Copyright © 2006 Elsevier, Inc. All rights reserved Chapter 19 Ethical Issues.

Copyright © 2006 Elsevier, Inc. All rights reserved

Chapter 19Chapter 19

Ethical IssuesEthical Issues


Understanding EthicsUnderstanding Ethics

What are your values?What are your values?– Clarify your valuesClarify your values

ChoosingChoosing

PrizingPrizing

Acting on your value choiceActing on your value choice

– Values may change over timeValues may change over time


Moral/Ethical Principles Moral/Ethical Principles

What is the best decision? How will I What is the best decision? How will I know?know?– AutonomyAutonomy– BeneficenceBeneficence– NonmaleficenceNonmaleficence– FidelityFidelity– JusticeJustice– VeracityVeracity



Which principle or rule is most Which principle or rule is most important?important?– Autonomy and nonmaleficence?Autonomy and nonmaleficence?– Consider relative benefits and burdensConsider relative benefits and burdens– Abstract ideas about right and wrong are Abstract ideas about right and wrong are

not helpful “enough” at the bedsidenot helpful “enough” at the bedside– Nursing ethicistsNursing ethicists

Emphasize an ethic of caring—preserve Emphasize an ethic of caring—preserve humanity and dignity and promote well-beinghumanity and dignity and promote well-being



So how do I make an ethical decision? So how do I make an ethical decision? Many approaches to decision makingMany approaches to decision making– Deontological—All life is worthy of respectDeontological—All life is worthy of respect– Teleological—That which causes a good Teleological—That which causes a good

outcome is a good actionoutcome is a good action– Situational—Decisions made in one Situational—Decisions made in one

situation cannot be generalized to situation cannot be generalized to another situationanother situation



What other resources are available to What other resources are available to help resolve ethical dilemmas?help resolve ethical dilemmas?– ANA Code of Ethics for NursesANA Code of Ethics for Nurses– ICN Code for NursesICN Code for Nurses– Your Rights as a Hospital PatientYour Rights as a Hospital Patient– Home Care Bill of Rights for patientsHome Care Bill of Rights for patients– Nuremberg CodeNuremberg Code


Controversial Ethical Controversial Ethical Issues Confronting NursingIssues Confronting Nursing

AbortionAbortion– When does life begin?When does life begin?– Does the fetus have rights?Does the fetus have rights?– Do the rights of the fetus take Do the rights of the fetus take

precedence over the right of the mother precedence over the right of the mother to control her reproductive functions?to control her reproductive functions?

– When is abortion morally justified?When is abortion morally justified?– Should minors have the right to abortion Should minors have the right to abortion

without parental consent or awareness?without parental consent or awareness?


Controversial Ethical Controversial Ethical

Issues Confronting Nursing Issues Confronting Nursing How does the abortion issue affect How does the abortion issue affect nursing?nursing?– What are your values and beliefs, and how can What are your values and beliefs, and how can

you apply these values to your work and possible you apply these values to your work and possible political action?political action?

– ANA’s Code of Ethics for Nurses Statement One ANA’s Code of Ethics for Nurses Statement One outlines your responsibility to care for all patientsoutlines your responsibility to care for all patients

– You do not have to sacrifice your own values and You do not have to sacrifice your own values and principles, but you cannot abandon your patientsprinciples, but you cannot abandon your patients

– Conscience clausesConscience clauses



Issues Confronting NursingIssues Confronting Nursing

EuthanasiaEuthanasia– ““Mercy killing,” “good death,” “right to Mercy killing,” “good death,” “right to

die”die”– Classified as active, passive, or Classified as active, passive, or

voluntaryvoluntary– Durable Power of Attorney for Health Durable Power of Attorney for Health

Care, living wills, Advance Medical Care, living wills, Advance Medical DirectivesDirectives



Issues Confronting NursingIssues Confronting Nursing Futile care and physician-assisted Futile care and physician-assisted suicidesuicide– Futility—medical intervention (beyond Futility—medical intervention (beyond

comfort care) without reasonable hope comfort care) without reasonable hope of benefit to patientof benefit to patient

– PAS—AMA opposes (doctors do no harm)PAS—AMA opposes (doctors do no harm)



Issues Confronting NursingIssues Confronting Nursing The use of reproductive technologyThe use of reproductive technology– Artificial inseminationArtificial insemination– Surrogate motherhoodSurrogate motherhood– Use of fetal tissueUse of fetal tissue– In vitro fertilizationIn vitro fertilization– Diagnosis of genetic defects prenatallyDiagnosis of genetic defects prenatally



Issues Confronting NursingIssues Confronting Nursing Allocation of scarce resourcesAllocation of scarce resources– Do all individuals merit the same care?Do all individuals merit the same care?– Is health care a right or a privilege?Is health care a right or a privilege?

Possible solutionsPossible solutions– Rationing for elderlyRationing for elderly– Uninsured children given more equitable Uninsured children given more equitable

shareshare– Emphasize preventive careEmphasize preventive care

Health care rationingHealth care rationing

Copyright © 2006 Elsevier, Inc. All rights reserved Chapter 19 Ethical Issues.

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