McGill University Nursing Ethics Notes 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? tools that help with your thinking ⊹ A basic structure developed to organize a number of concepts (focused on a particular set of questions) /themed ⊹ Historically, culturally, socially embedded phenomena ⊹ Developed and refined over time not static, and still relevant long time after they're created ⊹ Each has utility, strengths/weaknesses ⊹ ”Good to think with" ⊹ Different approaches and starting points, e.g., based on principles, rules, rights/obligations, virtues 1 first theory Virtue Ethics  not what decision should I make but what kind of perosn i want to be , self centered, what kind of a person am I and what kind of person should i be Virtue Ethics oldest theory,one of the 3 major aproaches ⊹ 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” what is acting ethically for him: 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.” integrety in the action, the motive should be aligned, right - Aristotle “The Politics” Book II, Chapter IXamount of action, not too much (Aristotle 350 B.C.E, as translated in Ross,1925; Rachels, 2003)  Virtue Ethics: Features not focused on rule principle, but on the character of the perosn -act well in all the area of your life, focused on action (doing the right thing) -virtue n the the middle, between excess and defficiency (do not too much not too little) 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)  important to be abble to act morally Phronesis – Practical Wisdom emotion and cognition is included to know what is the right thing to do "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) tt  Virtue Ethics: Critiques can tell you what is it that you want to be but can't guide you in how to act ⊹ 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 all about me, what i want to do (impact on other people not included) ⊹ Assumes virtuous people will always make the right choice ⊹ Do virtues change over time? growth mindset, ⊹ Difficult to apply across cultures ⊹ Lacks guidance as to how to become virtuous hw does one become virtuus what we retain in nursing way to reflect on what we want to do, who we want to be as clinitians NUR1 - 424 (Oakley, 2009; Pellegrino, 1985; Rachels, 2003; Wolff, 2018, Yang et al. 2010) 2 Utilitarianism the end justify the means deontoly vs utilitarianism: do the end justify most imoportant is the result; is the result good or bad the mean or not  assessing our hoices, what is the morally best choice 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? right or wrong based only on the consequences to measure : we compare the amount of hapiness (good) to the amount of pain (wrong) Actions are right based on what -some good are better than produces the "most good" others: small goods can be sacrificed for longer more All that matters is well-being/ sustainalbe goods -everbody's hapiness has the happiness/ absence of pain same value 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" sin of comission and omission: impact of doing nothing, doing nothing is also a desicion (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 & how to promotes the grestest good for the greatest number of Allocation of Resources people, allocation of healthcare ressources, efficiency ⊹ Striving for collective good (public pandemic: everyone took a small inconvenience for the greater good health) ⊹ Evidence-informed care ⊹ Global health (Felzmann, 2017; Savulescu, Persson, & Wilkinson, 2020; Singer, 1972; Wolff, 2018) 3 Deontology not the results but how you got there the end don't justify the mean, the means matter more 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? we use reasoning, the reasoning is more important, moral worth of action: are you act morally towards the good of others ⊹ 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 most frequently used paradigm Beauchamp, T. L. (2013). Principles of biomedical ethics. Oxford University Press.  Principlism: Features Autonomy Beneficence Nonmaleficence Justice idea of your wright to self take step to help other not seek to inflict harm fairness in determining what people determination, being in to do good and to and group are entitled to charge of one's self promote good Sub-principles veracity: telling the truth fidelity: be faithfull to you commitment, keeping your promise  Strengths Critiques ⊹ Common language ⊹ Risks of using as a ‘recipe’ robotic thinking ⊹ Widely used ⊹ Ignores context? ⊹ Structured how to think about and talk abut ethical delimma ⊹ Is there consensus on these 4 ⊹ Focus on rationality and analysis principles? principles can come in conflict with each other, some principles can be sacrificed for other for explemple autonomy can be sacrificed: -suicide prevention, someone is actively choosing against your own wellness, it's possible to take off you autonomy for your own good Rodney et al (2013) NUR1 - 424  Other Paradigms: 5 Relational Ethics Narrative Ethics Casuistry Hermeneutics  Relational Ethics happens in our everyday interaction, not big dilema all the time happens in the cintect of our everyday ⊹ Embodiment ⊹ Mutual Respect ⊹ Engagement ⊹ Locates ethical action in the therapeutic relationship NUR1 - 424  Narrative Ethics not helping us resolves delimma/make decision use narration to understand delima in someone's life, experience how things are lived/ understood -offers disruptive narrative, include everyone voices to think through some ethical dilemma Copyright © 2022 Ingram School of Nursing V.1 Casuistry methods of application of theory and applied ethics "the art or skill of applying abstract or general principles to particular cases." ~Jonsen, 1986, in Abbas (2017) p.464.  Interpretivism based of philosophy (phenomenology) looks at the idea of experience, more abstract -things presents themself to our senses and we experience them and interpret them based on our history/culture/beliefs ⊹ Phenomenology/Hermeneutics ⊹ Understanding in light of "Horizons of Significance" ethical approach: