Ethical Decision Making Lecture PDF

1  Ethical Decision-making Ethical decision-making refers to the process of evaluating and choosing among alternatives in a manner consistent with ethical principles. In making ethical decisions, it is necessary to perceive and eliminate unethical options and select the best ethica...

1  Ethical Decision-making Ethical decision-making refers to the process of evaluating and choosing among alternatives in a manner consistent with ethical principles. In making ethical decisions, it is necessary to perceive and eliminate unethical options and select the best ethical alternative. 2 Ethical Decision Making: Common Themes or Models  Clarification of the ethical dilemma- gather data  Determine if an ethical principle/s can guide the decision making process  Evaluate options- unpack the elements  Seek advice if possible  Justify the position and act on it 3  Guidelines for Ethical Reasoning Ethical reasoning holds two roles in life: Highlighting acts that enhance the well-being of other people. Highlighting acts that harm the well-being of other people Stay open-minded. Challenge your own views. It’s not enough just to hold a position, you must be able to support it with good reasons. Challenge the views of others if you disagree with them, but do so respectfully and considerately. Philosophical discussion loses most of its value if it’s used as a place to dominate or show off. Philosophical discussion is best done as a community enterprise, where all the discussants work together to get closer to the truth. 4  Ethical Decision Making The process of making informed choices about ethical dilemmas based on a set of standards differentiating right from wrong. wrong The changing meaning of ‘communication’ alone will bring with it new concerns by healthcare professionals for protecting patients’ rights of confidentiality, privacy, and autonomy. autonomy 5 The process of making ethical decisions requires: Commitment: The desire to do the right thing regardless of the cost Consciousness: The awareness to act consistently and apply moral convictions “opinions” to daily behavior Competency: The ability to collect and evaluate information, develop alternatives, and foresee potential consequences and risks 6  Ethical Committee Healthcare organizations establish formal ethics committees to provide consultation on situations in which ethical issues have arisen. Purpose of Ethical committee Known causes of moral distress for ICU clinicians include the failure to respect a patient’s known prior expressed capable wishes, failure to protect patients from harm, the treatment of patients as objects, and the prolongation of the dying process. Conflict between patient and family wishes often occurs. The debriefing sessions have helped clinicians experience and express their concerns, develop consensus plans of care & create educational programs on ethical topics. 7  Approach Assessm ent Planning Im plementation Evaluation Am I involved Determ ine goals W ork tow ards Determ ine of treatm ent a m utually w hether desired acceptable decision outcom es have been reached Collect Identify Use of Re-evaluate as necessary the facts Decision-M akers discussion and negotiation W hat Values are in confl ict List and Rank the options 8 How do we know that we are making the right decisions for our patients? 9  We all know that nursing professionals have the responsibility of being altruistic. This means that we have the ethical obligation to serve others without self-interest. The nurse that is altruistic will make decisions that are in the best interest of the patient. By doing so, they are being a patient advocate and will be practicing good nursing ethics. 10  Today, with modern technology, we can keep people alive indefinitely. But is that always the best option for the patient or their family? We put patients on life support, hook them up to multiple tubes, and pump them full of nutrients and medication. But will they ever have a chance at a productive life? These are the difficult questions that healthcare providers have to continually ask themselves. 11 ETHICAL Model for Decision Making “EDM” Examine the ethical dilemma Thoroughly comprehend the possible alternatives Hypothesize ethical arguments Investigate, compare, and evaluate the arguments for each alternative Choose the alternative you would recommend Act on your chosen alternative Look at the ethical dilemma and examine the outcomes while reflecting on the ethical decision 12  Factors that influence EDM 1. Codes for Nurses 2. The patient’s rights 3. Social and cultural attitudes 4. Science and technology 5. Legislation 6. Judicial –legal-decisions 7. Funding 8. Personal religious & philosophic viewpoint 13 Factors in the work environment that affect EDM 1. Status as an employment 2. Collective bargaining contracts 3. Collegial relationships 4. Authoritarian & paternalistic background 5. Ethics committees in health care 6. Consumer involvement in health care 14  Ethics Committees Many health care agencies now recognize the need for a systematic manner whereby to discuss ethical concerns. Multidisciplinary committees offer dialogue regarding ethical dilemmas. Ethics committees can lead to the establishment of policies and procedures for the prevention and resolution of dilemmas. 15  Ethics Committees With the increasing complexity of ethical issues in health care, ethics committees have been created to assist in making ethical decisions in clinical settings. Ethical committees can: 1. Provide structure and guidelines for potential problems. 2. Serve as an open forum for discussion & debate. 3. Function as a patient advocate by placing the patient at the core of the committee’s deliberations. 16 Enhancing Ethical Decision- Making Becoming aware of personal values and ethical aspects of nursing Becoming familiar with nursing code of ethics Seeking continuing education to remain knowledgeable about ethical issues in nursing Respecting the values, opinions, and responsibilities of other health care professionals Participating in or establishing ethic rounds Serving on institutional ethics committees 17 DECISION MAKING ABCDE MODEL 18 A = ASSESS: What is the problem or decision? B = BRAINSTORM: BRAINSTORM What are the possible choices or solutions? C = CONSEQUENCES: CONSEQUENCES Consider the consequences of each choice – both positive and negative D = DECIDE: Make a decision and act! E = EVALUATE: EVALUATE Evaluate the choice you made and the positive / negative consequences 19 20