Ethics in Healthcare Decision-Making

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Questions and Answers

What does justice in healthcare primarily concern?

Technological advancements in treatment

Patient confidentiality

Maximizing healthcare profits

Fairness in resource distribution (correct)

Which question is NOT part of Jensen et al's ethical decision-making framework?

How can I increase patient satisfaction? (correct)

To whom is my primary loyalty?

What is the greater harm?

Do I have a duty to tell the truth?

What ethical issue involves potentially compromising care due to limited staff?

Understaffing (correct)

Informed consent

Patient autonomy

Chemical restraints

In the context of minor consent, what is crucial for a capable decision-maker?

All relevant information must be provided Signup and view all the answers

What principle does the ethical dilemma of a Jehovah's Witness patient refusing a blood transfusion primarily challenge?

Respect for patient autonomy Signup and view all the answers

What is a major concern when prolonging the dying process with inappropriate measures?

Quality of life considerations Signup and view all the answers

What aspect of consent varies with a child's age and health circumstances?

The capacity to give consent Signup and view all the answers

Which issue is related to the use of chemical restraints?

Ethical treatment of patients Signup and view all the answers

What is a primary reason ethical dilemmas occur?

Conflicts between equally important ethical values Signup and view all the answers

How does limited knowledge impact ethical decision-making?

It makes it difficult to make fully ethical decisions Signup and view all the answers

Why is establishing a universal set of ethical principles challenging?

Ethical standards vary across cultures and individuals Signup and view all the answers

What role do personal biases play in ethical decision-making?

They can cloud objective ethical reasoning Signup and view all the answers

What is one way individuals can strive for better ethical conduct?

Seek knowledge and reflect on ethical implications Signup and view all the answers

Which of the following does not contribute to ethical challenges?

Absolute knowledge of ethics Signup and view all the answers

What is a potential outcome of changing circumstances on ethical assessments?

They can lead to revisions of ethical judgments Signup and view all the answers

What should individuals do to work towards ethical consistency?

Engage in ongoing self-reflection and learning Signup and view all the answers

What must care providers consider when assessing a minor's capacity for consent?

The context of the minor's self-awareness and decision-making Signup and view all the answers

In which of the following provinces can a mature minor provide consent for medical treatment regardless of age?

British Columbia Signup and view all the answers

At what general age does the consent for medical treatment without parental involvement typically begin in most provinces?

16 years old Signup and view all the answers

For children under the age of consent, what is generally required for medical treatment?

Parental or guardian consent Signup and view all the answers

When are healthcare providers allowed to provide treatment without parental consent?

In emergency situations requiring immediate treatment Signup and view all the answers

Which of the following statements regarding 16 and 17-year-olds and sexual activity is true?

They cannot consent to sexual activity with individuals in positions of trust Signup and view all the answers

What is the primary concern of ethics as a branch of philosophy?

Examining the rational justification for actions Signup and view all the answers

What role does the substitute decision-maker (SDM) have when a minor demonstrates no capacity for consent?

They act in the best interests of the child Signup and view all the answers

Which of the following is NOT a factor in determining a minor's maturity for consent?

The opinions of their peers Signup and view all the answers

What differentiates professional ethics from personal ethics?

Personal ethics are influenced by culture and beliefs Signup and view all the answers

Which type of ethics addresses ethical questions related to biological sciences?

Bioethics Signup and view all the answers

Which statement accurately reflects the distinction between morality and ethics?

Morality deals with specific right and wrong, while ethics refers to broader societal standards Signup and view all the answers

What is indicated as the minimum standard of behavior in society?

Laws and regulations Signup and view all the answers

Which of the following is an example of organizational ethics?

A company's mission statement guiding employee behavior Signup and view all the answers

Pain management and addiction fall under which ethical category?

Bioethics Signup and view all the answers

Why do personal ethics potentially lead to conflicts with other ethical categories?

They may clash due to differing influences and contexts Signup and view all the answers

At what age can someone legally consent to sexual activity with a partner who is less than 5 years older, under specific conditions?

14 or 15 Signup and view all the answers

Which of the following individuals cannot legally consent to sexual activity under any circumstances?

A 10-year-old Signup and view all the answers

What is a key principle that must not be present for someone aged 12 or 13 to legally consent to sexual activity?

Relationship of trust Signup and view all the answers

What does decisional capacity NOT include as a component?

Financial capability Signup and view all the answers

Under the Personal Directives Act (2008), what is required for an individual to make a personal directive?

It must be witnessed and in writing Signup and view all the answers

What is the main purpose of the Adult Capacity and Decision-Making Act (ACDMA)?

To offer a framework for decision-making for incompetent persons Signup and view all the answers

Which of the following terms refers to a person authorized to make decisions on behalf of someone who has created a personal directive?

Delegate Signup and view all the answers

Which condition is considered an example of incapacity under the Adult Capacity and Decision-Making Act?

Having a learning disability Signup and view all the answers

Who is authorized to conduct a capacity assessment?

Physician Signup and view all the answers

What should a nurse do if they are unsure about an individual's capacity to make personal care decisions?

Consult the primary care provider Signup and view all the answers

In the absence of capacity and a personal directive, who should a nurse seek out for decision-making?

The statutory decision-maker Signup and view all the answers

When a nurse believes an individual has capacity, what is the next step to take?

Obtain consent and provide service Signup and view all the answers

What action should a nurse take if there is disagreement about an individual's capacity?

Request assessment by an authorized health care professional Signup and view all the answers

Which of the following best describes pain management according to ethical considerations?

Is a subjective experience requiring a moral framework Signup and view all the answers

What is an essential aspect of pain management highlighted in the context provided?

It requires factoring in provider values Signup and view all the answers

In cases where a personal directive exists, what should a nurse do when a patient is assessed as lacking capacity?

Follow the instructions of the personal directive Signup and view all the answers

Study Notes

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.

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.

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.

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 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.

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

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Description

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.