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Ethical and Bioethical Issues in Nursing and Health Care

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Ethical and Bioethical Issues in Nursing and Health Care Key Concepts Selected ethical theories and principles Relationship between ethics and morality in relation to ... – PowerPoint PPT presentation

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Title: Ethical and Bioethical Issues in Nursing and Health Care


1
Ethical and Bioethical Issues in Nursing and
Health Care
2
Key Concepts
  • Selected ethical theories and principles
  • Relationship between ethics and morality in
    relation to nursing practice
  • Ethical decision-making model
  • Ethical and bioethical dilemmas

3
Nursing Ethics
  • System of principles concerning the action of the
    nurse in relationships with patients, families,
    other health care providers, policy makers, and
    society

4
Code of Ethics
  • Implicit values and standards for the profession
  • American Nurses Association (ANA)
  • ANA Code of Ethics
  • International Council of Nurses (ICN)
  • ICN Code for Nurses

5
Bioethics
  • Interdisciplinary field within health care that
    has evolved with modern medicine to address
    questions created as science and technology
    produce new ways of knowing
  • Physicians, nurses, social workers,
    psychiatrists, clergy, philosophers, and
    theologians are joining to address ethical
    questions in health care

6
Dilemmas for Health Professionals
  • Life and death
  • Quality of life
  • Right to decide
  • Informed consent
  • Alternative treatment issues

7
Dilemmas Created by Technology
  • Illnesses once leading to mortality are now
    classified as chronic illnesses
  • Cost is a consequence of prolonging life with
    technology

8
Ethical Decision Making
  • Answering difficult questions
  • 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 allows us
    to experiment with the basic origins of life?

9
Balancing Science and Morality
  • Nurses must examine life and its origins, as well
    as its worth, usefulness, and importance
  • What does it mean to be ill or well?
  • What is the proper balance between science and
    technology and the good of humans?
  • Nurses must understand their own values and seek
    to understand the values of others

10
Health Care Decisions
  • Patient
  • Family
  • Nurse
  • Transdisciplinary team

11
Values Formation and Moral Development
  • Value Personal belief about worth that acts as a
    guide to behavior
  • Value system Entire framework on which actions
    are based
  • Values clarification Process by which people
    examine personal values and how the values
    function as part of the whole

12
Values Formation and Moral Developmentcontd
  • Moral development Forming a world view and value
    system in an evolving, continuous, dynamic
    process that moves along a continuum of
    development

13
Examining Values Systems
  • Nurses must examine their own values
  • Nurses must commit to a virtuous values system

14
World View
  • Provides a cohesive model for life
  • Encourages personal responsibility for living
    life
  • Prepares one for making ethical choices

15
Learning Right and Wrong
  • Infants
  • No concept of right or wrong
  • If basic need for trust is met, will develop
    foundation for secure moral thought
  • School-age children
  • Have learned that good behavior is rewarded and
    bad behavior is punished
  • Begin to make choices based on an understanding
    of good and bad

16
Learning Right and Wrongcontd
  • Adolescents
  • Question moral values and relevance to society
  • Become aware of contradictions in adults values
    systems
  • Adults
  • Strive to make sense of contradictions
  • Develop own morals and values
  • Begin to make choices based on internalized set
    of principles

17
Moral Development Theory
  • Kohlbergs theory
  • Most widely accepted
  • Cognitive developmental process sequential in
    nature
  • Rules imposed by authority
  • Conformity to expected social and religious mores
  • Autonomous thinker strives for a moral code
    beyond the issues of authority and reverence

18
Essential Values for the Professional Nurse
  • Altruism
  • Equality
  • Esthetics
  • Freedom
  • Human dignity
  • Justice
  • Truth

19
Ethical Theories
  • Utilitarianism
  • Greatest good for the most people
  • Assumes that an action is right if it leads to
    the greatest balance of good consequences or to
    the fewest possible bad consequences
  • Deontology
  • Decision is right if it conforms to an overriding
    moral duty and wrong if it violates that moral
    duty

20
Purpose of Ethical Principles
  • Establish common ground between nurse, patient,
    family, other health care professionals, and
    society to discuss ethical questions and make
    ethical decisions
  • Permit people to take a consistent position on
    specific or related issues
  • Provide an analytical framework by which moral
    problems can be evaluated

21
Autonomy
  • Principle of respect for the person
  • Unconditional intrinsic value for all
  • People are free to form judgments and actions as
    long as they do not infringe on others
  • Concepts of freedom and informed consent are
    grounded in this principle

22
Beneficence
  • To promote goodness, kindness, and charity
  • To abstain from injuring others and to help
    others further their well-being by removing them
    from harm
  • Common bioethical conflict results from an
    imbalance between the demands of beneficence and
    those of the health care delivery system

23
Nonmaleficence
  • Implies a duty
  • Not to inflict harm
  • To abstain from injuring others
  • To help others further their own well-being by
    removing harm

24
Veracity
  • Principle of truth-telling
  • Consumers expect accurate and precise information
  • For trust to develop between providers and
    patients, there must be truthful communication
  • The challenge is to mesh the need for truthful
    communication with the need to protect

25
Ethical Decision-Making Model
  • Situation assessment procedure
    1. Identify ethical issues and problems 2.
    Identify and analyze available alternatives
    3. Select one alternative 4. Justify the
    selection

26
Identify Ethical Issues and Problems
  • What is the issue?
  • What are the hidden issues?
  • What are the complexities of the situation?
  • Is anything being overlooked?

27
Identify and Analyze Available Alternatives
  • What are the reasonable possibilities for action?
  • How do different parties want to resolve the
    problem?
  • What ethical principles are required for each
    alternative?

28
Identify and Analyze Available Alternativescontd
  • What assumptions are required, and what are their
    implications for future actions?
  • What additional ethical problems do alternatives
    raise?

29
Select One Alternative
  • Integration of multiple factors
  • Blend ethical theory, principles, and values

30
Justify the Selection
  • Specify reasons for action
  • Clearly present ethical basis for these reasons
  • Understand the shortcomings of the justification
  • Anticipate objections to the justification

31
Bioethical Dilemmas
  • Life
  • Reproduction
  • Death
  • Dilemmas in between
  • Injustice and the right to health care
  • Organ transplantation and allocation of scarce
    resources

32
Ethical Challenges
  • Veracity
  • Paternalism
  • Autonomy
  • Accountability
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