MedicalSurgical Nursing An Integrated Approach 2 E Chapter

Medical-Surgical Nursing: An Integrated Approach, 2 E Chapter 4 ETHICAL RESPONSIBILITIES

Ethics n The branch of philosophy concerned with the distinction of right from wrong on the basis of a body of knowledge rather than on just opinions. n Ethics looks at human behavior - things people do under different types of circumstances.

Bioethics n The application of ethical principles of health care.

Why is Ethics an Increasing Issue for Health Care? n an increasingly technological society with complicated issues that never had to be considered before. n the changing fabric of society, particularly in terms of family structure. n health-care has become a consumer-driven system based on clients becoming more knowledgeable.

Ethical Principles n Codes that direct or govern actions.

Basic Ethical Principles n n n Autonomy - The respect for individual liberty Justice - The equitable distribution of potential benefits and risks Fidelity - The duty to do what one has promised Nonmaleficence - The obligation to do or cause no harm to another Beneficence - The duty to do good to others Veracity - The obligation to tell the truth

Ethical Theories n n Teleology - the value of a situation is determined by its consequences. Deontology - the intrinsic significance of an act itself as the criterion for the determination of good. Situational Theory - holds that there are no set rules or norms. Each situation must be considered individually. Caring-Based Theory - focuses on emotions, feelings, and attitudes.

Values n Values are different from principles, in that they influence the development of beliefs and attitudes, rather than behaviors. They may, however, indirectly influence behaviors.

Value System n An individual’s collection of inner beliefs that guides the way the person acts and helps determine the choices made in life.

Value Clarification n The process of analyzing one’s own values to better understand those things that are truly important in life.

Value Clarification n The process of analyzing one’s own values to better understand those things that are truly important in life.

Self-Reflection n Because ethics and values are so closely associated, nurses must explore their own values in order to acknowledge the value systems of their clients.

Ethical Codes n Codes are used to help nurses act ethically. n These have been developed by nursing organizations such as the NFLPN, the ICN and the ANA.

The Patient’s Bill of Rights n A document designed to guarantee ethical care of clients in terms of their decision making about treatment choices and other aspects of their care.

Ethical Dilemma A conflict between two or more ethical principles. n In an ethical dilemma, there is no “correct” decision. n

Major Types of Ethical Dilemma n Euthanasia. n Refusal of Treatment. n Scarcity of Resources.

Euthanasia n Intentional action or lack of action that causes the merciful death of someone suffering from a terminal illness or incurable condition.

Refusal of Treatment n Based on the principle of autonomy. n A client’s rights to refuse treatment and to die often challenge the values of most health care providers.

Scarcity of Resources n The allocation of scarce resources (e. g. organs, specialists) is emerging as a major medical dilemma.

Ethical Decision Making

Ethics Committees n Many health care agencies now recognize the need for a systematic manner whereby to discuss ethical concerns. n Multidisciplinary committees offer dialogue regarding ethical dilemmas. n Ethics committees can lead to the establishment of policies and procedures for the prevention and resolution of dilemmas.

Nurse as Client Advocate n When acting as client advocate, the nurse’s first step is to develop a meaningful relationship with the client. n The nurse is then able to make decisions with the client based on the strength of the relationship.

Nurse as Whistleblower n Whistleblowing refers to calling attention to unethical, illegal, or incompetent actions of others. n Whistleblowing is based on the ethical principles of veracity and nonmaleficence. n Federal and state laws (to varying degrees) provide protection, such as privacy, to whistleblowers.

Questions for Whistleblowers Whose problem is this? n Must I do anything about it? n Is it my fault? n Who am I to judge? n Do I have the facts straight? n