Ethical Dilemma Lecture Notes PDF

Ethical Dilemma, Ethical decision-making Process & Codes of Ethics for Nurses Session By Bakhtyar Ali Shah Assistant Professor INS, KMU Objectives At the end of this Lecture the students will be able to  Describe E...

Ethical Dilemma, Ethical decision-making Process & Codes of Ethics for Nurses Session By Bakhtyar Ali Shah Assistant Professor INS, KMU Objectives At the end of this Lecture the students will be able to  Describe Ethical dilemma and Justification of Moral Standards  Discuss ethical decision making and its framework.  Identify ethical decision-making process  Discuss Codes of Ethics for Nurses Ethical dilemmas Ethical dilemmas, also known as a moral dilemmas, are situations in which there is a choice to be made between two options, neither of which resolves the situation in an ethically acceptable fashion. Example: Too many patients but scarce resources( How to provide proper care) Don’t resuscitate (DNR) Euthanasia or Irreversible coma Treatment of terminally ill patient like end stage Cancer, HIV etc. Rights of psychiatry patient etc. Ethical dilemmas A decision that morally requires two or more courses of action, which are in practice incompatible with each other. A decision that should "taken in one’s self interest, but which appears to violate a moral principle that you support. It is the imperative to act, combined with the uncertainty of which action to take, that causes a dilemma. Doing morally right Bad outcome Doing morally wrong Good outcome In such a dilemma, choosing one moral will result in violating another; or, doing one thing could bring positive results but is morally wrong. A common example is “stealing from the rich to feed the poor.”  Ethical dilemmas are situations involving conflicting morals claims, and give rise in such questions as What ought I to do? Ethical What harm and benefit result from this decision or actions? dilemmas What is good (virtue) or what is duty (right)? Aroskar et al Ethical Dilemmas in Nursing The challenge of decision making. The sanctity of life vs the quality of life. Truth-telling A code of ethics in nursing basically states that nurses are responsible for respecting human rights and treating all patients with respect while promoting health, minimizing suffering, and preventing sickness. 4 Common Nursing Ethics Dilemmas 1. Informed consent Concerns that patients and their families have not been fully informed about their treatments or clinical prognosis is a common ethical concern of nurses, 2. Disclosing medical conditions/Confidentiality “Sometimes families request that patients not be told about their medical condition or diagnosis. “The nurse must consider the patient's right to know. How does the nurse know what the family is saying is true?” (Altman) 3. NEGLIGENCE occurs when a person fails to perform according to the standards of care. It is the responsibility of the nurse to monitor the patient. 4 Common Nursing Ethics Dilemmas 4. Incompetence among peers Another dilemma when a nurse notes incompetence in a fellow health care team member and struggles with speaking up or staying silent, “Some dilemmas can be framed as competing obligations, such as protecting the patient on one hand and protecting the staff on the other. The principles to consider are nonmaleficence and fidelity. Example: it is the duty of a nurse to provide safe and competent care to the patients. Ethical Dilemma Video https://www.youtube.com/watch?v=oQl6b-fN1BI https://www.youtube.com/watch?v=oQl6b-fN1BI Codes of ethics in Nursing The ANA Code of Ethics for Nurses serves the following purposes: It is a concise statement of the ethical obligations and duties of every individual who enters in the nursing profession.. It is an expression of nursing's own understanding of its commitment to society. What does a code of ethics do? Gives guidance for decision making about ethical matters by providing a set of values that are basic to nursing practice Provide rules of ethical or moral behavior for every circumstance. Offer guidance about which values should take priority or how they can be balanced in practice. American Nurses Association Code of Ethics for Nurses Values and code of ethics Primary values that are central to ethical nursing practice. Providing Safe, Compassionate Competent and Ethical Care: Nurses value the ability to provide safe, compassion, competent and ethical care that allows them to fulfill their ethical and professional obligations to the people they serve. Promoting Health and Well Being: Nurses value health promotion and well being and assist persons to achieve their optimum level of health in situations of normal health, illness, injury, disability or at the end of life. Values and code of ethics Promoting and Respecting Informed Decision-Making: Nurses provide persons with appropriate information and services so they can make informed decisions. Ensure nursing care is given with informed consent. Preserving Dignity: Recognize and respect the inherent worth of each person and advocate for respectful treatment of all persons. Values and code of ethics Maintaining Privacy and Confidentiality: Nurses safeguard the trust of clients that information learned in the context of a professional relationship is shared outside the health care team only with the client's permission or as legally required or where failure to disclose would cause significant harm. Promoting Justice: Nurses apply the principles of equity and fairness to assist clients in receiving unbiased treatment (social justice) and a share of health services and resources proportionate to their needs. Values and code of ethics Being Accountable: Nurses act in a manner consistent with their professional responsibilities and standards of practice and are answerable for their practice. Accountable to the public to ensure that clients receive competent, safe, and ethical care. Ethical decision making In the context of decision making, your ethics are your personal standards of right and wrong. They are your basis for making ethically sensitive decisions. Ethical decision making is a cognitive process that considers various ethical principles, rules, and virtues or the maintenance of relationships to guide or judge individual or group decisions-oriented actions. Ethical Decision-making Model Ethical decision-making models provide a suggested mechanism for critical thinking and planning for the resolution of ethical dilemmas. An ethical decision-making model is a tool that can be used by health care providers to help develop the ability to think through an ethical dilemma and arrive at an ethical decision. The goal of each model is to provide a framework for making the best decision in a particular situation with which the health care provider is confronted. Ethical Decision-Making Process Guide for ethical discussion within the context of health care practice. It incorporates theories, principles and codes into the decision- making process. An ethical dilemma often forces a choice between one or more ethical principles. Deciding in favor of one principle can often violate another principle There is often no clear answer/decision in resolving ethical dilemmas. Often ethical dilemmas pose more questions than provide answers. How to Process an Ethical Dilemma Is this an ethical dilemma? I. CLARIFYING THE PROBLEM 1. Identify the uncertainty 2. Analyze your biases 3. Clarify the question 4. List the major stakeholders I. CLARIFYING THE PROBLEM 1. Identify the uncertainty This is the first and most important step in solving your problem. Take some time to consider the nature of the problem and how you know it’s a problem. Use your ethical sensitivity. 1. What is the main problem? 2. Why are you worried? 3. What information is missing? I. CLARIFYING THE PROBLEM 2. ANALYZE YOUR BIASES Identifying your own values, assumptions, and commitments Your gut feelings and personal motivations can have a profound effect on your decisions. 1. What are your biases and intuitions in this case? 2. What assumptions are you making? 3. What is your role in this situation? I. CLARIFYING THE PROBLEM 3. CLARIFY THE QUESTION Now that you’ve considered the dilemma and your own position on it, think about the question a little further. What is the nature of the conflict and the problem that needs to be solved? 1. What else is needed to move forward with the decision-making process? 2. Who is the ultimate decision-maker? 3. What is the key question? I. CLARIFYING THE PROBLEM 4. LIST THE MAJOR STAKEHOLDERS The list of people who could be affected by the decision can be very long. Understanding the perspectives, values and goals of each stakeholder will improve quality of the ultimate decision. 1. Who will be affected by the decision? 2. Who is accountable for making the decision(s) (if applicable)? (e.g. patient, client, resident, family member, caregiver, health professional, a community, society at large, etc.) II. DESCRIBING THE ETHICAL CONSIDERATIONS 1. CLINICAL/MEDICAL ISSUES Consider each of these topics for clinical (direct care) situations. a. MEDICAL/CLINICAL INDICATIONS Guiding Principles: Beneficence and Non-maleficence What is the person’s medical/clinical issue? History? Diagnosis? Prognosis? ♦ Is the issue acute? Chronic? Critical? Emergent? Reversible? ♦ What are the goals of the intervention? ♦ What are the probabilities of success? ♦ What are the plans in case of therapeutic failure? ♦ In sum, how can this person be benefitted by our interventions and how can harm be avoided? II. DESCRIBING THE ETHICAL CONSIDERATIONS b. PREFERENCES Guiding Principle: Autonomy ♦ Is the person mentally capable and legally competent? ♦ If competent, what is the person stating about preferences for treatment/intervention? ♦ Has the person been informed of benefits and risks, understood the information and given consent? II. DESCRIBING THE ETHICAL CONSIDERATIONS c. QUALITY OF LIFE Guiding Principles: Beneficence, Non-maleficence, Autonomy ♦ What are the person’s views on what makes a desirable quality of life? ♦ What are the prospects/chances, with or without treatment, for a return to a desirable life? ♦ What physical, mental, and social deficits is the person likely to experience if treatment/intervention succeeds? II. DESCRIBING THE ETHICAL CONSIDERATIONS CONTEXT Context will be important to consider for clinical and non-clinical situations. Guiding Principles: Loyalty and Fairness ♦ Are there family issues that might influence treatment decisions? ♦ Are there health care provider issues that might influence treatment decisions? ♦ Are there financial and economic factors? ♦ Are there religious or cultural factors? ♦ Are there confidentiality issues? II. DESCRIBING THE ETHICAL CONSIDERATIONS LIST THE RISKS AND CONSEQUENCES Think about the possible outcomes of the situation. Sometimes a decision will be made based on what will/might happen as a result, and whether the decision-maker is prepared to live with the consequences. ♦ What are the possible harms? Consider the likelihood and level of risk. ♦ How important is it to you? To the person and their family? To the wider community? II. DESCRIBING THE ETHICAL CONSIDERATIONS CONSIDER APPLICABLE RULES AND DUTIES Identify all the rules, guidelines, codes, and obligations that might need to be considered. These can be formal like laws, policies and professional standards, or informal, like social norms and cultural practices. ♦ What rules, duties, procedures or guidelines apply to this situation? ♦ Are there professional codes of ethics that can provide guidance? ♦ Are there legal considerations? II. DESCRIBING THE ETHICAL CONSIDERATIONS LIST THE ETHICAL PRINCIPLES INVOLVED Ethical principles or obligations that guide action. Often, an ethical situation involves conflicts between and among principles. What conflicts exist between/among ♦ Respect for Autonomy ♦ Beneficence ♦ Non-maleficence ♦ Justice ♦ Veracity ♦ Fidelity, Loyalty, and Fairness III. CHOOSING A SOLUTION 1. LIST OPTIONS Brainstorming can help at this stage, try to select the most realistic options. List the options that are most acceptable to the individual or group that is most responsible for implementing the action plan. ♦ List Viable or practicable options ♦ Rank – Most preferable to least preferable 2. MAKE A CHOICE AND JUSTIFY IT ♦ Based on all your deliberations and discussions, decide what is the best option. IV. IMPLEMENTING AND EVALUATING 1. MAKE AN ACTION PLAN ♦ Describe your plan for action and communication. Once the decision is made, communicated and implemented, it is important to review it and know that you made the best possible choice. But there will always be elements you can take and learn from. ♦ How do you feel at the end of the process? ♦ How do others who were involved feel? ♦ Are you comfortable with the outcome? ♦ Are you confident that others are also comfortable with the outcome? IV. IMPLEMENTING AND EVALUATING 3. WHAT HAVE I LEARNED? ♦ Did the process and outcome achieve the desired results? ♦ Were there any unforeseen consequences? References Aroskar; M.A., Davis, A., Drought, T., Liaschenko, J.(1997). Ethical dilemmas and nursing practice https://www.noodle.com/articles/ethical-dilemmas-in-social-work- what-to-know-about-nasw-code-of-ethics Retrieved on 6 April 2020 Ethics Services – Winnipeg Regional Health Authority