Unit 10 Ethical and Bioethical Issues in Nursing and Health Care PDF

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Unit 10: Ethical and Bioethical Issues in Nursing and Health Care Textbook------Chapter 9: Ethical and Bioethical Issues in Nursing and Health Care

Key Terms: ● Accountability: An ethical duty stating that one should be answerable legally, morally, ethically, or socially for one’s activities. ● Autonomy: Personal freedom and the right of competent people to make choices. ● Beneficence: An ethical principle of compassion and patient advocacy, stating that one should do good and prevent or avoid doing harm. ● Bioethics: The study of ethical problems resulting from scientific processes. ● Code of ethics: A set of statements encompassing rules that apply to people in professional roles. ● Deontology: An ethical theory stating that moral rule is binding. ● Ethical sensitivity: The capacity to decide with intelligence and compassion, given uncertainty in a care situation, with an additional ability to anticipate consequences and the courage to act. ● Ethics: Science or study of morals. ● Ethics acculturation: The didactic and experimental process of developing ethical reasoning abilities as a part of ongoing professional preparation. ● Fidelity: The agreement to keep promises and commitments, based on the virtue of caring. ● Justice: The equal and fair distribution of resources, regardless of other factors. ● Nonmaleficence: An ethical principle stating the duty to not inflict harm. ● Paternalism: Based on the health care provider’s belief about what is in the best interest of the patient, he or she chooses to reveal or withhold patient information such as diagnosis, treatment, or prognosis. ● Rights of conscience: The civil right that protects conscientious health care providers about discrimination, allowing them the right to act according to the dictates of the most people. ● Utilitarianism: An ethical theory stating that the best decision is one that brings about the greatest good for the most people. ● Values: Customs, ideas of life, and ways of behaving that society regards as desirable. ● Veracity: An ethical duty to tell the truth. PUBLIC VIEW

Unit 10: Ethical and Bioethical Issues in Nursing and Health Care Textbook------Chapter 9: Ethical and Bioethical Issues in Nursing and Health Care

NURSING ETHICS ● Ethics ○ Science or study of moral values ● Nursing Ethics ○ A system of principles concerning the actions of the nurse in his or her relationships with patients, patients’ family members, other health care providers, policymakers, and society A profession is characterized by its relationship to society. ● Code of Ethics ○ Implicit standards and values for the profession ○ International Council of Nurses Code for Nurses ○ American Nurses Association Code of Ethics ● Current dynamics, such as the Patient Protection and Affordable Care Act, the emerging genetic interventions associated with therapeutic and reproductive cloning, debates about securing stem cells for research and treatment, evolving legal definitions of family, ongoing questions about euthanasia and assisted suicide, and escalating threats to the effective delivery of health care as a result of significant nursing shortages, now being called ethical climate in the workplace, bring nursing’s code of ethics into the forefront. International Council of Nurses Code of Ethics for Nurses ● The fundamental responsibility of the nurse is fourfold:

Unit 10: Ethical and Bioethical Issues in Nursing and Health Care Textbook------Chapter 9: Ethical and Bioethical Issues in Nursing and Health Care

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To promote health To prevent illness To restore health To alleviate suffering

Box 9-1: American Nurses Association Code of Ethics for Nurses ● The nurse practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person. ● The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population. ● The nurse promotes, advocates for, and protects the rights, health, and safety, of the patient. ● The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care. ● The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. ● The nurse through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care. ● The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. ● The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. ● The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

Box 9-2: International Council of Nurses Code of Ethics for Nurses ● People ○ Primary responsibility is those needing nursing care ○ Respect patient’s values, customs, spiritual beliefs ○ Confidentiality of personal information ● Practice ○ Maintain competence/continual learning ○ Maintains high standard of care ○ Uses judgment in accepting/delegating care ● Society ○ Initiates/supports action to meet health/social needs of the public

Unit 10: Ethical and Bioethical Issues in Nursing and Health Care Textbook------Chapter 9: Ethical and Bioethical Issues in Nursing and Health Care

● Coworkers ○ Sustains cooperative relationships ○ Safeguards patient when safety is compromised by others ● Profession ○ Determines/implements desirable nursing practice standards & nursing education ○ Develops a core of professional knowledge ○ Active in professional organizations/promotes working conditions of nurses BIOETHICS ● Description ○ Interdisciplinary field within health care that has evolved with modern medicine to address questions that arise as science and technology produce new ways of knowing ○ Think of the questions that come from stem cell research, sexual reassignment, and reproductive-assisting technologies such as donor insemination, in vitro fertilization, removal of unused zygotes, surrogate parenting, organ transplantation, and funding for end-of-life. Bioethics is a response to these and other contemporary advances and challenges in health care. ● Dilemmas for health professionals ○ Physicians, nurses, social workers, psychiatrists, clergy, philosophers, and theologians are joining to address ethical questions in health care ○ Life and death ○ Quality of life ○ Right to decide ○ Informed consent ○ Alternative treatment issues ○ Stem cell research ○ Therapeutic and reproductive cloning ○ In vitro fertilization; donor insemination ○ Surrogate motherhood ○ Organ transplantation ● Dilemmas created by technology ○ Illnesses that once led to mortality are now manageable and are classified as high-risk or chronic illness ○ Cost is a consequence of prolonging life with technology ○ Mortality for most will be a long, drawn-out process phenomenon, laced with a lifetime of potential conflicts about what ought to be done. ○ Manipulation of DNA THE ETHICS OF CARE ● Involves the nurse fulfilling the caring task by seeking the best way to care for each patient, one patient at a time, thus fulfilling a moral imperative to alleviate suffering by

Unit 10: Ethical and Bioethical Issues in Nursing and Health Care Textbook------Chapter 9: Ethical and Bioethical Issues in Nursing and Health Care

taking action ● “The measures nurses take to care for the patient enables the patient to live with as much physical, emotional, social, and spiritual well-being as possible,” and “The nurse respects the worth, dignity, and rights of all human beings irrespective of the nature of the health problem.” ● Today’s nurse will be deemed competent only if he or she can promote well-being through the scientific and technologic aspects of care and has the ability to deal effectively with the ethical problems encountered when respecting the rights of those being cared for. Answering Difficult Questions ● Care that combines human dimensions with scientific and technical dimensions forces some basic questions? ○ What is safe care? ○ What effect might a patient’s cultural preferences have on safe care? ○ When staffing is inadequate, what care should be accepted or refused? ○ What are other barriers to ethical practice brought about by the workplace environment? ○ What does it mean to be ill or well? ○ What is the proper balance between science and technology and the good of humans? ○ Where do we find balance when science will allow us to experiment with the basic origins of life? ○ What happens when the proper balance is in tension? ○ What happens when tension exists between personal beliefs and values and institutional policy or patient desires? ● At one end of the spectrum lies the obvious; at the other there is often only uncertainty. Health care professionals in everyday practice often find themselves somewhere between the two. Balancing Science and Morality ○ Nurses must first attempt to understand not just what they are to do for their patients but who their patients are. ○ Nurses must examine life and its origins, as well as its worth, usefulness, and importance. ○ Nurses must determine their own values. ○ Nurses must seek to understand the values of others. ○ Nurses must be competent in the scientific and technological aspects of care. ○ Nurses must be competent in dealing effectively with ethical problems encountered in patient care. ● Health care decisions ○ Decisions are made with the patient, family, other nurses, and other health care providers. ○ Nurses must develop a reasoned thought process and sound judgment in all

Unit 10: Ethical and Bioethical Issues in Nursing and Health Care Textbook------Chapter 9: Ethical and Bioethical Issues in Nursing and Health Care

situations that take place within the nurse-patient relationship. ○ The nurse promises to deliver holistic care to the best of his or her ability. ○ The patient’s expectations and the nurse’s promises require a commitment to develop a reasoned thought process and sound judgment in all situations that take place within this important relationship. ○ The more personal, subjective, and value-laden situations are deemed to be among the most difficult situations for which the nurse must prepare. VALUES FORMATION AND MORAL DEVELOPMENT ● Definitions ○ Values: Personal belief about worth that acts as a guide to behavior ○ Value system: Entire framework on which actions are based and it is the backbone to how one thinks, feels, and takes action ○ Values clarification: A process by which people attempt to examine the values they hold and how those values function as a part of the whole ○ Moral development: Forming a worldview and value system through an evolving, continuous, dynamic process that moves along a continuum development Examining Value Systems ● Nurses must examine their own value systems; values clarification ● A clear understanding of what is right and wrong is a necessary first step to a process sometimes referred to as values clarification, a process by which people attempt to examine the values they hold and how each of those values functions as part of a whole. ● Nurses must acknowledge their own values by considering how they would act in a particular situation. ● Diane Uustal: First nurse leader to describe the role of values clarification in the decision-making process of the nurse ○ A values clarification process is an important learning tool as nursing students prepare themselves to become competent professionals. ● Ethical acculturation ● Nurses must commit to a virtuous value system ● A refined value system and worldview can serve professionals as they deal with the meaning of life and its many choices. ● A worldview provides a cohesive model for life, it encourages personal responsibility for the living of that life, and it prepares one for making ethical choices encountered throughout life. ● Encourages personal responsibility for living life ● Prepares one for making ethical choices ● Forming a worldview and a value system is an evolving, continuous, dynamic process that moves along a continuum of development often referred to as moral development. ○ Just as there is an orderly sequence of physical and psychological development, there is an orderly sequence of right and wrong conduct development. ○ With each biological developmental milestone there is a more mature, more expanded physical being; likewise with each life experience that has choices

Unit 10: Ethical and Bioethical Issues in Nursing and Health Care Textbook------Chapter 9: Ethical and Bioethical Issues in Nursing and Health Care

between right and wrong, there is a more mature, more virtuous person. Learning Right and Wrong ● Often described in pediatric textbooks ● Donna Wong: ○ Describes learning from right and wrong in the development of children and adults ○ Infancy: ■ Moral development begins ■ No concept of right or wrong ■ No beliefs and no convictions ○ Toddlers: ■ Incorporate values and beliefs of those around them into their own behavioral code ■ Begin to display behavior in response to the world around them ■ Imitate behavior seen in others, even though they do not comprehend the meaning of the behavior they are imitating ○ School-aged: ■ Learn that wrong behavior has consequences and good behavior is associated with rewards and bad behavior with punishment ■ Through their experiences and social interactions with people outside their home or immediate surroundings, begin to make choices about how they will act based on an understanding of good and bad ■ The conscience is developing, and it begins to govern the choices they make ○ Adolescents: ■ Question existing morals and values and his or her relevance to society ■ Understand duty and obligation, but sometimes seriously question the moral codes that society operates on as they become aware of the contradictions ○ Adults: ■ Strive to make sense of the contradictions and learn to develop their own set of morals and values as autonomous people, sometimes referred to as developing a moral compass ■ Begin to make choices based on an internalized set of principles that provides them with the resources they need to evaluate situations in which they find themselves Table 9-1: Essential Nursing Values and Behaviors Essential Values

Attitudes and Personal Qualities

Professional Behaviors

Altruism: concern for the

Caring, commitment,

Gives full attention to the client when

Unit 10: Ethical and Bioethical Issues in Nursing and Health Care Textbook------Chapter 9: Ethical and Bioethical Issues in Nursing and Health Care

welfare of others

compassion, generosity, perseverance

giving care; assists other personnel in providing care when they are unable to do so; expresses concern about social trends and issues that have implications for health care

Autonomy: right to selfdetermination

Respectfulness, trust, objectivity

Provides nursing care based on respect of patients’ rights to make decisions about their health care; honors individual’s right to refuse treatment

Human dignity: respect for inherent worth and uniqueness of individuals and populations

Consideration, empathy, humaneness, kindness, respectfulness

Values and respects all patients and colleagues, regardless of background

Integrity: acting in accordance with an appropriate code of ethics

Moral, ethical, and legal professional behavior

The nurse is honest and provides care based on an ethical framework that is accepted in the profession

Social justice: acting in accordance with fair treatment regardless of economic status, race, ethnicity, age, citizenship, disability, or sexual relation

Courage, integrity, morality, objectivity

Acts as a health care advocate; allocates resources fairly; reports incompetent, unethical, and illegal practices objectively and factually

Unit 10: Ethical and Bioethical Issues in Nursing and Health Care Textbook------Chapter 9: Ethical and Bioethical Issues in Nursing and Health Care

ETHICAL THEORY ● Utilitarianism ○ An approach that supports what is best for most people, rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences ○ The best decision is one that brings about the greatest good for the most people ○ Basis of modern health care ○ Basis of triage system ● Deontology ○ An approach that is rooted in the assumption that humans are rational and act out of principles that are consistent and objective and compel them to do what is right ○ Ex: A decision is made to resuscitate and provide mechanical ventilation to a 23week, otherwise viable fetus, despite ability to pay for care and availability for newborn intensive care beds. ○ Claims that a decision is right only if it conforms to an overriding moral duty and wrong only if it violates that moral duty ■ All decisions must be made in such a way that the decision could become universal law. ○ Persons are to be treated as ends in themselves and never as means to the ends of others. ○ Ex: Lourdes Hospital did not want to tie tubes because it is against Catholic religion.

Unit 10: Ethical and Bioethical Issues in Nursing and Health Care Textbook------Chapter 9: Ethical and Bioethical Issues in Nursing and Health Care

Ethical Principles ● Autonomy ○ Self-governance ○ The principle of respect for a person ○ The primary moral principle ○ Humans have incalculable worth or moral dignity not possessed by other objects or creatures. ○ There is unconditional intrinsic value for everyone. ○ Concepts of freedom and informed consent ○ Ex: the choice of being resuscitated if you stop breathing

● Beneficence ○ Do good ○ Promote goodness, kindness, and charity ○ Provides benefits to others by promoting their good ○ It is not always clearly evident what is good and what is harmful.

● Nonmaleficence ○ Do no harm - implies a duty not to inflict harm

Unit 10: Ethical and Bioethical Issues in Nursing and Health Care Textbook------Chapter 9: Ethical and Bioethical Issues in Nursing and Health Care

○ To abstain from injuring others ○ To help others further their own well-being by removing harm and eliminating threats

The beneficence-nonmaleficence principle is largely a balance of risk and benefit. ● Veracity ○ Truth telling ○ Trust factor ○ Health care consumers today expect accurate and precise information that is revealed in an honest and respectful manner. ○ The deontological theory of the health care provider having a duty to tell the patient the truth has taken precedence over the fear of harm that might result if the truth is revealed. ○ The challenge today is to mesh the need for truthful communication with the need to protect. ETHICAL DECISION-MAKING MODEL ● Exist for the purpose of defining a process by which a nurse or another health care provider actually can move through an ethical dilemma toward an informed decision. ● Situation Assessment Procedure 1. Identify the ethical issues and problems i. Steps: ● Attempt to find out the technical and scientific facts and the human dimension of the situation - the feelings, emotions, attitudes, and opinions ● Make an attempt to understand what values are are inherent in the situation ● Must deliberately state nature of the ethical dilemma ○ What is the issue here? ○ What are the hidden issues? ○ What exactly are the complexities...