Bioethics-2024-lec-1.pdf

BIOETHICS  NCM 108 HEALTH CARE ETHICS (BIOETHICS) Diadima D. Lucas RM, RN, MAN BIOETHICS I. INTRODUCTION TO BIOETHICS Episode 1 Course Description This course deals with the application of ethico-moral concepts and principles affecting care of individuals, families,...

BIOETHICS  NCM 108 HEALTH CARE ETHICS (BIOETHICS) Diadima D. Lucas RM, RN, MAN BIOETHICS I. INTRODUCTION TO BIOETHICS Episode 1 Course Description This course deals with the application of ethico-moral concepts and principles affecting care of individuals, families, population group, and community. Definition The term Bioethics is made up of two parts (from the Greek word bios means life; and ethos, means behaviour ) was coined in 1926 by Fritz Jahr, So Bioethics - is ethics of life Definition Bioethics is the application of ethics to the field of medicine and healthcare and Ethics means the science of right doing/ what is good behavior and what is bad behavior SIGNIFICANCE OF BIOETHICS 1. To provide awareness to the members of the health profession of the do’s and dont’s of medical and nursing practice. 2. It will enlighten us on what, why, where, when and how we ought to act or execute our duties and responsibilities in the field of nursing SIGNIFICANCE OF BIOETHICS 3. Enhance the competence by understanding that the patient is a person and a holistic individual— meaning human being in not only consist of physical, but also mental and emotional aspect,, so when we care, we care/consider them all Purpose of Bioethics 1. It entails the objective appraisal of how our values, desires and actions affect others, including animals and the environment in short it will make us careful in executing our duties and responsibilities to avoid any untoward results/or to avoid hurting someone including animals and our environment Purpose of Bioethics 2. It mandates that equal and fair consideration be given to: human rights issues, animal rights issues, and environmental concern. Be fair in everything you do…regardless of status Terms Related to Bioethics 1. Health - the state of being free from illness or injury. - a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity. WHO Terms Related to Bioethics 2. Ethics –studies of human acts or conduct from a moral perspective as to whether they are good or they are bad Morality vs Ethics Ethics Morality personal and normati standards of ve “good and bad” Science of right doing knowledge wisdom Morality vs Ethics 4. Custom - is a pattern 3. Etiquette of behaviour that is "the rules indicating followed by members of the proper and polite a particular culture way to behave.“ action approved by good manners group or society Acceptable behaviour e.g. shaking hands upon Table etiquette, work meeting someone Health Ethics branch of ethics that deals with ethical issues in health, health care, medicine and science. It involves discussions about treatment choices and care options that individuals, families, and health care providers must face. Health Care Ethics (a.k.a “medical ethics”) is the application of the core principles of bioethics to medical and health care decisions. Scope of Bioethics All aspects of human life – before birth, during his life and after death – fall within the scope of bioethics. It consists of human conducts that directly and particularly relate to the application of technology in his natural life…. E.g. Genetic Engineering CONCEPT OF NURSING ETHICS Nursing is consistently rated as the most honest and ethical profession ( Louisiana State University at Alexandria) Dean Recio: once said that “you can not be a nurse if you are not honest” So here in Nursing “honesty is the best policy”. CONCEPT OF NURSING ETHICS Nurses practice and use ethics on a daily basis In everything we do , we use ethics.. Ethical decisions have become routine and inherent/inseparable part of clinical practice for registered nurses. CONCEPT OF NURSING ETHICS Many times nurses experience moral distress when faced with making ethical decisions in practice,: partly because of lack of knowledge and education about ethical content and the ethical topic itself CONCEPT OF NURSING ETHICS and partly because nurses are placed in volatile ethical situations where they feel forced to continue treatment beyond a possible cure. This profession is a profession of decisions, we always make decision whenever we perform ,,,so be careful in your decision- making possible cure. Principles of the Nursing Profession This profession is a profession of decisions, we Patients always entrust their dignity to nurses, so nurses make decision whenever we perform ,,,so must guard their privacy, listen to their concerns and be careful in your decision-making consider their wishes concerning the care they want ion is a profession of decisions, we always make to receive… decision whenever we perform ,,,so be careful Our patient is our boss…and client, they have all the in your decision-making right to receive their rights as patients…so give their dues… This profession Ex. privacy is a profession of decisions, we always make decision whenever we perform ,,,so be careful in your decision-making possible cure. Principles of the Nursing Profession This profession is a profession of decisions, we Ethics is fundamental to nursing. always make decision whenever we perform ,,,so be>All nurses should respect careful in your decision-makingtheir patients, maintain patients’ dignity and protect ion is a profession of decisions, we always make patients’ rights. decision whenever we perform ,,,so be careful in >Nurses must create an environment of your decision-making mutual trust and respect between patients andprofession This healthcareis aprofessionals. profession of decisions, we always make decision whenever we perform ,,,so possible cure. Principles of the Nursing Profession This profession is a profession of decisions, In Summary, Nursing is a calling…we must do our we always duties make decision whenever and responsibilities out ofweloveperform …with ,,,so be carefuland dignity… in your withdecision-making compassion … ion Andis in a profession everything weof decisions, do ,,, do it we withalways makeas our might unto thewhenever decision Lord…andwe notperform unto men….trying to honor ,,,so be careful in and decision-making your please God rather than men… Godprofession This bless us…. is a profession of decisions, we always make decision whenever we perform ,,,so FOUNDATIONAL ETHICAL CONCEPTS and HISTORICAL PERSPECTIVE of ETHICS in NURSING I. WHY STUDY ETHICS IN NURSING? I. WHY STUDY ETHII. WHY STUDY ETHICS IN I. WHY NURSING? STUDY ETHICS IN NURSING? Ethics CS within healthcare are IN NURSING? important because workers must recognize healthcare dilemmas, make good judgments and decisions based on their values while keeping within the laws that govern them. I. WHY STUDY ETHICS IN NURSING? I. WHY STUDY ETHII. WHY STUDY ETHICS IN I. WHY NURSING? STUDY ETHICS IN NURSING? CS IN NURSING? A. Difficult ethical encounter experienced by nurse in the clinical setting (Ethical Challenges) e.g. - oncology nurses - emergency care providers I. WHY STUDY ETHICS IN NURSING? I. I.WHY STUDY ETHII. WHY STUDY ETHICS WHY STUDY ETHICS IN NURSING? IN NURSING? CS IN NURSING? Oncology nurses a. Resuscitation state of the patient b. Futile treatment c. Not telling the truth d. Dying with dignity e. Conflicting values in pain management f. Use of resources g. Decision-making at the end-of-life-care h. Giving bad news ( Baysal et al., 2019) I. WHY STUDY ETHICS IN NURSING? I. WHY STUDY ETHII. WHY STUDY ETHICS IN I. WHY NURSING? STUDY ETHICS IN NURSING? CS IN NURSING? Emergency care providers a. Perception of the situation b. Patient-related factors c. Input and output imbalance d. Uncoordinated health system  B. Unsupportive organizational environments 1.Low staffing levels 2.Overload of work 3.Hierarchical interactions that do not promote the dignity of nurses  B. Unsupportive organizational environments Specifically, nurses’ ethical conflicts were related to situations such as; Violated the rights, safety or well being of the patient or relatives, those that threatened nurses 'dignity and professionalism, inadequate attention to the moral conflict of nurses’ values, physician-nurse- power hierarchy, influence of culture and insufficiency of patient care and prof collaboration.  C. Moral Distress/ Ethical Dilemma by professional nurses, newly graduates and nursing students -Specifically, feelings of moral distress were associated with the following; 1. Professional anguish over patient care decisions - e.g. concerns of continuing life support measures perceived not in the patient’s best interest or futile care;  C. Moral Distress/ Ethical Dilemma by professional nurses, newly graduates and nursing students 2. Team & unit level concerns – e.g. – poor communications, bullying, working with incompetent colleagues, witnessing practice errors and lack of collegial collaboration.  C. Moral Distress/ Ethical Dilemma by professional nurses, newly graduates and nursing students 3. System- level factors – e.g. –feeling unsupported by senior administration and institutional culpability as a result of health care processes and system constraints impeding reliable patient care delivery.  Result of Moral distress Burn – out Leaving the profession Moral disengagement leading to ethical insensitivity Withdrawal from the moral dimensions of patient care Even now nsg students and nsg graduates are not exempt Bullying, Exclusion, being a scapegoat, collegial incivility can cause ethical tensions making them doubt their capabilities due to lack of experience, at worst, new graduates experience disillusionment from lost ideals about ethical practice.  Review only Ethics Nursing ethics Nurse practice acts vs. Code of ethics Nursing code of ethics-BON resolution 220 series 2004 Provide guidelines for safe and compassionate care Guarantees the public that nurse adhere to standards of professional practice. Page 11  Review only International Council of Nurses Code of Ethics 4 Fundamental Responsibilities To promote health To prevent illness To restore health To alleviate suffering Page 11 SESSION 2 Theories and Principles of Nursing Ethics II. THEORIES AND PRINCIPLES OF NURSING ETHICS Episode 2 Theories and Principles of Health Ethics A. Ethical theories B. Virtue ethics C. Ethical Principles D. Other relevant Ethical Principles II. THEORIES AND PRINCIPLES OF NURSING ETHICS A. ETHICAL THEORIES 1. DEONTOLOGY theory aka, formalism or Kantianism (Immanuel Kant) ( Duty-oriented theory ) it is sometimes described as "duty" or "obligation" or "rule" based ethics, because rules "bind you to your duty". In this terminology, action is more important than the consequences Actions must be guided by adherence to principles DEONTOLOGY – implies that ethics are derived from fulfilling duties Most professional codes of ethics are based upon Kantian principles Nurses’ code of ethics stress the importance of: fulfilling duties that are inherently owed to patients, preserving the dignity and autonomy of each individual patient You are utilizing Deontic Principles if: Maintain confidentiality Advocate for a patient Keep your promises Tell the truth Practice expert skills DEONTOLOGY Encompasses the following: 1. Natural law-/eternal law- we must do good and we must avoid evil (St. Thomas Aquinas) 2. Kantianism- an action could be known right when it is in accordance with a rule that satisfies a principle Kantianism >Ethical rules are universal that humans can drive certain principle to guide actions >emphasizes conscience and represented God primarily as the moral ideal.  DEONTOLOGY 3. Ross’s Prima Facie Duties : is a duty that is binding or obligatory, other things being equal. is one that dictates what we should do when other relevant factors in a situation are not considered: 1. Duty of fidelity- faithful and practice of keeping promises 2. Duty of reparation – duty of compensation, repair  Ross’s Prima Facie Duties 3. Duty of justice – fairness to everyone 4. Duty of beneficence – promote good, prevent/remove harm or evil 5. Duty of self-improvement – aim to self cultivation/self development  Ross’s Prima Facie Duties 6. Duty of non-maleficence – avoid causing harm during performance of beneficial acts 7. Duty of gratitude – appreciate and recognize the service others done for us In short …we are guided by rules and regulations in our actions,,, so we must act according to principles… For example …we nurses have the so called aseptic principle… Every time we are going to clean anything, it must be from cleanest to dirtiest part or surface…it could be a wound cleaning or merely cleansing our hands, always start with the cleanest part… that is adherence to principle of aseptic technique  2. TELEOLOGICAL THEORY Consequence-oriented theory) Ethical egoism Utilitarianism aka consequentialism Eudaimonism Focuses on consequences, utility or end/result Judges the rightness or wrongness of decision based upon the outcome, or predicted outcome Derives duty or moral obligation from what is good or desirable as an end to be achieved Promotes the greatest good for greatest number E.g. utilitarianism – the greatest good for the greatest or utility it provides and selecting the course number/end of action is survival & growth -when the decision is based on listing the possible alternatives for action, weighing it in regard to the amount of pleasure of action that maximizes pleasure In this theory, the most important is the result,,, it should be a good or desirable outcome whatever the means on achieving it… or how it could be attained the outcome as long is it is a positive outcome, not minding the principles…unlike the deontology which is principle based  B. Virtue Ethics Virtue – means morally good behaviour or character Virtue ethics is person rather than action based it looks at the virtue or moral character of the person carrying out an action, rather than at ethical duties and rules, or the consequences of particular actions.  B. Virtue Ethics It is reasonable to say that good character is the cornerstone of good nursing care, and the nurse with virtue will act according to principles ( Basic ethical principles )  B. Virtue Ethics F. Nightingale, thought virtue was an important trait of a good nurse The Nightingale’s pledge, implies virtue of character as nurses promise purity, faith, loyalty, devotion, trustworthiness, and temperance in their endeavour  Nightingale Pledge solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practise my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping, and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those  Virtues of the health care Provider 1.Godly or God-fearing/God- centered - Christ like means imitating Christ, His moral attribute: ----loving….caring …compassionate….. 2. Nationalism -has the virtues of a Filipino Nurses Live the Panatang Makabayan,, memorize it with your heart 3. Fidelity – faithfulness in the relationship of trust… considering the Best interest of the patient first  Virtues of the health care Provider Fidelity, from the Latin fides meaning faithfulness, is concerned with promise keeping, integrity and honesty.... Making promises can change ethically neutral acts into obligations and duties. Among the duties of fidelity is not to neglect the patient having accepted a responsibility for their welfare 4. Honesty – truthfulness, about Illness, prognosis and effectiveness of care  Virtues of the health care Provider Humility Compassion Prudence courage Types of virtue ethical theories: 1. individual character ethics 2. work character ethics 3. professional character ethics  Virtues of the health care Provider Aristotle proposed, “it is not possible to possess excellence in character without wisdom, nor to be wise without excellence of character”. He believed that practice creates a habit of acting in a virtuous way, And that virtue can be learned and improved. personal training and routine practice  VIRTUE Watch your thoughts, they become words Watch your words , they become actions Watch your actions, they become habits Watch your habits, they become character Watch your character, it become your destiny