Introduction to Bioethics,Nursing Ethics, and Ethical

Decision Making

Bioethics

• Bioethics is a specific domain of ethics that is focused on moral issues in the field of health care

• “Who lives? Who dies? and Who decides?”

Ethical Principles• Belmont Report

– Respect for persons• includes the rule to do good, and to do no harm

– Beneficence– Justice

Ethical Principles

• Principles of Biomedical Ethics– four bioethical principles—autonomy,

nonmaleficence, beneficence, and justice

Ethical Principles

• Ethical Principlism

– provides guidelines that can be used to make justified moral decisions and to evaluate the morality of actions

– one of the most popular tools used today for analyzing and resolving bioethical problems

Autonomy

• The freedom and ability to act in a self-determined manner

Autonomy– Informed consent is respecting a person’s

autonomy to make personal choices based on the appropriate appraisal of information about the actual and/or potential circumstances of a situation

• Receipt of information• Consent for the treatment must be voluntary• Persons must be competent

Autonomy

– Patient Self Determination Act• The first federal statute designed to facilitate a

patient’s autonomy through the knowledge and use of advance directives

Ethical Principles

• Nonmaleficence is the principle used to communicate the obligation to “do no harm”; the maxim or norm that “one ought not to inflict evil or harm”

– slippery slope argument is a metaphor that is used as a “beware the Ides of March” warning with no justification or formal, logical evidence to back it up; a situation that could hypothetically slip toward a morally unacceptable situation

Ethical Principles

• The principle of beneficence consists of deeds of “mercy, kindness, and charity”; people take actions to benefit and to promote the welfare of other people

– paternalism is the deliberate overriding of a patient’s opportunity to exercise autonomy because of a perceived obligation of beneficence

Ethical Principles

• Justice refers to fairness, treating people equally and without prejudice, and the equitable distribution of benefits and burdens

– Social justice is usually thought of in terms of how benefits and burdens should be distributed fairly among members of a society, or ideally, how all people in a society should have the same rights, benefits, and opportunities

Ethical Dilemmas

• Ethical dilemma is a situation in which an individual is compelled to make a choice between two actions that will affect the well-being of a sentient being, and both actions can be reasonably justified as being good, neither action is readily justifiable as good, or the goodness of the actions is uncertain

Introduction to Nursing Ethics

• Nursing ethics is relationship-based and specifically refers to ethical issues as they directly relate to and affect nurses and their patients (individuals, families, communities, or populations) in nurses’ daily work, whatever that work may be

Relationships

• Moral suffering occurs when nurses experience a disquieting feeling of anguish, uneasiness, or angst

Relationships

• Moral Anguish can be experienced when nurses attempt to sort out their emotions when they find themselves in imperfect situations that are morally unsatisfactory or when forces beyond their control prevent them from positively influencing or changing unsatisfactory moral situations

Relationships

• Nurse-Patient-Family Relationships

– Unavoidable Trust-Patients, in most cases, have no option but to trust nurses and other health care professionals when the patient is at the point of needing care

Relationships

• Nurse-Patient-Family Relationships

– Human Dignity-Patients, in most cases, have no option but to trust nurses and other health care professionals when the patient is at the point of needing care

Relationships

• Nurse-Patient-Family Relationships

– Patient Advocacy-Nurses try to identify unmet patient needs and then follow up to address the needs appropriately

Relationships

• Nurse-Physician Relationships

– Nurses and physicians, as members of the health care community, must work together for the health and well-being of patients, whether those patients are individuals, families, groups, communities, or populations

Relationships

• Nurse-Nurse Relationships

– exist together within communities and use similar moral language.

– they “share a moral narrative and commitments [and] common understandings of the foundations of morality, moral reason, and justification”

Introduction to Critical Thinking and Ethical Decision Making

• In health care and nursing practice, ethical dilemmas and moral matters are so ever-present that nurses often do not even realize that they are making minute-to-minute moral decisions

Introduction to Critical Thinking and Ethical Decision Making

• Critical Thinking– “self-directed, self-disciplined, self-

monitored, and self-corrective thinking [that] requires rigorous standards of excellence and mindful command of their use”

Introduction to Critical Thinking and Ethical Decision Making

• Moral Imagination

– moral decision making through reflection that involves “empathetic projection” and “creatively tapping a situation’s possibilities”

Introduction to Critical Thinking and Ethical Decision Making

• Moral Imagination

– involves moral awareness and decision making that goes beyond the mere application of standardized ethical meanings, decision-making models, and bioethical principles to real life situations

Introduction to Critical Thinking and Ethical Decision Making

• Reflection in Nursing Practice

– reflection in action involves stopping to think about what one is choosing and doing before and during one’s actions

– since ethics is an active process of doing, reflection in any form is crucial to the practice of ethics

Introduction to Critical Thinking and Ethical Decision Making

• The Moral Ground Model: A Virtue-Based Nursing Model– implies that nurses may start at a

groundless, uneducated state of moral functioning

– the nurse can move toward flourishing moral ground by traveling along a path of intellectual and moral virtues

The Moral Ground Model: A Virtue-Based Nursing Model

• Moral Ground Model Virtues– Moral Virtues

• truthfulness, gentleness, compassion, loving kindness, just generosity, courage, sympathetic joy, equanimity

– Intellectual• insight, practical wisdom

Introduction to Critical Thinking and Ethical Decision Making

• Nurse as Part of a Health Care Team– many problematic bioethical decisions will not be

made unilaterally

– an ethics committee usually consists of physicians, nurses, an on-staff chaplain, a social worker, a representative of the organization’s administrative staff, possibly a legal representative and community representatives, and others drafted by the team.

Introduction to Critical Thinking and Ethical Decision Making

• Nurse as Part of a Health Care Team

– also, the involved patient, the patient’s family, or a surrogate decision maker may meet with one or more committee members

Introduction to Critical Thinking and Ethical Decision Making

• The Four Topics Approach to Ethical Decision Making– Case-based approach allows nurses and

other health care professionals to construct the facts of a case in a structured format that facilitates critical thinking about ethical problems.

Introduction to Critical Thinking and Ethical Decision Making

• The Four Topics Approach to Ethical Decision Making– Cases are analyzed according to four

topics: “medical indications, patient preferences, quality of life, and contextual features”