Class 2 Part 2 Ethical Analysis PDF

Ethical Dilemmas and Decision-Making Process Class 2: Ethical dilemmas and tools Marianne Sofronas, RN, PhD Faculty Lecturer, Ingram School of Nursing, McGill University with thanks to Catherine-Anne Miller...

Ethical Dilemmas and Decision-Making Process Class 2: Ethical dilemmas and tools Marianne Sofronas, RN, PhD Faculty Lecturer, Ingram School of Nursing, McGill University with thanks to Catherine-Anne Miller Copyright © 2024 Ingram School of Nursing  What keeps Nurses Awake at Night summary of video: https://www.youtube.com/watch?v=pOakDs41IsI  Content for Class 2 A) Normative Ethics Virtue Ethics Utilitarianism B) Ethical Dilemmas and Decision- Deontology Making Process Principlism Ethical Dilemmas defined Other paradigms: Narrative Ethics, Ethical Decision-Making Tools & Relational Ethics, Casuistry, Frameworks Interpretivism The Ethical Question Feminist Ethics and Ethic of Care Moral distress, moral resilience, moral (screencast on MyCourses) courage, moral communities 3  What is an ethical dilemma? Involves a choice of a course of action in the face of multiple alternatives and possible consequences It often generates uncertainty to those involved about the best alternative to be chosen May result in complexity due to the many interpersonal and contextual aspects involved Decision-making process Commonly, the best alternative is considered There is not just one the one that is in right and one wrong accordance with the alternative! ethical norms and moral values of a community  Other components of ethical dilemmas? Conflict or opposition between 2 or more moral values/principles Compromises well-being Communication difficulties are often present Difficult for the health care team Difficult for the patient/family (Olsen, 2017) Copyright © 2024 Ingram School of Nursing  Aligning Values to Practice: Example importance of aligning the care with our values -recogninze when social inequities is prevent in health -make the rule and access to care as fair as possible ee Colleen Varcoe: Equity is Good for Everyone - YouTube Ethical Decision-Making Tools & Frameworks how to work trough an ethical dilemma 1. IDEA Framework 2. Canadian Nurses Association (CNA) 3. Storch Model 4. Community Ethics Toolkit NUR1 - 424 Copyright © 2024 Ingram School of Nursing  IDEA: Ethical Decision-Making Framework four main steps -cycle Image: IDEA: Ethical Decision-Making Framework. Regional Ethics Program (2013). IDEA: Ethical decision-making Framework. Trillium Health Partners. https://trilliumhealthpartners.ca/aboutus/Documents/IDEA -Framework-THP.pdf  1. Determine 8. Explore 9. Decide the who is options and course of Canadian Nurses involved alternatives action Association (CNA) other model for decision making 2. Describe the 7. Clarify legal 10. Develop an issue rules action plan 6. Identify 3. Assess the 11. Evaluate ethical situation the plan principles 5. Explore the 4. Clarify story and note Image: Cover of Code of Ethics for values Registered Nurses (2017) and Logo of Canadian Nurses Association. reactions  Storch Ethical Principles Model Social Expectations Values/Beliefs Legal Requirements Value Conflicts Step 2: Clarification & Evaluation Step 1: Information& Range of Actions/ Step 3: Identification Anticipated Action & Professional Review Consequences Codes of Ethics Image: Adapted from Appendix A: Storch Model for Ethical Decision-Making (p.538). Storch et al. 2013 OIIQ Ethics self- study guide  Identifying the ethical question try to understand whats going, understand the different point of view, what are the stakes -50% of the work -take the time to look at everyone's perspective, everyone who's involve in this Class 2: Ethical dilemmas and tools how to ask and frmulate a good ethical question Copyright © 2024 Ingram School of Nursing SBNH values are not the same as the principles helps us articulate what are the different values at stake -important to articulate all of the different persectives: even if you don't agree with them -has to be an open question, not to broad question, not yes/no question -good exemple: what is at stake when, what are the possible implication  I case study Woman Stop life who wants I s sustaining therape - Good questions Autonomy US good doing > - What a re the implications : what are the factor we need to considered In order to find the ethical question ; we ~ What a re the factors that lead her into this decision - Does she understand the consequence of action - Is she educated on all the choices there is - What is going to happen during the 2 years of rehab h ow is her mental health : is depressed/discouraged What the ethical implication of stopping +x - > a re > - Is the pt able to make the decision CASES Encounters with Moral Distress We don't have enough nurses! Why are we doing all of this? Patients should not suffer in pain! A person should die with dignity! What is best for the child? It's difficult to be a nursing student! They are not competent! Carnevale (2013)  Moral Distress is... Negative feelings that arise when one knows the correct response to a situation but cannot act accordingly because of institutional or hierarchical constraints (Jameton 1984) know what the good decision is but you can't You get to it Psychological disequilibrium and state of negative feelings experienced when a person makes a moral decision but does not follow through by performing the moral behaviour indicated by that decision (Wilkinson 1987) V.1  Moral Distress is NOT... Moral uncertainty: when one does not know the correct course of action or moral choice when faced with a number of different options and differing values (Jameton 1984) Emotional distress (McCarthy & Deady 2008) V.1  Moral Distress is... Negative feelings that arise when one knows the correct response to a situation but cannot act accordingly because of institutional or hierarchical constraints (Jameton 1984) Inflict with the definition a right How doyouwhat > - is the thin o > - Place the n u rs e as a victim V.1  Moral Distress Distress not necessarily an indication of personal weakness Distress can be an indication of professional conscience in confrontation with an environment that prevents clinicians from practicing in an ethically correct manner Moral distress can be an indicator of problems in the practice environment V.1 From Moral Distress to Moral Agency Agency: capacity for a person to engage in deliberate action Moral agency: A stronger framework for understanding the moral dimension of clinical practice A person’s capacity to engage in deliberate actions that are morally relevant Pertaining to matters of right & wrong, good & bad, just & unjust All nurses are moral agents! Hunt & Carnevale (2011)  What Nurses Can Do to Address Moral Distress Recognize the symptoms of moral distress Reflect on and be curious about the ethical aspects of clinical situations Reconnect to your original purpose and intention for being a nurse Leadership Commit to your personal well-being Support and restore your moral integrity Learn to listen to your intuition and somatic responses Develop ethical competence Speak up about your ethical concerns Take principled actions Contribute to a culture of ethical practice NUR1 - 424 (Adapted from Rushton, Caldwell, & Kurtz, 2016) Moral Courage, Resilience, and Communities 'Becoming' as a nurse  Moral Courage: an expression of moral agency  Moral Resilience: “The capacity of an individual to sustain or restore their integrity in response to moral complexity, confusion, or setbacks.” —Cinda Rushton (2016) Moral Resilience Going Beyond the Individual Resistance and System Improvement (Traynor, 2017)  Moral Community Workplace where values are made clear and are shared, where these values direct ethical action and where individuals feel safe to be heard (adapted from Rodney, Buckley, Street, Serrano, & Martin, 2013). Coherence between publicly professed values and the lived reality is necessary for there to be a genuine moral community (Webster & Baylis, 2000). NUR1 - 424