Trends and Issues 7

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.
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
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
 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
 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
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
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
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.
Codes for Nurses (code of ethics)
The Patient’s Rights
Social and Cultural Factors
Science and Technology
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
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
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
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
 The
nurse safeguards the client's right to privacy by
judiciously protecting information of a confidential
 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
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
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
 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
 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 !!!!!!!
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