Ethics in Healthcare Decision-Making

Ethics in Practice

• Ethical decision-making in practice involves several key areas, including beginning of life (e.g., minor consent), decisional capacity, pain management, addiction, and involuntary psychiatric treatment.
• A specific course, NRSG 3101, covers these ethical considerations.

What is "Ethics"?

• Ethics is a branch of philosophy that examines human conduct.
• It evaluates the reasons behind actions and inactions, and judges whether actions are right or wrong, just or unjust.
• Ethics encompasses multiple aspects of a person's life.

Societal Ethics

• Societal ethics are based on laws and regulations to guide ethical behavior.
• "Law" sets the minimal standard of behavior expected of all members of society.
• Nursing ethics includes clinical standards of care, liability, negligence, and malpractice.

Organizational Ethics

• Organizational ethics are formal and informal principles and values that guide the behavior, decisions, and actions of members of an organization.
• These guidelines direct all aspects of the organization.

Professional Ethics

• Professional ethics sets ethical standards and expectations for specific professions (e.g., nursing).
• These professionals are held to a higher standard due to their privileged roles in society.
• Codes of conduct are aimed at upholding high ideals within the profession.

Bioethics/Clinical Ethics/Research Ethics

• Bioethics explores ethical questions arising from biological sciences and technology.
• Clinical ethics focuses on decisions made directly at the bedside.
• Research ethics is a component of bioethics and involves the conduct of human and animal research.

Personal Ethics

• Personal ethics refers to the moral principles and values that guide an individual's behavior and decision-making.
• Personal ethics is shaped by various factors, including culture, social factors, religion, and beliefs.
• Personal ethics continually intersects with other ethical categories, occasionally resulting in conflicts.
• Ethical standards are not static and change over time.

Morality vs. Ethics

• Morality defines accepted social standards and morals guiding behavior.
• Ethics focuses on the concepts of right and wrong.

Can We Be 100% Ethical?

• Achieving perfect ethics is challenging due to inherent complexities and ethical dilemmas.
• Factors such as conflicting principles, insufficient knowledge, cultural differences, personal biases, and subjective judgment can make ethical consistency difficult to achieve.

Factors Contributing to Ethical Challenges

• Ethical dilemmas arise when conflicting ethical principles must be weighed against each other.
• Limited knowledge or information can hinder effective ethical decision-making.
• Cultural and contextual differences influence ethical standards and values, making it challenging to establish a universal set of ethical principles.
• Personal biases and subjective judgments can cloud objective reasoning and lead to inconsistencies in ethical decision-making.

Ethical Conflict

• Ethical conflicts can occur when personal experiences, professional values, societal expectations, cultural norms, religious beliefs, or peer influence create disagreements and difficulties in making ethical choices.

Moral Distress

• Moral distress arises when individuals feel unable to act in a morally acceptable way due to a conflict between personal and professional values.
• End-of-life situations and similar ethical issues often lead to moral distress.

Four-Principles Approach to Ethical Decision Making (Jonsen et al.)

• A framework to guide ethical decision-making in healthcare settings.
• Based on four core principles: autonomy, beneficence, non-maleficence, and justice.

Autonomy

• The principle of respecting an individual's right to make their own decisions and choices.
• Patients have the right to make informed decisions about their own bodies and healthcare.
• Individuals' values, preferences, and wishes should be respected in decision-making processes.

Beneficence

• The principle of doing good and promoting the well-being of others.
• Actions should benefit others, enhance their quality of life, and promote their welfare.
• In healthcare, this principle guides professionals to act in the patient's best interest, ensuring well-being, and maximizing benefits of care.

Non-maleficence

• The principle of avoiding harm or minimizing harm to others.
• Emphasizes the duty to do no harm, prevent risks and minimizing potential negative outcomes.
• Balancing potential benefits and harms of medical interventions.

Justice

• The principle of fairness and equity in distributing resources, opportunities, and access to healthcare.
• Fair and equal treatment of individuals and addressing disparities in healthcare.

Key Questions for Ethical Decision Making

• Asking crucial questions using the framework when facing decisions: duty to tell the truth, greatest harm, primary loyalty, and patient's best interests.

Reflective Exercise (Patient Refuses Blood Transfusion)

• A case study about a patient refusing a blood transfusion due to religious beliefs, juxtaposed with the well-being of their children.

Ethical Issues in Nursing

• Several ethical issues in nursing include patient rights, informed consent treatment, risks to the nurse, chemical or physical restraints, staffing issues, prolonging living/dying processes, quality of care policies, and working with unethical colleagues.

Beginning of Life (Minor Consent)

• Consent guidelines for patients; ability to understand information relevant to a procedure and its consequences.
• Capacity of young children varies by age and health circumstances.
• Incapacitated children require a capable decision-maker with full information for informed consent.

Minor Consent and Care Providers

• Responsibilities of care providers in assessments involving minors.
• Acknowledgment of the minor's emerging autonomy, beliefs, and cognitive development is crucial in assessment.
• Provincial/territorial legal framework on minor consent; decision-making authority rests with the suitable designated person if lacking capacity.

Age of Consent

• Ability of children varies by age and understanding of treatment details and consequences.
• "Mature minors" can provide consent for certain medical treatment decisions if their capacity is demonstrated.
• Parental or guardian consent is typically required for children under the age of consent, or in cases of medical necessity.

Age of Consent & Sexual Assault

• Age restrictions on consent for sexual activity between individuals of differing ages, considering trust, authority, or dependency relationships.
• Age restrictions for minors involved in sexual relationships.
• Consent standards for children under 12, highlighting the illegality of sexual activity (incest).

Case Study – Josh

• A case study on the ethical considerations involved.

Decisional Capacity

• The ability to make medical decisions, stand trial in court, and to make decisions regarding personal care and finances.
• Key elements of decisional capacity include understanding, appreciation, and reasoning, and the ability to make a choice.

Elements of Capacity

• Key elements of capacity (choice, understanding, appreciation, and reasoning).

Personal Directives Act (2008) & Regulations

• Allows individuals to outline their personal care decisions to be made, outlining preferences if they lose capacity.
• Definitions related to personal care, delegate, making declarations in writing, and witnessed signatures.

Adult Capacity and Decision-Making Act (ACDMA)

• Legislation for adults lacking capacity, with authorized decision-making processes.
• Specific professionals (physicians, psychologists, and other licensed healthcare providers) are authorized to assess capacity.

Capacity, Provider Roles & Accountability

• Responsibilities for the nurses in assessing capacity under PDA and ACDMA.
• Follow agency policies, and obtain consent if the individual has capacity.
• Seek primary care provider consultation if capacity is uncertain.
• Informed consent procedure for adults and minors, and the process for handling disagreements.

Pain Management & Addiction

• Exploring the ethical considerations and responsibilities regarding pain treatment and addiction prevention.
• Understanding the subjective nature of pain and its dependence on patient/provider values.

Reflective Exercise (Pain Management)

• A reflective exercise prompting questions about the ethical permissibility of untreated pain, patient manipulation, treatment rights, and truthfulness regarding pain.

Involuntary Psychiatric Treatment Act (IPTA)

• Nova Scotia's legislation for involuntary treatment of persons with severe mental illness who can't make treatment decisions.
• Pre-conditions necessitating involuntary admission including danger, risk of harm, impairment, loss of decision-making capacity.

Reflective Exercise (Involuntary Psychiatric Admission)

• Prompting reflection on whether involuntary psychiatric commitment violates fundamental rights.

Case Study – Social Media

• A case study related to ethical issues in social media usage.

This quiz explores key ethical principles and dilemmas in healthcare. Examine critical decisions involving patient consent, resource limitations, and the complexity of ethical frameworks in medical settings. Test your understanding of how various factors influence ethical decision-making in healthcare contexts.