NUR1 424 Fall 2024 Class 2 Part 1 Normative Theories PDF

Announcements If you want to make announcements in class, please let us know ahead of time (by Thursday am) to add the slide and decide on timing. Canadian Black Nurses Alliance McGill Chapter  ▪ Est.2021 ▪ The mission of this non-profit organization is to serve,...

Announcements If you want to make announcements in class, please let us know ahead of time (by Thursday am) to add the slide and decide on timing. Canadian Black Nurses Alliance McGill Chapter  ▪ Est.2021 ▪ The mission of this non-profit organization is to serve, mentor and empower Black Canadian nurses through the power of community. ▪ Through CBNA - McGill, black nursing students will have an avenue to connect with one another, support Mission and share resources enabling them for a successful academic and professional career as Canadian Black nurses. Furthermore, they will feel empowered, take on leadership positions, and draw inspiration through interactions with nurses of color successfully navigating different areas of the nursing profession. Past events  Allies Welcomed! (and necessary) The McGill CBNA Chapter welcomes new members. To learn more, visit their Instagram page: @cbna.mcgill Our email address: [email protected] OR [email protected] For more information about the CBNA, visit https://canadianblacknursesalliance.org/ Thank You!  Introduction to Normative Ethics Marianne Sofronas, RN, PhD Faculty Lecturer, Ingram School of Nursing, McGill University with thanks to Catherine-Anne Miller Copyright © 2024 Ingram School of Nursing NUR1 424 Fall 2024 Situating class material for Week 2 ⊹ Lecture: ethical theories, dilemmas, tools, moral distress/agency/courage/communities × Adds to Walton (2019) reading from class 1 ⊹ Supplemental material on MyCourses: × Feminist ethics and ethic of care content + videos × How to formulate an ethical question × Readings: Kotalik & Martin (2016); Keatings & Adams (2024) × Research ethics: Storch (2023) × Glenda Sandy: Indigenous perspectives on ethics  Learning objectives ⊹ Compare how each ethical theory can provide a distinct perspective on ethical issues ⊹ Recognize ethical dilemmas and situations where fundamental values are in opposition ⊹ Articulate an ethical issue in practice using the frames of ethical theories, principles, and values ⊹ Apply an ethical analysis process to ethical dilemmas ⊹ Reflect on moral resilience as a valuable concept to foster growth in nursing when faced with moral distress Where are we? NUR1 - 424  Guidance/Sources of Nursing Ethics ⊹ Legal frameworks ⊹ Codes of Ethics ⊹ Coursework/Clinical Placements ⊹ Institutional Policies and Procedures ⊹ Clinical Ethics Service ⊹ Other Supports: institutional and external ⊹ History of Medicine/Nursing ⊹ Moral Philosophy/Bioethics NUR1 - 424  Content for Class 2 ⊹ A) Normative Ethics × Virtue Ethics × Utilitarianism × Deontology × Principlism × Other paradigms: Narrative Ethics, Relational Ethics, Casuistry, Interpretivism × Feminist Ethics and Ethic of Care (screencast on MyCourses) ⊹ B) Ethical Dilemmas and Decision-Making Process ×Ethical Dilemmas defined ×Ethical Decision-Making Tools & Frameworks ×The Ethical Question; review of cases ×Moral distress, moral resilience, and moral courage  What is an ethical theory/framework? ⊹ A basic structure developed to organize a number of concepts (focused on a particular set of questions) ⊹ Historically, culturally, socially embedded phenomena ⊹ Developed and refined over time ⊹ Each has utility, strengths/weaknesses ⊹ ”Good to think with" ⊹ Different approaches and starting points, e.g., based on principles, rules, rights/obligations, virtues 1 Virtue Ethics Virtue Ethics ⊹ Focus on the moral agent ⊹ Rather than asking "what should I do?" Virtue ethics asks: o What kind of person am I? o What kind of person should I be? ⊹ Eudamonia: “human flourishing” The challenge is to do the right thing “to the right person, to the right extent, at the right time, with the right motive, and in the right way.” - Aristotle “The Politics” Book II, Chapter IX (Aristotle 350 B.C.E, as translated in Ross,1925; Rachels, 2003)  Virtue Ethics: Features Virtue: “a trait of character, manifested in habitual action” (Rachels, 2003. p.175) ⊹ The Aristotelian Mean ⊹ Mean between extremes (of deficiency and excess) ⊹ The just middle may differ from one individual to another (Aristotle 350 B.C.E, as translated in Ross ,1925; Rachels, 2003) Phronesis – Practical Wisdom "A virtuous person is someone who deliberates and sees things in particular ways and has the right sort of emotional response to situations. A virtuous person also acts on his or her perceptions of what ought to be done. This idea is called phronesis, or practical wisdom..." (Wolff, 2018,​ p.205)  Virtue Ethics: Critiques ⊹ No clear guide as to how to act ⊹ Weighing of virtues – what if they conflict? ⊹ Focuses on agent's own character, not how to behave towards others ⊹ Assumes virtuous people will always make the right choice ⊹ Do virtues change over time? ⊹ Difficult to apply across cultures ⊹ Lacks guidance as to how to become virtuous NUR1 - 424 (Oakley, 2009; Pellegrino, 1985; Rachels, 2003; Wolff, 2018, Yang et al. 2010) 2 Utilitarianism  Jeremy Bentham "The Greatest 1748-1832 Happiness Principle holds that actions are right in proportion as they tend to promote happiness and wrong as they tend to produce the reverse of happiness." John Stuart -J.S. Mill (1863) Mill 1806-1873 Image: Image: John Stuart Mill. Public Domain Jeremy Bentham, by Henry William Pickersgill, Public Domain What is good? What is right? Actions are right based on what produces the "most good" All that matters is well-being/ happiness/ absence of pain Actions are right/wrong based on the calculation of utility/consequences Greatest happiness for greatest number of people Each person’s happiness is equal “Sins of commission & omission" (Mills, 1863; Wolff, 2018; Savulescu & Birks, 2012)  Does the end justify the means? Critiques… ⊹ Only looks at future consequences, which are to a certain extent unknowable ⊹ Who defines what is "good"? And for whom? ⊹ Possible conflicts with social justice & rights ⊹ Penalizes vulnerabilized minorities NUR1 - 424  Utilitarianism in Healthcare ⊹ Scarcity – Limited Resources & Allocation of Resources ⊹ Striving for collective good (public health) ⊹ Evidence-informed care ⊹ Global health (Felzmann, 2017; Savulescu, Persson, & Wilkinson, 2020; Singer, 1972; Wolff, 2018) 3 Deontology Kant and the Categorical or Moral Imperative (aka the Golden Rule) “Act as if the maxim of your action were to become by your will a universal law of nature.” - Immanuel Kant 1785 (as translated by Gregor & Timmermann, 2012, p. 42) Immanuel Kant (1724-1804) What is good? What is right? ⊹ Non-consequentialist ⊹ Rather than results, moral worth = motive of duty ⊹ Actions should be motivated by duty to be right and good ⊹ Requires following of rules because morality based on human reason ⊹ Universal laws: certain principles are “unconditionally good” ⊹ Ought to do right thing for right reason V.1 (Kant, 1785, as translated by Gregor & Timmermann, 2012) Deontology: Features All humans have dignity and require respect We are all rational beings capable of reason Moral worth involves free will and is found in choices that are in accordance with principles Autonomous when we act out of moral duty (Burkhardt, Nathaniel & Walton, 2018; Kant, 1785, as translated by Gregor & Timmermann, 2012; Rachels, 2003; Sandel, 2009)  Deontology: Critiques ⊹ Outcomes and context are not particularly considered ⊹ Denies exceptions ⊹ What about conflicting duties? ⊹ Who makes the rules and who do they apply to? Who determines moral duties? ⊹ Dismisses moral value of actions motivated by emotions or “good will” because motivation is not duty (Burkhardt, Nathaniel & Walton, 2018; Wolff, 2018b) Deontology in Healthcare and Nursing ⊹ Kantian duties in Codes of Ethics ⊹ Duty-based language often underpins laws, roles, and responsibilities ⊹ Dignity, respect, and promotion of autonomy (Burkhardt, Nathaniel & Walton, 2018; Kearns, 2017) 4 Principlism Beauchamp, T. L. (2013). Principles of biomedical ethics. Oxford University Press. Principlism: Features Autonomy Beneficence Nonmaleficence Justice  Strengths Critiques ⊹ Common language ⊹ Risks of using as a ‘recipe’ ⊹ Widely used ⊹ Ignores context? ⊹ Structured ⊹ Is there consensus on these 4 ⊹ Focus on rationality and analysis principles? Rodney et al (2013) NUR1 - 424  Other Paradigms: 5 Relational Ethics Narrative Ethics Casuistry Hermeneutics  Relational Ethics ⊹ Embodiment ⊹ Mutual Respect ⊹ Engagement ⊹ Locates ethical action in the therapeutic relationship NUR1 - 424  Narrative Ethics Copyright © 2022 Ingram School of Nursing V.1 Casuistry "the art or skill of applying abstract or general principles to particular cases." ~Jonsen, 1986, in Abbas (2017) p.464. Interpretivism ⊹ Phenomenology/Hermeneutics ⊹ Understanding in light of "Horizons of Significance"