Ethical Principles and Decision Making

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Ethical Principles and Decision Making

• Issues in Professional Nursing

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Aspects of Nursing

• Legal- what must be done
• Practical- what can be done
• Ethical- what should be done

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Ethics

• Philosophy
• Unable to test
• Standards for evaluation

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Beneficence

• Do good.
• One person takes action for the good of another
  person.

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Beneficence

• Foundation of biomedical ethics

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Biomedical Assumption

• Goal of health care

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Beneficence

• Obligation to help others further their
  legitimate and important interests

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Beneficence

• Contributes to the well being of another
• Demands action

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Beneficence

• Provision of benefits
• Includes prevention and removal of harm
• Balancing benefits and harm

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Beneficence

• While obligated, we have discretion in
  discharging it.
• No expected to put self at risk

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Nonmaleficence

• Do no harm
• One person avoids hurting another.

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Nonmaleficence

• Distinct from beneficence

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Nonmaleficence

• Beginning of beneficence
• Inflict no harm
• Prevent harm
• Remove harm
• Do good

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Balancing beneficence and nonmaleficence

• Giving chemotherapy
• Using restraints
• Monitoring for adverse effects

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Negligence

• Duty to the affected party
• Duty is breached
• Affected party is harmed
• Link between breached duty and harm

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Decisions based on nonmaleficence

• Killing or letting die
• Levels of care provided
• Obligatory or optional

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Autonomy

• Do for self.
• An individual has the right to make decisions and
  take independent actions without external control.

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Respect for Autonomy

• Belief a person has unconditional value
• Capacity to determine own destiny

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Respect for Autonomy

• Self rule
• Intentional action

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Respect for Autonomy

• With understanding
• Without controlling influences

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Respect for Autonomy

• Recognize persons capacity and perspective
• Right to hold views
• Right to make choices

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Respect for Autonomy

• Actions taken based on personal values and
  beliefs.

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Respect for Autonomy

• What are valid reasons to constrain autonomy?

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Persons who lack capacity to be autonomous

• Infants
• Irrationally suicidal individuals
• Drug-dependent individuals

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Informed Consent

• Based on respect for autonomy
• Disclose risks and benefits
• Understanding
• Voluntarily agreeing

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Justice

• Do what is fair.
• An individual receives what is deserved.

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Justice

• Giving what is deserved
• Need
• Ability to contribute

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Basic Principle of Justice

• Equals must be treated equally

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Need

• Fundamental needs
• Person harmed unless need is met.
• Distributive justice

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Other criteria for justice

• Effort
• Contribution
• Merit
• Free-market exchange

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Is it fair for you to get a raise?
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Is it right for the CEO of an HMO to get a raise
when the HMO is limiting services to enhance
profit?
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Ethical values

• Support rules for professional-patient
  relationships

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Rule of veracity

• Obligation to tell the truth
• Not to lie or deceive others

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Rule of veracity

• Respect for others
• Implicit promise
• Relationships of trust

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Whole truth

• How much of the truth am I to tell?
• Do I force unwanted information on a patient?

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Rules of privacy

• Limited access to person and personal information
• Access allowed to build or maintain relationships

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Privacy violated

• Outsider breaks into a database
• Universal compulsory screening

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Rules of confidentiality

• Ones control over information generated about
  you
• Context of professional relationship

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Confidentiality

• Special case of privacy
• Person entrusted with information discloses
  without authorization

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Rules of fidelity

• Keeping ones promises
• Contracts, agreements, and relationships

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Ethical dilemma

• Values in conflict within the professional
• Values of stakeholders in conflict

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Who wins?
Lose-Lose
Lose-Win
Win-Lose
Win-Win
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Approaches to decision making

• Relativism
• No definitive right or wrong.
• Dependent on situation and culture.

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Approaches to decision making

• Justice
• Ethical if benefits are equally available to the
  population

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Approaches to decision making

• Objectivism
• Ethical behavior is an unattainable goal.
• Codes of ethics

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Approaches to decision making

• Teleology
• Results determine what is right.
• End justifies the means.

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Teleology

• Egoism
• Greatest good for me
• Utilitarianism
• Greatest good for the greatest number

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Approaches to decision making

• Deontology
• Acts are inherently right or wrong
• Universal law

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Approaches to decision making

• Hybrids

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Nurse as a moral agent

• Personal characteristics
• Moral development
• Cultural history
• Professional characteristics

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Social and cultural factors

• Laws
• Available resources
• Professional standards

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Institutional environment

• Environmental factors
• Supports
• Constraints
• Moral milieu

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Moral reasoning

• Judgments about what is right and wrong
• Assessing
• Planning

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Moral behavior

• Judgments about who is responsible
• Implementing
• Evaluating

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Ethical decision making process

• Identifying the problem
• Describe the moral problem
• Rights, obligations, and positions of key
  stakeholders identified
• What is in conflict?
• Gather more information if needed

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Ethical decision making process

• Planning
• Decide who are the key decision makers.
• Identify all possible courses of action.
• Compare and select which one is best.

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Ethical decision making process

• Implementing
• Legal requirements
• Provide support to stakeholders during
  implementation.

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Ethical decision making process

• Evaluating
• Review outcomes of decisions and actions
• Was process followed?
• What would you do differently next time?

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