Ethical and Bioethical Issues in Nursing and Health Care

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Ethical and Bioethical Issues in Nursing and
Health Care
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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

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Nursing Ethics

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

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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

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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

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Dilemmas for Health Professionals

• Life and death
• Quality of life
• Right to decide
• Informed consent
• Alternative treatment issues

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Dilemmas Created by Technology

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

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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?

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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

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Health Care Decisions

• Patient
• Family
• Nurse
• Transdisciplinary team

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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

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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

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Examining Values Systems

• Nurses must examine their own values
• Nurses must commit to a virtuous values system

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World View

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

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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

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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

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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

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Essential Values for the Professional Nurse

• Altruism
• Equality
• Esthetics
• Freedom
• Human dignity
• Justice
• Truth

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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

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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

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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

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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

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Nonmaleficence

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

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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

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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

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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?

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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?

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Identify and Analyze Available Alternativescontd

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

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Select One Alternative

• Integration of multiple factors
• Blend ethical theory, principles, and values

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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

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Bioethical Dilemmas

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

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Ethical Challenges

• Veracity
• Paternalism
• Autonomy
• Accountability