Presented by Group 3
DIGNITY IN DEATH AND
DYING
NURSING ROLES AND
RESPONSIBILITIES
ETHICAL DECISION
MAKING PROCESS
Values and Profession Ethics
MEET THE TEAM
FESTEJO
FORTEZA
GABRIANA
GETUABAN
IBASCO
Dignity in Death
and Dying
Dignity in Death
and Dying
Nursing Roles and
Responsibilities
Nursing Roles and
Responsibilities
Ethical Decision
Making Process
LIMCUANDO
MALAZZAB
MANDI
MANUEL
Dignity in Death
and Dying
Dignity in Death
and Dying
Ethical Decision
Making Process
Ethical Decision
Making Process
LAPID
Nursing Roles and
Responsibilities
Objectives
FIRST GOAL
SECOND GOAL
THIRD GOAL
To discuss the concepts of
what nursing roles should
nursing students embody in
making ethical decisions.
Discuss the topic of dignity
To understand the process of
in death and dying and the
going through an ethical
terms under it.
decision making.
Outline
DIGNITY IN DEATH AND DYING
1. Euthanasia and Prolongation of life
2. Inviolability of Human Life
3. Euthanasia and Suicide
4. Dysthanasia
5. Orthotanasia
6. Administration of Drugs to the Dying
7. Advance Directives
8. DNR or END of Life Care Plan
Outline
NURSING ROLES AND
RESPONSIBILITIES
1. Roles and Responsibilities
2. Extended Roles of Nurses
ETHICAL DECISION MAKING PROCESS
1. Ethical Dilemmas
2. Ethical Decision Making
3. Framework for Understanding Ethical Decision Making
4. Ethical Decision-Making Process
5. Three Ethics Theories
Dignity
in Death
and Dying
Dignity in Death and Dying
Death - refers to the process of dying.
Dignity - refers to someone who lives well.
DYING WITH DIGNITY
The ability to confront death on your own terms.
It's commonly recognized that healthcare providers
should attempt to ensure that terminally ill individuals
in their care die with dignity."
Two arguments:
1. The first point is that life without dignity should be
DEATH WITH DIGNITY
A personal achievement for it is not
something,
such
as
permitted to make the decisions necessary to
provide a dignified death.
care
professionals, can impart.
Indignities are a risk to one's personal dignity. They
are things that prohibit or obstruct someone from
living with dignity.
ended.
2. The second point is that people should be
health
Healthcare
providers
cannot
guarantee
someone dies with dignity, but they can
contribute to a dignified dying.
that
The Inviolability of Life - deliberate killing is immoral and
Inviolability of
Human Life
should not be authorized.
The notion of inviolability is a crucial link between religious
ethics and legal ethics, as each seeks justification for its
principles based on both purity and natural concept, as well as
universality of application.
In religion and ethics, the inviolability or sanctity of life is a
principle of implicit protection about aspects of conscious
existence that are said to be holy, sacred, or otherwise of such
value, are not to be violated.
'Sanctity of life' - the idea that human life is sacred as argued
primarily by the pro-life side in political and moral debates over
such
controversial
topics
as
abortion,
contraception,
euthanasia, embryonic stem-cell research, and the 'right to die'.
Euthanasia and Suicide
What is Euthanasia?
Euthanasia, also known as “mercy killing”, is
considered an act of putting down a patient’s
life to end their suffering in a quick manner. It
is intended to benefit a terminally ill patient by
giving them a peaceful and painless death.
Coming from the Greek word “Eu” meaning
good or easy and “Thanatos” meaning death,
or “Good death or easy death”.
Euthanasia and Suicide
What is Euthanasia?
In technical terms, Euthanasia mostly involves
the administering of a lethal injection.
It is considered illegal in most countries except
Switzerland, Netherlands, Spain, Belgium,
Luxembourg, Canada, Colombia, Australia,
USA (In states of Oregon, Washington,
Vermont, California, Colorado, Washington
DC, Hawaii, New Jersey, Maine, Montana and
New Mexico), France, and New Zealand.
Types of Euthanasia
Voluntary – involves the consent and request of the terminally-ill patient to intake lethal
drugs or a lethal injection for a peaceful and quick death.
Involuntary - performed on a person who would be able to provide informed consent,
but does not, either because they do not want to die, or because they were not asked.
This is called murder, as it’s often against the patients will.
Non-voluntary – is performed when the patient is physically and mentally unable to
consent and is usually done based on the decision of another person close to the patient
such as family, or friends.
Types of Euthanasia
Passive – happens when a terminally-ill patient withholds or withdraws life-sustaining
treatment, surgery, or medication, with the intention of slowly dying. Some would argue
that this is not euthanasia since it does not have the intention of taking a life.
Withdrawal of treatment – involves removal of support machines and medication,
with the intention of letting the patient die. This may or may not involve the consent of
the patient, depending on the case.
Withholding of treatment – involves not carrying out surgeries or resuscitation
measures to prolong the patient’s life for a short time. This may or may not involve the
consent of the patient, depending on the case.
Types of Euthanasia
Active – involves lethal doses of medication or mostly lethal injection, to
hasten the death of the patient, usually with the assistance of a physician.
Direct - when life is ended actively and intentionally as the result of a
specific action.
Indirect – is allowing death to occur without a direct link between the
action, intent, and result.
Euthanasia and Suicide
What is Assisted Suicide?
Assisted suicide, sometimes called physicianassisted suicide (PAS), means a doctor knowingly
helps someone end their life. This usually applies to
terminally-ill patients who are experiencing
unbearable suffering. Their doctor will determine the
most effective, painless method.
In most cases, physicians would prescribe lethal
doses of medicine in order to assist in the quick
death of patient.
Considerations for Euthanasia and Assisted-suicide
Religion
The Hippocratic Oath
Arguments For
Arguments Against
Religion
Many religions are opposed to the act of Euthanasia generally
because of these reasons:
a. Life is sacred and should be respected, therefore taking it
regardless of intention is considered a sin and an act of
disrespect.
b. God doesn’t allow people to kill, and only he can take one’s life.
The Hippocratic Oath
“I will neither give a deadly drug to anybody who asked for it, nor will I
make a suggestion to this effect.”
This oath is taken by all doctors.
This oath argues against euthanasia and physician-assisted suicide as it
emphasizes the responsibility of providing different kinds of medicine to
patients, and the goal of all physicians to save lives and not hurt or harm.
Arguments for Euthanasia and Assisted-suicide
Freedom of choice: Advocates argue that the patient should be able to make their own choice.
Quality of life: Only the patient really knows how they feel, and how the physical and emotional pain
of illness and prolonged death impacts their quality of life.
Dignity: Every individual should be able to die with dignity.
Witnesses: Many who witness the slow death of others believe that assisted death should be
allowed.
Resources: It makes more sense to channel the resources of highly-skilled staff, equipment, hospital
beds, and medications towards life-saving treatments for those who wish to live, rather than those
who do not.
Arguments for Euthanasia and Assisted-suicide
Humane: It is more humane to allow a person with intractable suffering to
be allowed to choose to end that suffering.
Loved ones: It can help to shorten the grief and suffering of loved ones.
We already do it: If a beloved pet has intractable suffering, it is seen as
an act of kindness to put it to sleep. Why should this kindness be denied
to humans?
Arguments against Euthanasia and Assisted-suicide
The doctor’s role: Health care professionals may be unwilling to compromise
their professional roles, especially in the light of the Hippocratic Oath.
Moral and religious arguments: Several faiths see euthanasia as a form of
murder and morally unacceptable. Suicide, too, is “illegal” in some religions.
Morally, there is an argument that euthanasia will weaken society’s respect for the
sanctity of life.
Patient competence: Euthanasia is only voluntary if the patient is mentally
competent, with a lucid understanding of available options and consequences and
the ability to express that understanding and their wish to terminate their own life.
Determining or defining competence is not straightforward.
Arguments against Euthanasia and Assisted-suicide
Guilt: Patients may feel they are a burden on resources and are
psychologically pressured into consenting. They may feel that the financial,
emotional, and mental burden on their family is too great. Even if the costs of
treatment are provided by the state, there is a risk that hospital personnel
may have an economic incentive to encourage euthanasia consent.
Mental illness: A person with depression is more likely to ask for assisted
suicide, and this can complicate the decision.
Slippery slope: There is a risk that physician-assisted suicide will start with
those who are terminally ill and wish to die because of intractable suffering,
but then begin to include other individuals.
Arguments against Euthanasia and Assisted-suicide
Possible recovery: Very occasionally, a patient
recovers, against all the odds. The diagnosis might be
wrong.
Palliative care: good palliative care makes euthanasia
unnecessary.
Regulation: Euthanasia cannot be properly regulated.
Dysthanasia
Known as a slow and painful death without quality of life.
Occurs when a person who is dying has their biological life extended
through technological means without regard to the person's quality of
life.
Coming from the Greek word δυσ, dus meaning "bad” or “difficult" +
θάνατος, Thanatos meaning “death". In other words, a “bad or
difficult death”.
In simple terms, it attempts to extend the life of terminally-ill patients
but only ends up prolonging their suffering and therefore prolonging
the dying process.
Palliative Care and Respect for Patient Rights’ help in preventing
Dysthanasia.
Orthotanasia
It is the same as passive
euthanasia.
A normal or natural
manner of death and
dying.
It is sometimes used to
denote the deliberate
stopping of artificial or
heroic means of
maintaining life.
Administration of Drugs to the Dying
Palliative sedation is an option
of last resort for patients
whose symptoms cannot be
controlled by any other means.
It is not a form of euthanasia,
as the goal of palliative
sedation is to control
symptoms, rather than to
shorten the patient's life.
Advance Directives
An advance directive is “a written expression
of a person’s wishes about medical care,
especially care during a terminal or critical
illness” (Veatch, 2013).
This is used to document his or her wishes
about the aggressiveness of treatment and
values to consider if he or she is unable to
participate in the decision-making process.
Advance Directives in the Philippines
An advance directive is a document with written
instructions made by a person before he/she
reaches the terminal phase of a terminal illness
or a persistent vegetative state and incapable of
malting decisions about medical treatment when
the question of administering the treatment arises.
It includes, but is not limited to, a health care
proxy or a living will. (Senate No. 812, Magna
Carta of Patient’s Rights)
Advance Directives in the United States
In the United States, there are two commonly
recognized legal advance directives: a living
will and a durable power of attorney for
health care. However, other methods for
noting one’s health care preferences exist,
about which nurses should be aware, such as
the Five Wishes.
Advance Directives in the United States
FIVE WISHES:
1. The person you want making care decisions for
you when you can’t
2. The kinds of medical treatment you do or don’t
want
3. How comfortable you want to be
4. How you want to be treated
5. What you want loved ones to know
Critical Issues in Advance Directives
specific treatments to be refused or that are
desired
the time the directive needs to take effect
specific hospitals and physicians to be used
what lawyer, if any, should be consulted
specific other consultations, such as an ethics
team, a chaplain, or a neighbor
Types of Advance Directives
LIVING WILL
a formal legal document that provides written
directions concerning what medical care is to be
provided in specific circumstances (Devettere, 2000)
MEDICAL CARE DIRECTIVE
not a formal legal document but provides specific
written instructions to the physician concerning the
type of care and treatments that individuals want to
receive if they become incapacitated
Types of Advance Directives
DURABLE POWER OF ATTORNEY
a legal written directive in which a designated
person can make either general or specific health care
and medical decisions for a patient
HEALTH CARE PROXY
an individual who acts on behalf of a patient and
either is chosen by the patient, such as a family
member; is court appointed; or has other authority to
make decisions
Types of Health Care Proxy
SUBSTITUTED JUDGMENT STANDARD
used to guide medical decisions that involve formerly
competent patients who no longer have any decision-making
capacity
PURE AUTONOMY STANDARD
based on a decision that was made by an autonomous
patient while competent but later drifts to incompetency
In this particular case, the decision is upheld most of the time
based on the principle of autonomy extended (Veatch, 2003).
Types of Health Care Proxy
BEST INTERESTS STANDARD
an evaluation of what is good for an incompetent
patient in particular health care situations when the
patient has probably never been competent, for
example, an infant or mentally retarded adult
The proxy attempts to decide what is best for the
incompetent patient based on the patient’s dignity
and worth as a human being without taking into
consideration the patient’s concept of what is good or
bad.
7 Principles for Proxy Decision with
Incompetent Patients
1. Competent patients have an autonomy-based right, recognized under the
Constitution and common law, to refuse treatment, including life-sustaining
treatment. Life-sustaining treatment includes artificially provided nutrition and
hydration.
2. Incompetent patients have the same panoply [full array] of rights as com¬ petent
patients, although the manner in which those rights are exercised is different.
3. No right is absolute, but instances in which a patient’s right to refuse life support
is outweighed by societal interests are rare.
4. Withholding and withdrawing treatment from a terminally ill or permanently
unconscious patient allows a natural dying process to take its course. It does not
constitute killing or assisted suicide.
7 Principles for Proxy Decision with
Incompetent Patients
5. In making decisions for incompetent patients, surrogate decision
makers should seek first and foremost to follow a subjective standard
of implementing the patient’s wishes. When this test proves
inadequate, a best interests standard may be applied.
6. In ascertaining an incompetent patient’s wishes, the proxy, family,
and physician should rely on a patient’s advance directive if one has
been issued.
7. A local process of review in the clinical setting should be employed
to facilitate resolution of disagreements. Recourse to the courts
should be rare.
Weaknesses of Advance Directives
very few people ever complete an advance
directive
a proxy may be unavailable for decision
making
health care professionals cannot overturn
advance directives in the event that a decision
needs to be made in the best interest of a
patient
DNR or END of Life Care Plan
PALLIATIVE CARE
consists of comfort care measures that
patients may request instead of aggressive
medical treatments when their condition is
terminal
main goals of palliative care are to prevent
and relieve suffering and to allow for the best
care possible for patients and families
DNR or END of Life Care Plan
PALLIATIVE CARE
In the Code of Ethics for Nurses with
Interpretive Statements, Provision 1.3, the
ANA (2001) has taken the position that nurses
ethically support the provision of
compassionate and dignified end-of-life care
as long as nurses do not have the sole
intention of ending a person’s life.
Types of Palliative Care
DO NOT RESUSCITATE (DNR)
a written physician’s order placed in a patient’s chart, meaning
that hospital personnel are not to carry out any type of CPR or other
resuscitation measures
Unofficial—and unauthorized—’’slow codes” have been practiced
and can be described as “going through the motions” or as giving
half-hearted CPR to a patient whose condition has been deemed
futile. At one time, nurses initiated slow codes when a physician had
not yet written the DNR order of a terminally ill patient. However, a
slow code is an unethical and illegal practice, and physicians and
nurses should never initiate them. Slow codes are not recognized
as a legal procedure.
Types of Palliative Care
THE RIGHT TO DIE AND
THE RIGHT TO REFUSE TREATMENT
a patient’s autonomy over the dying process insofar as wellinformed patients with decision-making capacity have an
autonomous right to refuse and forego recommended
treatments
WITHHOLDING AND WITHDRAWING
LIFE-SUSTAINING TREATMENT
foregoing of life-sustaining treatment that the patient does
not desire because of a perceived disproportionate
burden on the patient or family members or for other reasons
Types of Palliative Care
ALLEVIATION OF PAIN AND SUFFERING
IN THE DYING PATIENT
primary responsibility for nurses and
providers of care, which makes the whole arena
of palliative care an ethical concern
Most of the time, it is the nurse who administers
the pain medication and evaluates a patient’s
condition between and during pain injections.
Types of Palliative Care
RULE OF DOUBLE EFFECT
According to Cavanaugh (2006), the rule of double effect (RDE) is
based on an individual’s reasoning that an act causing good and
evil is permitted when the act meets the following conditions:
The act considered independently of its evil effect is not in itself
wrong.
The agent intends the good and does not intend the evil either
as an end or as a means.
The agent has proportionately grave reasons for acting,
addressing his relevant obligations, comparing the
consequences, and, considering the necessity of the evil,
exercising due care to eliminate or mitigate it.
Nursing
Roles and
Responsibilities
I. Roles and
Responsibilities
NURSING ROLES AND
RESPONSIBILITIES
Caregivers
As
caregivers,
perform
activities
Communicators
nurses
As communicators, nurses
that
communicate with clients,
assist the client physically
support
and psychologically.
health care professionals,
and
persons,
people
community.
in
other
the
As
Teacher
educators,
nurses
educate
clients about their health and health
procedures,
assistive
teach
personnel,
unlicensed
and
share
expertise with other nurses and
health care personnel.
Client advocate
Counselor
Change agent
As counselors, nurses provide emotional,
It is a person with a formal or informal legitimate power
intellectual, and psychological support to
who is in charge of directing and guiding change
help clients recognize and cope with
(Sullivan, 2012). The change agent develops a vision
represent clients’ needs and
stressful psychological or social problems,
and reason for change and serves as a example for
wishes
develop
nurses and other health-care professional workers.
As client advocates, nurses act
to
protect
to
clients.
other
They
health
professionals and assist clients
to exercise rights and speak up
for themselves.
relationships,
growth.
improved
and
interpersonal
promote
personal
As change agents, nurses not only assist clients to
make modifications in behavior but also act to make
changes 8n the healthcare system
Research consumer
As research consumers, nurses are aware of the process of research, are sensitive
to protection of the rights of human subjects, participate in the identification of
researchable problems, and discriminately use research findings to improve clients.
`e.g. cold water on washing patients before but after some research it has
proven wrong or bad for lowering the temperature of sick patient (*tap water is
now used instead.)
involves the field of research to further bring development in the healthcare
field.
for innovation, betterment, and development
All nurses share a commitment to the advancement of nursing science, as research
consumers, nurses should be able to support the research process and assist with
data collection and analysis.
Leader
Manager
Case manager
As leaders, nurses influence others to work
As
for
As case managers, nurses work with
together
individuals, families, and communities. They
multidisciplinary health care teams
to
accomplish
specific
goals
whether working with individual clients, other
health professionals, or community groups
.Nurse
leaders
are
also
important
in
administrative and executive roles. The
clinical and administrative obligations of this
leadership post are mixed.
managers,
delegate
nurses
nursing
manage
activities
to
care
ancillary
personnel and other nurses, supervising and
management plans and to monitor
evaluating their performance.
good
researcher,
critical
to measure effectiveness of case
thinker,
good
practice, professional, reactive to change.
outcomes.
EXTENDED ROLES OF
NURSES
Registered Nurse
A registered nurse's primary responsibility is to guarantee that every patient receives the direct
and appropriate care they require, which they do in a variety of ways.
Registered Nurses are usually responsible for these tasks:
Assessing, observing, and speaking to patients
Recording details and symptoms of patient medical history and current health
Preparing patients for exams and treatment
Administering medications and treatments, then monitoring patients for side effects and
reactions
Creating, implementing, and evaluating patient care plans with the medical team
Performing wound care, such as cleaning and bandaging them
Assisting in medical procedures as needed
Operating and monitoring medical equipment
Drawing blood, urine samples, and other body fluids for lab work
Educating patients and family members on treatment and care plans, as well as answering their
questions
Supervising licensed practical and vocational nurses, nursing assistants, and nursing students
Nurse Practitioner
Clinical Nurse Specialist
Nurse Midwife
a nurse who has completed either as
a nurse who has completed a master’s
a nurse who has completed a
certificate program or a master’s degree in
degree in specialty and has considerable
program in midwifery;
a specialty and is also certified by the
clinical expertise in that specialty.
Provide
appropriate specialty organization.
Provides
Skilled at making nursing assessments,
participates in educating health care
performing
Examination,
professionals and ancillary, acts as a
counseling, teaching and treating minor
clinical consultant and participates in
birthing
and self- limiting illness.
research.
residences.
Physical
expert
care
to
individuals,
gynecological
and
obstetrics services for women.
They may work in hospitals,
clinics
or
private
Nurse Researcher
Nurse Educator
Nurse Anesthetist
A nurse usually with advanced degree,
Nurse researchers are scientists who
A nurse who hold bachelor's degree.
who beaches in clinical or educational
study various aspects of health,
They
settings, teaches theoretical knowledge,
illness and health care. By designing
procedures,
clinical skills and conduct research.
and implementing scientific studies,
anesthetic.
Instructs and teacher aspiring nurse and
they look for ways to improve health,
Provide
health
health care services and health care
operative and post-operative period.
outcomes.
Assist to anesthetist during surgery.
professions
towards their career.
in
their
journey
assist
care
mainly
with
medical
specifically
with
pre-operative,
intra
ETHICAL DECISION
MAKING
ETHICAL DILEMMA
Ethical dilemmas are circumstances in which a difficult choice
must be made between two or more solutions, none of which
resolves the problem in a manner compatible with generally
recognized ethical standards.
In ordinary life, ethical challenges come far too frequently
example:
The corporate world's reliance on digital communication has undoubtedly
produced ethical challenges about information access and privacy. You
may find yourself in a position where you require information from a
coworker's computer while the coworker is away from the office. You are
aware that you are not permitted to use other people's computers, but this
coworker is a friend of yours and has previously revealed her password with
you. When you log in, you notice that a coworker has been keeping credit
card data from customers on the computer, which is against corporate
rules.
Ethical
Decision
Making
Process
Ethical Decision Making
Ethical decision making refers to the process of
weighing and choosing among options while
adhering to ethical principles. It is necessary to
recognize and eliminate unethical options when
making ethical decisions, and then choose the
best ethical option.
Ethical Decision Making
Decision Making
Decision making is the action or process
of thinking through possible options and
selecting one (Bright et. al, 2019). A
rudimentary framework for how managers
engage in the decision making process
contains four steps.
1) Identify the problem
2) Generate alternatives
3) Decide on a course of action
4) Implement
1. Identify the problem
The first challenge in decision making is
working to understand what the problem
is. Ineffective managers focus on the
symptoms
without
identifying
the
underlying issues. A child with a runny
nose does not have a runny nose problem,
she has an infectious disease causing a
running nose. The implication here is
simple; if we treat symptoms, the problem
will re-create the symptoms if given
enough time.
2. Generate alternatives
Problems come in different scopes and
magnitude. In some cases they are routine,
like a manager putting together a shift
schedule for the week. The problem
identification is simply a matter of
understanding that personal preferences and
personal obligations will conflict as he tries
to schedule shifts. This problem does not
require the manager to generate a wide list
of alternatives.
3. Decide on a course of action
Once we have generated a list of
alternatives, we need a way to decide which
of the alternatives should be pursued. Again,
managers can use intuition, analysis, or
democracy to achieve this. However, a
common approach is the employment of a
cost benefit analysis. The cost-benefit
analysis is a process by which managers
evaluate a course of action based on the
anticipated positive and negative effects an
alternative will generate.
4. Implement
Once the alternatives are evaluated and one
(or more) are selected, implementing the
course of action requires the manager to put
resources towards that choice. This could
mean signing a check, empowering an
employee to take on responsibility, or in the
example above, calling an employee into the
office to communicate a decision has been
made
THREE ETHICS THEORIES
Utilitarian Perspective
In this case, the decision maker considers the
possible outcomes of a decision and aims to
maximize the greatest good for as many people as
possible.
Rights Perspective
A decision maker who takes a rights-based
approach would take into account the
rights of people affected by the decision
Justice Perspective
A justice perspective may be oriented around the
equitable distribution of benefits and expenses
associated with plant closures and staff layoffs
(distributive justice), or around the maintenance of
regulations and standards (administrative justice)
(procedural justice).
References: Books
Beauchamp, T. & Childress, J. (2020). Principles of biomedical ethics [8th Ed.].
Washington, DC
Bosek, M. S. & Savage, T. (2007). The ethical component of nursing education:
Integrating ethics into clinical experience. Philadelphia, PA: Lippincott Williams &
Wilkins
Butts, J. & Rich, K. (2008). Nursing ethics : across the curriculum and into practice
[2nd Ed.]. USA: Jones and Bartlett Publishers, LLC
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References: Online
Hegde, S. (2019, January 30). What Is An Ethical Dilemma: Definition, Examples and Explanation. Science ABC;
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D
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Thank You!