Chapter 9

Ethical Issues

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Concept of Ethics

The study of the rightness of conduct. Deals with one’s responsibilities (duties

and obligations). Ethical persons put their beliefs into

action.

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Concept of Ethics

The term morals is often mistakenly used when ethics is intended.

Morality is behavior that usually reflects personal or religious beliefs.

Ethics is rooted in the legal system.

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Relationship Between Legal and Ethical Concepts

There is a connection between acts that are legal and acts that are ethical.

The legal system judges action rather than intention.

Ethical opinions reflect individual differences.

Laws change according to social and political influences.

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Ethics in Health Care

Bioethics is the application of ethical principles to health care.

Ethics affects every area of health care. Ethics helps provide structure by raising

questions that ultimately lead to answers.

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Factors Contributing to the Need for Ethics in Health Care

Technological advances Changing fabric of our society Increased consumer demand for health

care information Decreasing allocation of federal funds for

health care

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Examples of Ethical Issues

Newborns surviving at earlier gestational ages with serious health problems

People living longer than ever before Organ transplants and the use of bionic

body parts Experimental research

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Ethical Theories

Teleology• The value of a situation is determined by its

consequences. • Principle of utility states that an act must

result in the greatest good for the greatest number.

• “Good” refers to positive benefit.

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Ethical Theories

Deontology• The intrinsic significance of the act itself is

the criterion for determination of good.• Concept of categorical imperative states that

actions should be based on a principle that is universal.

• The person should never be treated as a means to an end.

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Ethical Principles

Autonomy• The belief that every competent person has

the right to determine his or her own course of action.

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Autonomy

Examples of autonomous behavior that can impair recovery or treatment:• Smoking• Refusing to take medication• Refusing to receive a blood transfusion

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Ethical Principles

Nonmaleficence• Duty to cause no harm to others• Physiological, psychological, social, spiritual• Helps guide decisions about treatment

approaches

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Ethical Principles

Beneficence • Duty to promote good and to prevent harm• Providing benefit• Balancing benefits and harm

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Beneficence

Paternalism is a negative outcome of beneficence.

Paternalism occurs when health care providers decide what is “best” for clients.

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Ethical Principles

Justice

• Based on concept of fairness

• Equality in treatment and allocation of resources

Material Principle of Justice

• Determines when there can be unequal allocation of scare resources

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Ethical Principles

Veracity• Truthfulness, neither lying nor deceiving

others.• Deception can take the form of intentional

lying, nondisclosure of information, or partial disclosure.

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Ethical Principles

Fidelity• Faithfulness and keeping promises• Demonstrated by nurses in the role of client

advocate

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Values and Ethics

Values are individual rather than universal.

Individuals often fail to consider the impact of values on decisions.

Nurses often care for clients whose value systems conflict with theirs.

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Values Clarification

The process of analyzing one’s own values to better understand what is truly important

Three-step process of valuing:• Choosing• Prizing• Acting

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Ethical Codes

International Council of Nurses Code for Nurses

American Nurses Association Code of Ethics

Canadian Nurses Association Code of Ethics for Nursing

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Clients’ Rights

Clients have certain rights to• Make decisions regarding their care.• Be actively involved in the treatment

process.• Be treated with dignity and respect.

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Clients’ Rights

Patient Bill of Rights • Established by the American Hospital

Association.• Increases awareness of the need to treat

clients in an ethical manner.• Encourages health care providers to protect

the rights of clients.

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Ethical Dilemmas

Occur when there is a conflict between two or more ethical principles.

The most beneficial decision depends on the circumstances.

Ethical analysis is not an exact science.

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Ethical Dilemmas

Frequently Occurring Ethical Dilemmas• Informed Consent• Refusal of Treatment• Use of Scarce Resources• Cost-Containment Initiatives that Negatively

Affect Client Well-Being• Incompetent Health Care Providers

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Ethical Decision Making

Ethical Reasoning • Thinking through what one ought to do in an

orderly, systematic manner• Justification of actions based on principles

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Ethical Decision Making

Framework for Ethical Decision Making• Which theories are involved?• Which principles are involved?• Who will be affected?• What will be the consequences of the

alternatives?• What does the client desire?

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Ethical Decision Making

Steps of Ethical Analysis• Gathering of relevant data to identify the

problem• Consideration of all the people involved• Selection of a course of action• Evaluation of the resolution process

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Ethical Dilemmas

Euthanasia Refusal of Treatment Scarce Resources

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Euthanasia

“Good or gentle death” Mercy killing (deliberate ending of life as

a humane action)

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Euthanasia

Active euthanasia is taking deliberate action that will hasten the client’s death.• Assisted suicide is a form of active

euthanasia.

Passive euthanasia is the omission of an action that would prolong dying.• Discontinuing the client’s tube feedings is a

form of passive euthanasia.

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Refusal of Treatment

The client’s right to refuse treatment is based on the principle of autonomy.

A client’s right to refuse treatment and the right to die challenge the values of some health care providers.

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Scarce Resources

The availability of specialists and organs, is contributing to a scarcity of resources.

The use of expensive services is influenced by social and political forces.

Health care reform is needed to ensure services to all.

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Ethics and Nursing

Professional nurses’ actions are both legal and ethical.

Sound nursing practice involves making ethical decisions.

Ethics affects nurses in every health care setting.

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Ethics and Nursing

Ethics Committees • One approach for facilitating dialogue

regarding ethical dilemmas

Nurse as Client Advocate• Nurses are accountable for protecting the

rights and interests of the client.

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Ethical Decision-Making Model

Assessing the outcome of moral actions;“Were the actions ethical?”

“What were the consequences?”

EVALUATION

Carrying out selected moral actions

IMPLEMENTATION

Consideration of priorities of claims;Generation of alternatives for resolving the dilemma;Consideration of the consequences of alternatives

PLANNINGANALYSIS AND DIAGNOSIS

Problem identification: Statement of the ethical dilemma

ASSESSMENT

Determination of claims and parties