Ethical Dilemmas in Healthcare

Ethical Dilemmas

• An ethical dilemma involves choosing between two or more morally acceptable courses of action, where selecting one prevents choosing another.
• Ethical dilemmas may also involve choosing between equally unacceptable alternatives.

Complexity of Ethical Issues in Healthcare

• Advances in medical and information technologies, increasing stress, and renewed emphasis on team-based care approaches are increasing complexity.
• Clinicians may encounter varying expectations and values, which could challenge their personal sense of morality.

Ethical Considerations in Healthcare

• Healthcare practitioners need to resolve ethical dilemmas by integrating their own moral reasoning with that of all parties involved, including patients.
• There should be consideration of clients and practitioners within and outside one's discipline, balancing reasoning with practical realities.
• Professionals must look beyond their own values to facilitate critical exchange of ideas and collaboration which requires skills in clarification, communication, negotiation, and teamwork for successful resolution of moral issues.
• Cases involving ethical dilemmas can be perplexing in medical and clinical settings, and reasons for action may be balanced by arguments.
• Common sense alone does not ensure appropriate responses in healthcare.

Ethical Dilemmas

• They can evoke strong emotions and personal opinions, however emotions and opinions are not enough when resolving ethical dilemmas

Clinical Ethics vs. Professional Ethics

• Health care professionals seek ethical guidance from professional codes and oaths taken as students.
• New members of the profession pledge to the public and patients to be guided by principles and values in their oath or code.

Shortcomings of Professional Oaths

• Professional oaths are unilateral declarations lacking input from patients or the public.
• Codes do not acknowledge society's right to insist on standards in exchange for granting medical autonomy.
• Content criticism states the Hippocratic tradition is paternalistic, giving patients little say in decisions.
• Oaths and codes have general precepts that fail to address specific ethical issues or provide resolutions for dilemmas

Clinical Ethics Functionality

• Clinical ethics helps with identification of ethical issues and to better recognize ethical issues that might arise in individual cases..
• Clinical ethics aids in understanding areas of ethical consensus and controversy.
• Health care workers may be perplexed about difficult decisions but fail to identify the ethical nature of problems.
• Clinical ethics can identify actions that are clearly right or wrong and identify actions that may be controversial.
• Some acts are optional due to balanced arguments for and against, leading to reasonable disagreements.
• Other actions are optional because of praise for doing them, though there is no fault in omitting them.

Ethical Decision-Making Model

• A five-step decision-making model by Burkhardt & Nathanial, (2008) exists to resolve ethical dilemmas.
• Step 1: Clarify the difference between the current situation and the desired goal by articulating the problem. Solve articulating the problem
• Step 2: Gathering data helps identify conflicting moral claims causing the ethical dilemma and identify the key person involved in the decision-making process.
• Step 3: Exploring strategies helps to narrow a series of acceptable alternatives so that participants can make the best decision quickly/easily.
• Step 4: Implementing the strategy is a major goal during ethical issues can be simple especially if participants make sound decisions.
• Step 5: Evaluating outcomes of action throws light on the process's effectiveness and prevents a similar occurrence.

Reading Recommendation

• Suzuki, C., Ota, K. & Matsuda, M. (2015) discuss public health nurses in Japan and their challenges.

Ethical Considerations in Clinical Research

• Nurses must be accountable for care quality, demonstrated through research.
• Research is necessary for the development of nursing, providing a framework for practice.

Research Participation & Concerns

• Research participation can encourage professional growth.
• It can present dilemmas for nurses and nurse researchers in academic and clinical settings.
• There are a number of questions about whether current regulations adequately protect the rights and welfare of subjects in research 老人家用尿片來身粉prevent粘→住後→改良,用泡泡both forpt

Foundational Principles

• Principles of beneficence, respecting human dignity (confidentiality & autonomy), and justice underlie ethical research conduct including (ANA 1985; Belmont Report, 1978; Newland, 1999). not ethical principle but包含敛 x2

Beneficence in Research

• Beneficence implies the right to protection from harm/discomfort, requiring a consideration of benefits against the risk. This principle derives from the maxim "above all, do no harm"
• In research, this means that the need to design/conduct so as to protect from physical, mental, emotional, spiritual, economic and social harm
• Discomfort can include the anticipated effects to certainty of permanent damage, and include fatigue, physical pain,embarrassment, threats to self-esteem or to values, lost earnings for time given to participate in research, social stigma.
• If discomfort is anticipated within the research protocol, the participant’s willingness must be there including relevance of all risks.
• Researchers must minimize risks while maximizing benefits to participants when risks are greater.
• Studies should be redesigned or discontinued if risks outweigh benefits. 医生做 research recruit pt/ Leads to nurse 推介 and留意 research内容

Respect via Human Dignity

• This principle implies rights to full disclosure (confidentiality) and self-determination/autonomy.
• Included in this principle, the right to self-determination acknowledges potential participant autonomy.
• Participants have the right to choose whether or not to participate.
• This means participation is 100% voluntary and has no/is free of coercion. If say no to do research,不可再劝
• Coercion includes threat of penalty, or excessive rewards for participation in the research.
• Right to self-determination means the right to withdraw participation in the study at any time.
• Voluntary participation in research means full disclosure (confidentiality), and anticipated risks.

Justice in Research

• Justice implies the right to fair treatment.

ANA's Human Rights Guidelines

• Right to freedom from intrinsic risk of injury.
• Guarantee of privacy must be provided to all participants.
• Anonymity should always be a thing and there's a right to that. about disclosure of name

Additional Aspects of Ethical Research

• Research needs to have scientific objectivity= reporting all data, both supportive and unsupportive of hypotheses, also not engage with misconduct, and fraud. collecting data客观性
• Cooperation= submitting proposals to the recommendations of review the research for protection of human rights.
• Nobility needs working activity to ensure proper protection of participants from harm, deceit, coercion, and invasions of privacy, even when this may inconvenience the study 保护者
• Integrity and truthfulness needs Honestly describing the research process. Includes things like purpose, procedures, methods, risks, discomforts, benefits, and findings
• Impeccability= ensuring anonymity and confidentiality of data utilizing discretion with information learned about people 用号碼代替名 sharing findings
• Illumination= publishing and presenting research findings in order to enhance nursing's body of scientific knowledge
• Equitability= noting contributions of other's that have assisted/published in presentations and research completed differences
• Forthrightness= disclosing funding sources and

Explore ethical dilemmas in healthcare, involving choices between morally acceptable courses of action. The increasing complexity due to technology and stress requires healthcare practitioners to integrate moral reasoning with diverse values. Balancing ethical considerations with practical realities is crucial.