What Would You Do?
A Case Study in Ethics
Jeanie Krause-Bachand, Ed. D., RN
York College of Pennsylvania
Ethics and Ethical Dilemmas
• Ethics – involves the principles or assumptions
underpinning the way individuals or groups ought
to conduct themselves.
• Ethical dilemma – a situation where a choice
needs to be made involving options that a person
believes can be accepted and justified as moral or
there is not a more appropriate choice in that
situation.
Ethical Principles
• Autonomy – the right to chose
what will happen to one’s self.
• Beneficence – one’s actions
should promote good.
• Nonmaleficence – one should
do no harm.
• Veracity – persons should tell
the truth.
• Fidelity – maintaining one’s
promises and commitments.
• Paternalism – decisions are made
by someone other then the patient
or DPA.
• Justice – fair and equal treatment.
• Respect for Others – the right of
persons to make decisions and to
live or die based on their decisions.
Ethical Theories
• Utilitarianism
– Utility makes an action right or wrong and useful
actions bring about the greatest good for the
greatest number of people. The usefulness of an
action is determined by the happiness that it
creates.
• Deontology
– The person’s good intentions will determine the
worthiness of the action. Centers on the norms
and rules owed to another person by virtue of the
commitments made and roles assumed.
• Principalism
– Incorporates existing ethical principles to resolve
conflicts. The use of ethical principles as the basis
for professional decision making.
Code of Ethics for Nurses with
Interpretive Statements
• 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.
• The nurse's primary commitment is to the patient, whether an individual,
family, group, or community.
• The nurse promotes, advocates for, and strives to protect the health,
safety, and rights of the patient.
• 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.
• 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 and professional growth.
American Nurses Association
• The nurse participates in establishing, maintaining, and improving
healthcare environments and conditions of employment conducive to the
provision of quality health care and consistent with the values of the
profession through individual and collective action.
• The nurse participates in the advancement of the profession through
contributions to practice, education, administration, and knowledge
development.
• The nurse collaborates with other health professionals and the public in
promoting community, national, and international efforts to meet health
needs.
• 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.
American Nurses Association, Code of Ethics for Nurses with Interpretive Statements, © 2001 By American Nurses Association
MORAL Model
• Orderly, systematic, and objective ethical
decision making process.
Thiroux (1977) & Halloran (1982)
M-Massage the dilemma
• Identify and define the issues.
• Consider the opinions of the patient, family
members, nurses, physicians, clergy, other
health care team members as well as their
values.
O-Outline the options
• Review all options including the less realistic
and opposing ones.
• Identity and list all the pros and cons of the
options.
R-Resolve the dilemma
• Apply ethical principles to each option.
• Select the best option based on the
perspectives of all concerned.
A-Act by applying the chosen option
• Most difficult as it requires actual
implementation of the decision.
• Involves more then just dialogue and
discussion.
L-Look back and evaluate the process
• Ensure that those involved are on board with
the decision and are willing to follow through
on the final option.
• If that is not the case, request a second
decision and begin the process over from the
beginning.
Case Study
Palliative Sedation
• Palliative sedation:
The monitored use of medications (sedatives,
barbiturates, neuroleptics, hypnotics,
benzodiazepines or anesthetic medication) to
relieve refractory and unendurable physical,
spiritual, and/or psychosocial distress for patients
with a terminal diagnosis, by inducing varied
degrees of unconsciousness. The purpose of the
medication(s) is to provide comfort and relieve
suffering and not to hasten death.
Concept of Double Effect
• Concept of Double Effect - when an action
intended to have a good effect can achieve this
effect only at the risk of producing a harmful/bad
effect, then this action is ethically permissible.
Doctrine of Double Effect is applicable if:
 The action is good itself
 The intention is solely to produce the good effect
 The good effect is not achieved through the bad
effect
 There is sufficient reason to permit the bad effect
Principle of Proportionality
• Principle of Proportionality - death with
palliative sedation is foreseen, but the
sedation itself is not causing the death of the
patient.
Proportionality is relevant based on :
• The terminal condition of the patient
• The urgent need to relieve suffering
• The consent of the patient or healthcare proxy
Ethical Principles
Ethical Theory
Code of Ethics
MORAL Model