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Focuses on universal truths, and where and how ethical principles are developed.
Focus on moral standards that regulates behaviors
Focus on specific difficult issues such as euthanasia, capital punishment, abortion, and health disparities
Bioethics (biomedical ethics)
Is the application of ethical theories and principles to moral issues or problems in health care.
- Basic & obvious moral truths that guide deliberation and action (some contradict each other)
- Presuppose a basic respect for persons
- Underlying assumption/foundation
- Respect for persons is a human right. One is respected as an individual with equality for all others.Ethical decision making is the process of choosing between actions based on a system of beliefs & values.
- An act is moral if its motives or intentions are good, regardless of the outcome.
- The need to do ones duty
- Ex: "Always keep a promise" "Never tell a lie"
- Maximizing the greatest good for the benefit happiness, or pleasure of the greatest number of people is moral.
- Only worry about outcomes not the means
- Ex: Outcome justifies the means
Principles of Ethical Behavior
- 1. Autonomy
- 2. Justice
- 3. Fidelity/privacy
- 4. Beneficence
- 5. Nonmaleficence
- 6. Veracity/truth-telling
- Standards of Best Interest
- human dignity and respect are the foundation
Demand to fulfill & honor rights of others
Owed to an individual as the result of just claims, legal guarantees, or moral principles
- Uses key ethical principles of beneficence, nonmaleficence, autonomy, and justice in the resolution of ethical conflicts or dilemmas.
- Fidelity and veracity used as well but not as much.
Code of ethics
"the nurse practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes or the nature of health problems"
- Asserts that individuals have the right to determine their own actions and the freedom to make their own decisions.
- This person is: respected, able to determine personal goals, has the capacity to decide upon a plan of action, is free to act on choices
What are autonomous decisions based on?
- 1. individual's values
- 2. adequate information
- 3. freedom from coercion
- 4. reason and deliberation
Beneficence (critical ethical principle)
- "The doing of good"
- Always consider one's actions in the context of promoting good for others.
- Prevent harm
- Remove evil or harm
- The duty to do no harm
- The nurse must not act in a manor that would intentionally harm the patient (nursing code of ethics)
- Do not cause harm even if it occurs during the performance of beneficial acts
Double Effect (Nonmaleficence)
As moral agents we may not intentionally produce harm, but it is ethically permissible to do what may produce a distressful or undesirible result if the intent is to produce an overall good effect
4 Conditions needed for double effect principle
- 1. The action must be good or at least morally indifferent.
- 2. The health care provider must intend only the good effects.
- 3. The undesired effects cannot be a means to the end or good effect.
- 4. There is a favorable balance between desirable and undesirable effects
- In other words, patients with the same diagnosis and health care needs should receive the same care.
- Those with greater or lesser needs should receive different care.
- Also at issue with justice is who receives health care.
- Often leaves us with more questions then answers
Application of the principle of justice that focuses on distributions of goods & services
- refers to faithfulness or honoring one's commitments or promises
- The licensure process is intended to ensure that only a qualified nurse, appropriately trained and educated, can practice nursing.
- Nurses must faithfully: uphold the profession's code of ethics, Practice within established scope of practice, practice competently, keep promises to patients
- Telling the truth or not lying
- Implies respect for others
- Is required of those who support autonomy of others
- Authorities disagree on the absolute necessity of truth telling in all instances
- Not always black and white
- How much truth do you tell?
Ethical decision making model
- 1. Clarify the ethical dilemma
- 2. Gather additional data
- 3. Identify options
- 4. Make a decision
- 5. Act
- 6. Evaluate
- What is right & wrong?
- Morals provide standards of behavior that guide the actions of an individual or social groups
- Laws represent the minimal standard of morality. Health care workers have higher calling than the law
- Established rules or standards that guide behavior in situations in which a decision about right and wrong must be made
- What should be done? That is, exceptions to the "rule"
- Branch of philosophy that studies the propriety of certain courses of action
- Ethics is a guide to decision making, guiding ones actions and behaviors
Characteristics of Ethical Dilemmas
- The choice is between equally undesirable alternativesThe real choice exists between possible courses of actionThe people involved place significantly different value judgment on the consequences of cations or possible actions
- Data alone will not help resolve the dilemma
Major issues involved in nursing ethical dilemmas
- 1. Personal Value Systems
- 2. peers' and other professions' behavior
- 3. patients' rights
- 4. institutional and societal issues
- 5. patient data access issues
- 6. global dilemmas