Untitled Quiz

Ethical Decision Making in Practice

• Ethical decision-making in practice encompasses various areas, including beginning-of-life issues (minor consent), decisional capacity, pain management, addiction, and involuntary psychiatric treatment.

What is "Ethics"?

• Ethics is a branch of philosophy concerned with human conduct.
• It examines the justification for actions (or inactions).
• It involves judgments about what constitutes right, wrong, just, or unjust behavior.
• Ethics encompasses various aspects of a person's life.

Societal Ethics

• Societal ethics are defined by laws and regulations that provide a normative basis for ethical behavior.
• Laws define the minimum standards of behavior for all members of society.
• Legal standards in nursing include clinical standards of care, liability, negligence, and malpractice.

Organizational Ethics

• Organizational ethics encompass the formal and informal principles and values that guide behaviors, decisions, and actions within an organization.
• These principles guide every aspect of the organization.

Professional Ethics

• Professional ethics establish standards and expectations for specific professions like nursing.
• Professionals are expected to maintain a higher ethical standard due to their privileged role in society.
• Professional codes of conduct exist to ensure that the highest ideals of practice are upheld.

Bioethics/Clinical Ethics/Research Ethics

• Bioethics explores ethical considerations arising from biological sciences and technology.
• Clinical ethics addresses ethical dilemmas encountered at the bedside.
• Research ethics, a part of bioethics, focuses on the conduct of research involving humans and animals.

Personal Ethics

• Personal ethics refers to the moral principles and values that guide an individual's behavior and decision-making.
• Personal ethics influence how individuals interact with others and make choices in life.
• Personal ethics is constantly intertwined with other ethical categories.
• Potential conflicts may exist among different ethical categories.
• Sources of personal ethics are dynamic and evolve over time.

Morality vs. Ethics

• Morality refers to an accepted group of social standards or morals to guide behavior.
• Ethics deals more specifically with concepts of right and wrong conduct.
• Morality is a broader term than ethics.

Can We Be 100% Ethical?

• Achieving absolute ethical perfection is challenging due to inherent complexities and ethical dilemmas.

Factors Contributing to Ethical Challenges

• Ethical Dilemmas: Ethical principles often conflict, creating situations where individuals must choose between equally important but incompatible values; honesty versus loyalty, for example.
• Limited Knowledge/Information: Ethical decision making relies on accurate information, which may be lacking or incomplete in certain situations. New information or changing circumstances may also influence judgments.
• Cultural and Contextual Differences: Ethical standards and values may vary widely across cultures and contexts, making it difficult to establish universal principles applicable to all situations.
• Personal Biases/Subjective Judgments: Individuals may be predisposed to biases and subjective judgments. These can influence ethical decision-making, leading to inconsistencies.

Basic Ethical Practices

• Individuals should constantly reflect on values and their consequences.
• Continuously engage in learning, reflecting, and ethical discussions to further develop their ethical conduct.
• Strive to align actions with ethical principles, acknowledging ongoing complexities and limitations.

Ethical Conflict

• Ethical conflicts arise from overlapping spheres of influence, such as family, peers, religion, culture, personal experiences, and profession.

Moral Distress

• Moral distress arises when individuals are unable to act in a way that aligns with their personal and professional values.
• Moral distress resembles ethical dilemmas.
• End-of-life situations commonly lead to moral distress.

Ethical Consideration Examples

• The dilemmas are prevalent in various situations in nursing practice.
• Cases involving choices about treatment and patient autonomy, as well as staffing patterns and resources, are prime examples.

Four-Principles Approach to Ethical Decision Making

• The four principles (autonomy, beneficence, non-maleficence, justice) provide a structured approach to ethical dilemmas in healthcare.

Autonomy

• Respecting individual self-determination and the right to make their own decisions.
• Includes informed consent, patient rights, body autonomy, and choices about healthcare.

Beneficence

• Promoting the well-being, welfare, and quality of life for others.
• Healthcare professionals act in the patient's best interest.

Non-maleficence

• Avoiding harm and minimizing risk to others.
• Healthcare professionals prioritize patient safety and carefully consider potential risks and benefits of interventions.

Justice

• Ensuring fairness and equality in the distribution of resources and opportunities in healthcare.
• Treating all individuals fairly, considering disparities.

Key Questions for Ethical Decision Making

• Determining one's duty to tell the truth, considering the greater harm, prioritizing loyalties, and safeguarding patient best interests are essential.

Reflective Exercise - Case Study - Patient Refuses Blood Transfusion

• A patient with Jehovah's Witness beliefs refuses a blood transfusion. How should a practitioner balance this treatment with the potential well-being of the patient's children?

Ethical Issues in Nursing Practice

• Issues arise with respecting patient rights, consent, protecting a nurse's health, employing appropriate restraints, or prolonging a dying process through inappropriate measures.

Exemplar - Beginning of Life (Minor Consent)

• Consent involves a patient's understanding of relevant treatment information and the foreseeable consequences of a decision or lack of decision.
• Age varies with prevailing health circumstances in different jurisdictions.
• In cases of incapacity, a capable decision maker must receive needed information.

Minor Consent and Care Providers

• Healthcare providers assess children's emergent self-awareness, values, and capacities.
• In cases where children demonstrate incapacity, those with decision-making authority make decisions in their best interest.

Age of Consent

• In Canada, age of consent for medical treatment varies by province or territory.
• Mature minors are some provinces can provide consent for their medical treatments.
• Parental or guardian consent is usually required for young children.
• Exceptions are in cases of emergencies.

Age of Consent and Sexual Assault

• Specific rules apply regarding the age of consent to sexual activity, particularly when relationships involve trust or vulnerability.

Case Study - Josh

• A case study about a young patient

Exemplar: Decisional Capacity

• The ability to make medical decisions, stand trial, and make financial decisions is a critical aspect of decision-making capacity.

Elements of Capacity

• The elements of capacity include choice, understanding, appreciation, and reasoning.

Personal Directive Act (2008) & Regulations

• Allows individuals to outline personal care decisions (health care, hygiene) for when they lose capacity.
• Establishes the role of delegates in making those decisions on the individual's behalf.
• Directives must be signed, documented formally, and witnessed.

Adult Capacity and Decision-Making Act (ACDMA)

• Adults may require assessment for their capacity to make their own decisions for various reasons.
• Specific authorities (physicians, psychologists, nurse practitioners) can make capacity assessments.

Summary of Provider Roles in Assessing Capacity

• This table summarizes which healthcare provider roles and responsibilities are responsible for capacity assessments.

Nurses' Accountabilities Related to Capacity

• Nurses must understand local laws and policies on capacity assessment.
• The decision to treat a patient, or not, often involves multiple considerations.

Exemplar: Pain Management & Addiction

• Pain management is a morally complex undertaking.
• Morally, is there an obligation to treat pain and resist addiction?
• Assessing pain involves trust and understanding of patients’ values.

Reflective Exercise - Case Study (Pain Management)

• Discusses the permissibility of untreated pain.

Exemplar: Involuntary Psychiatric Treatment Act (IPTA)

• The IPTA ensures appropriate treatment for patients with severe mental illness unable to make decisions.
• Pre-conditions for involuntary admission include danger to self or others, likelihood of serious impairment or deterioration, lacking decision-making capacity, or requiring care in a psychiatric facility.

Reflective Exercise - Case Study (Involuntary Psychiatric Admission)

• This exercise questions the morality of involuntarily committing patients.