseases, for example, tuberculosis, that affect society, the individual can be forced by the healthcare and legal systems to take medications to cure the disease. Beneficence refers to the obligation to do good, not harm, to other people. It also maintains that we ought to prevent evil or harm .Thus, the concept of beneficence extends from promoting good to nonmaleficence ( The prevention of intentional harm), e.g. hand washing before care. In healthcare, we recognize that sometimes we unintentionally do harm to individuals. For example, the discomfort associated with debridement of wounds, adverse drug reactions. Justice: referred to as fairness, fairness mean that people should always be treated the same in terms of access to healthcare. Distributive Justice: all individuals have an equal opportunity to access scarce resources and healthcare organizations and health plans. Comparative Justice: making decisions based on criteria and outcomes. i.e.: How to determine who qualifies for one available kidney. 55 year old male with 3 children versus a 13 old girl. Non Comparative Justice: i.e. a method of distributing needed kidneys using a lottery system. Fidelity refers faithful to the agreements, commitments, and responsibilities that one has made to oneself and others, both implicitly and explicitly. Fidelity is the foundation of the concept of accountability and responsibility. What are the responsibilities of healthcare personnel to individuals, employers, the government, society, and each other? When these responsibilities conflict, which should take priority? Example: Conflict nurses may experience with this concept in a discussion of situations in which duties clash—as in a disaster where there is a clash between obligations to one’s family (particularly if small children or elderly adults are involved) and to a professional obligation to report to work. A Right to Know, it is the principle of truthfulness. It requires the health-care provider to tell the truth and not to deceive or mislead clients intentionally. The primary limitation to this principle is when telling the client the truth would seriously harm (principle of non-maleficence) the client’s ability to recover or would produce greater illness. 1. 2. 3. 4. 5. 6. 7. Codes for Nurses (code of ethics) The Patient’s Rights Social and Cultural Factors Science and Technology Legislation Funding Personal Religious and Philosophic Viewpoints A code of ethics is a written list of a profession’s values and standards of conduct. The code of ethics provides a framework for decision making for the profession and should be oriented toward the daily decisions made by members of the profession. Through their professional organizations, nurses have developed some common guidelines to use in making ethical decisions. They are contained in the ANA’s Code for Nurses, the International Council of Nurses’ Code for Nurses, and others. Each attempts to outline the nurse’s responsibilities to the patient and to the profession of nursing. ANA Code of Ethics 2001 emphasizes the principles of respects for persons, caring for persons without regard for their ability to pay, concepts of dignity and uniqueness of individuals who are recipients of care, also the obligation to protect the safety of individuals as a major plank. 1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. 2. The nurse’s primary commitment is to the patient, whether an individual, family, group, or community. 3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. 4. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care. 5. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal professional growth. 6. The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment, contributing to the provision of quality of health care and consistent with the values of the profession through individual and collective action. 7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development. 8. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs. 9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy. The nurse provides services with respect for human dignity and the uniqueness of the client, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. The nurse acts to safeguard the client and the public when health care and safety are affected by the incompetent, unethical, or illegal practice of any person. The nurse safeguards the client's right to privacy by judiciously protecting information of a confidential nature. The nurse assumes responsibility and accountability for individual nursing judgments and actions. The nurse maintains competence in nursing. The nurse exercises informed judgment, uses individual competence and qualifications as criteria in seeking consultation, accepting responsibilities, and delegating nursing activities to others. The nurse participates in activities that contribute to the ongoing professional knowledge development. The nurse participates in the profession's efforts to implement and improve standards of nursing. The nurse participates in the profession's efforts to establish and maintain conditions of employment conductive to high quality nursing care. The nurse participates in the profession's efforts to protect the public from misinformation and misrepresentation and to maintain the integrity of nursing. The nurse collaborate with members of the health professions and other citizens in promoting community and national efforts to meet the health needs of the public. 1. Identify and Clarify the Ethical Problem 2. Gather Data 3. Identify Options 4. Make a Decision 5. Act and Assess 1. Commitment to the Patient & family 2. Commitment to the Employer 3. Commitment to Your Colleagues 4. Commitment to Personal Excellence 5. Commitment to the Nursing Profession Patient with terminal cancer request to be removed from the ventilator and allowed to die. What two ethical principles apply? Two patients are admitted with the same diagnosis that requires immediate intervention with a medication. The institution has one dose available, the other dose will be delivered in 6 hours. The first patient is 24 years old, otherwise healthy and is going to college. The second patient is 26 years old, and alcoholic. Which patient should get the immediate dose? Which principles apply? There has been an exposure to a biological agent in a small town in rural area. The health department will administer the treatment. There is limited supply of the treatment but more is on its way. The medical professionals know that those who receive immediate treatment will have a better outcome. How do you decide who gets treated first. What principles apply? Last Slide>>> It’s Over THANK YOU !!!!!!!