ETHICS MIDTERM .pdf

HEALTH CARE ETHICS : NCM 108 ABLE TO FOLLOW AN ETHICAL CODE WHEN WORKING WITH PATIENTS WHICH WAS CLINICAL INSTRUCTOR: MS MASICAMPO ONCE A PROBLEM. -THIS COURSE DEAL WITH THE APPLICATION...

HEALTH CARE ETHICS : NCM 108 ABLE TO FOLLOW AN ETHICAL CODE WHEN WORKING WITH PATIENTS WHICH WAS CLINICAL INSTRUCTOR: MS MASICAMPO ONCE A PROBLEM. -THIS COURSE DEAL WITH THE APPLICATION ETHICAL PROBLEMS HAD A CLEAR OF ETHICO-MORAL CONCEPTS AND CONNECTION TO PROBLEM IN HEALTH PRINCIPLES AFFECTING CARE OF THE CARE, SO BY THE EMERGENCE OF INDIVIDUALS, FAMILIES, POPULATION BIOETHICS, THE HEALTHCARE OF OUR GROUP AND COMMUNITY. COUNTRY HAS BEEN SIGNIFICANTLY -IT INVOLVES DISCUSSION OF ISSUES AND IMPROVED. CONCERNS IN VARIED HEALTH CARE BIOETHICS EDUCATION FOR MEDICAL SITUATIONS PRACTICE IS ESSENTIAL IN TODAY’S - THE LEARNERS ARE EXPECTED TO APPLY COMPLEX WORLD BECAUSE: SOUND ETHICAL DECISION -MAKING IN MEDICAL POLICIES AND PATIENT’S VARIED HEALTH SCENARIOS. RIGHTS LEGISLATION ARE EVER CHANGING. HEALTHCARE SYSTEMS FUNCTION HEALTH CARE ETHICS (AKA MEDICAL DIFFERENTLY THAN BEFORE ETHICS OR BIOETHICS), AT ITS SIMPLEST, IS CLINICAL PRACTICE NOW INVOLVES A SET OF MORAL PRINCIPLES, BELIEFS,AND DECISION MAKING ABOUT MANY ISSUES. VALUES THAT GUIDE US IN MAKING CHOICES ABOUT MEDICAL CARE. BIOETHICS AT THE CORE OF HEALTH CARE ETHICS IS INTERDISCIPLINARY FIELD WITHIN HEALTH- OUR SENSE OF RIGHT AND WRONG AND CARE THAT HAS EVOLVED WITH MODERN OUR BELIEFS ABOUT RIGHT WE POSSSESS MEDICINE ADDRESS QUESTION CREATED AS AND DUTIES WE OWE OTHERS SCIENCE AND TECHNOLOGY PRODUCE NEW WAYS OF KNOWING. IMPORTANCE OF BIOETHICS PHYSICIANS, NURSES, SOCIAL WORKERS, BIOETHICS IN HEALTHCARE BROUGHT PSYCHIATRIST, CLERGY, PHILOSOPHER- etc ABOUR AWARENESS TO HEALTH WORKERS OF THE MEDICAL PRACTICE AS WELL AS ENRICHING THE ABILITY OF HEALTH IT BORN BY NECESSITY OF A CRITIC WORKERS TO FURTHER UNDERSTAND THE REFLECTION ABOUT ETHICAL CONFLICTS. PATIENT AS A PERSON. HIGHLIGHTING THE ETHICAL SIDE OF BIOETHICS, HEALTH WORKERS WERE NOW IT IS IMPORTANT TO KNOW THAT BIOETHICS PHILOSOPHY, THEOLOGY, SOCIOLOGY, AND DOES NOT DEFEND A PARTICULAR MORAL ANTHROPOLOGY. ATTITUDE NOR OFFER DETERMINANT AND ETHICAL CODES IN DIFFERENT ERA WERE DEFINITIVE ANSWERS, BUT IT SEARCHES A BASED ON THE RELIGIOUS BELIEFS OF THE GROUNDED, CRITIC AND ARGUED PEOPLE OR NEEDS OF HUMANITY. REFLECTION CENTERED IN THE SINGULARITY OF A CONCRETE SITUATION. MEDICAL DEFINITION OF BIOETHICS WHAT IS ETHICS - THE DISCIPLINE DEALING WITH THE ETHICAL IMPLICATIONS OF THE FORMAL STUDY OF WHAT IS WRONG BIOLOGICAL RESEARCH AND AND RIGHT APPLICATIONS ESPECIALLY IN THE STUDY OF THE BASES OR PRINCIPLES MEDICINE. FOR DECIDING WHAT IS WRONG AND RIGHT - BIOETHICS INCLUDES THE STUDY OF WHAT IS RIGHT AND WRONG IN THE ANALYSES OF THE PROCESS BY WHICH NEW DISCOVERIES AND WE DECIDE WHAT IS WRONG OR RIGHT. TECHNIQUES IN BIOLOGY, SUCH AS INVOLVES THE SET OF RULES THAT SOCIETY GENETIC ENGINEERING AND THE HAVE AGREED ABOUT LIVING WITH TRANSPLANTATION OF ORGANS - WHAT SHOULD BE DONE NURSING ETHICS - BIOETHICS LOOKS AT QUESTIONS SYSTEM OF PRINCIPLES CONCERNING THE ABOUT VALUES AND WHAT ACTION OF THE NURSE IN RELATIONSHIP MATTERS IN MEDICINE, BIOLOGICAL WITH PATIENTS, FAMILIES, OTHER HEALTH RESEARCH, CARE OF PEOPLE WHO CARE PROVIDERS, POLICY MAKERS AND CANNOT SPEAK UP FOR SOCIETY. THEMSELVES (THE SEVERELY MENTALLY ILL, SMALL CHILDREN, ACCORDING TO WORLD MEDICAL ASSOCIATION PRISONERS) AND SIMILAR TOPICS. IT IS THE STUDY OF MORALITY, CAREFUL AND SYSTEMATIC REFLECTION ON, AND THOMAS PERCIVAL WAS ENGLISH ANALYSIS OR MORAL DECISIONS AND PHYSICIAN QND AUTHOR, BEST KNOWN BEHAVIOR. FOR CRAFTING PERHAPS THE FIRST MODERN CODE OF MEDICAL ETHICS. AS A SCHOLARLY DISCIPLINE, MEDICAL ETHICS ENCOMPASSES IT’S PRACTICAL APPLICATION IN CLINICAL SETTINGS AS IHE DREW UP A PAMPHLET WITH THE CODE WELL AS WORK ON ITS HISTORY, IN 1974 AND WROTE AN EXPANDED VERSION IN 1803, MEDICAL ETHICS OR CODE OF INSTITUTES AND PERCEPTS , 1954 SALK POLIO VACCINE TRIALS ADAPTED TO THE PROFESSIONAL CONDUCT 1960 CONTRACEPTIVE PILL APPROVED BY OF PHYSICIANS AND SURGEONS IN WHICH FDA HE COINED THE EXPRESSION MEDICAL ETHICS. 1960 INVENTION OF THE SCRIBNER SHUNT 1961 COVENING OF HELSINKI PUBLISHED BY THE WORLD HEALTH ORGANIZATION HE WAS ALSO A PIONEERING CAMPAIGNER FOR PUBLIC HEALTH MEASURES AND 1967 FIRST HEART TRANSPLANT FACTORY IN MANCHESTER (OCCUPATIONAL 1968 HARVARD’S COMMITTEE REPORT BIOETHICS) DEFINITION OF IRREVERSIBLE COMA HISTORY OF BIOETHICS 1972 REVELATION OF THE TUSKEGEE THEY POINT TOO, TO THE CONSCIOUSNESS SYPHILIS EXPERIMENT RAISING IMPACT OF HUMAN 1973 AMERICAN HOSPITAL ASSOCIATION EXPERIMENTATION SCANDALS FROM THE ADOPTS A PATIENT BILL OF RIGHTS POSTWAR, NUREMBURG TRIALS TO THE INFAMOUS 1973 ROE VERSUS WADE DECISION WILLOWBROOK CASE, WHERE 1975 INSTITUTIONALIZED RETARTED CHILDREN 1976 WERE INFECTED WITH HEPATITIS, TO PHYSICIAN HENRY BEECHER 1966 1976 REVELATIONS OF 22 CASES OF UNETHICAL 1978 EXPERIMENTATION. 1978 DECLARATION OF ALMA ATA 1980 HISTORY OF BIOETHICS: MAJOR EVENTS 1981 1974 NUREMBERG DOCTOR TRIALS AND THE NUREMBERG CODE 1994 OREGON DEATH WITH DIGNITY ACT 1948 UNIVERSAL DECLARATION OF HUMAN 1997 BIRTH OF DOLLY THE CLONED SHAPE RIGHTS ADOPTED BY THE UN 2000 PUBLICATION OF THE ROUGH DRAFT 1951 CLINICAL TRIAL OF CONTRACEPTIVE OF THE HUMAN GENOME BEGUN 2001 TERRI SCHIAVO CASE 1953 ELUCIDATION OF THE DOUBLE 2001 GEORGE W. BUSH ANNOUNCES STEM HELICAL STRUCTURE OF THE DNA CELL POLICY. 2006 LAUNCHING OF NO LIE MRI 1. META ETHICS – deals with the nature OF THE RIGHT OR GOOD, AS 2007 SPERM SORTING OFFERED BY CLINIC WELL AS THE NATURE AND IN VIRGINIA JUSTIFICATION OF ETHICAL CLAIM’S 2008 HEALTH CARE ACCESS ON THE AGENDA 2. NORMATIVE ETHICS - the standards and principles used to determine whether something is right or good BIOETHICS – IS A NATIVE AMERICAN 3. APPLIED ETHICS- deals with the PRODUCT actual application of ethical principles to a particular situation. OCCURRED AS A REACTIVE RESPONSE TO BIOMEDICINE TECHNOLOGY ADVANCES THEORIES AND CULTURAL PLURALISM CONSEQUENTIALIST – ARE PRIMARILY INTERNATIONAL BIOETHICS BEGAN MORE CONCERNED WITH THE ETHICAL THEN A DECADE AFTER THE BIRTH OF CONSEQUENCES OF A PARTICULAR ACTION. BIOETHICS IN USA utilitarian approach ( greatest good and IN THE20TH CENTURY, THERE HAVE BEEN does the least harmful) NUMEROUS UNETHICAL AND INHUMANE egoistic approach(self interest) EXPERIMENTS PERFORMED ON HUMAN TEST SUBJECTS IN THE UNITED STATES THAT the common good approach ( general will) WERE OFTEN PERFORMED ILLEGALLY, WITHOUT THE KNOWLEDGE, OR INFORMED CONSENT OF THE TEST SUBJECTS. Is the greatest happiness THESE EXPERIMENTS WERE FUNDED BY USA Teleology – theory of morality that derives GOVERNMENT, CIA, MILITARY AND PRIVATE duty or moral obligation from what is good AGENCIES. or desirable as an end to be achieved Utilitarian type theories hold that the end consist in an experience or feeling produced BIOETHICS COINED IN THE EARLY 1970 VAN RENSSELAER POTTER (A WAYBOF ACTING) Non consequentialist – tend to be broadly concerned with the intentions of the person FRITZ JAHR making ethical decisions about particular actions. THE FIELD OF ETHICS The rightness of an action does not depend The moral issues regarding abortion, entirely on its consequences euthanasia, giving to the poor, sex before marriage, the death penalty, war tactics, It depends primarily or completely on the gay/lesbian marriage, censorship, so-called nature of the action itself. “white lies” The duty based approach – deontological Moral obligations theories- what is right ethics, Immanuel Kant thing to do, DUTY The right approach – best ethical action is FOCUS ON ACTION ITSELF -UTILITY AND that which protects the ethical rights of OUTCOME those who are affected by the action. VIRTUE THEORIES The fairness or Justice approach WHAT KIND ON PERSON YOU OUGHT TO BE The divine command approach- god’s will FOCUS ON AGENT AND MOTIVATIONS Named for philosopher Immanuel Kant, Kantianism is directly opposed to VIRTUES, SUCH AS PATIENCE, ARE LEARNED utilitarianism EXHIBIT BEHAVIOR, IN A PREDICTABLE AND Suggest that our actions are bound by a CHARACTERISTICS WAY, THAT IS EVEN – sense of duty, called deontology TEMPERED, PERSEVERANT, AND CONSIDERATE OF OTHERS Agent centered theories – unlike consequentialist and non consequentialist VIRTUES ARE HABITUAL PATTERNS theories are more concerned with the Further, generosity for example cannot be overall ethical status of individuals, or satisfied by giving a certain sum of money agents and are less concerned to identify to a particular charity in order to get tax the morality of particular actions. deduction Charitable giving is only generous if the The virtue approach -whole of s person life, person ideal human virtues. Virtue ethics – refer to specific character The feminist approach traits Applied ethics -deals with difficult moral Virtues become apparent through one’s questions and controversial moral issues behavior and are obviously linked to ethical that people actually face in their lives. principles Example: Descriptions of character portray a way of being rather than the process of decision making The ability to respond to ethical dilemmas SOME CLIENTS MAY FEEL STRONGLY ABOUT then becomes hinged upon one’s character. THEIR NEED FOR PRIVACY, WHEREAS OTHERS MAY DISMISS IT AS UNIMPORTANT. Major points FAITH THAN FACT Introduces the character of the individual THINKING AND BEHAVIORAL Individual moral actions are based on innate moral virtue ALTRUISM – IT’S A CONCERN FOR THE WELFARE AND WELL BEING OF OTHERS. IN Based on cardinal virtues PROFESSIONAL PRACTICE ALTRUISM IS Focal virtues for ethics include compassion, REFLECTED BY THE NURSE CONCERN FOR discernment, trustworthiness, and integrity. THE WELFA RE OF PATIENTS … The good colleague- is a person who AUTONOMY- IS THE RIGHT TO SELF contributes to human well being DETERMINATION The good caregiver – is someone who HUMAN DIGNITY – IT’S THE RESPECT FOR supports human flourishing THE INHERENT WORTH AND UNIQUENESS OF INDIVIDUALS AND POPULATIONS. IN The good person – characteristics that PROFESSIONAL PRACTICE, promote well-being in oneself and others INTEGRITY – ACTING IN ACCORDANCE WITH Virtues of a nursing professional AN APPROPRIATE CODE OF ETHICS AND VALUES ACCEPTED STUDENTS IN PRACTICE. FREELY CHOOSEN SOCIAL JUSTICE – IT’S UPHOLDING MORAL, LEGAL AND HUMANISTIC PRINCIPLES. THIS VALUES UNDERLIE ALL MORAL DILEMMA VALUE IS REFLECTED IN PROFESSIONAL THOUGH NOT ALL VALUES ARE MORAL PRACTICE WHEN THE NURSE WORKS TO VALUES ASSURE EQUAL TREATMENT UNDER THE FAMILY, RELIGION, POLITICS, MONEY AND LAW AND EQUAL ACCESS.. RELATIONSHIP IMPORTANT: VALUES INFLUENCE DECISIONS AND ACTIONS, SUCH AS NURSES BELIEFS – OPINION , INTERPRETATION OR CONCLUSIONS THAT PEOPLE ACCEPT AS TRUE ATTITUDE – MENTAL POSITION OR FEELING TOWARD A PERSON, OBJECT, OR IDEA ETHICS DAY 2: BIOETHICAL - study of the ethical issues - involving the patient in PRINCIPLES raised by the biological and treatment decisions medical sciences, and of - considering the patient Ethics - Branch of philosophy questions of life and death as needs, desires and abilities. concerned with the distinction of they arise in the context of - Safeguarding the patient’s right from wrong on the basis of a health care privacy body of knowledge - The right of patients to make – Examine and understand the decisions about their PRINCIPLES OF ETHICS way in which choices are made medical care without their involving issues of right and Autonomy - Acknowledge health care provider trying wrong. people’s right to make choices for to influence the decision themselves based on their own - - Does not allow the health - Deals with what “ought” to be values and beliefs care providers to make the rather than what “is” - Auto is self decision for the patient - Refers to standards of behavior - - Refers to the capability and that tell us how human beings - Nomy / nomos is governance right of ought to act in the many situations - patients to control the course - Born from the New Testament in which they find themselves- as of them (freedom to make decisions) friends, parents, children, citizens, own medical treatment. businesspeople, teachers, - In Health care setting: “Principle professionals, and so on. of Informed Consent” IMPORTANT: WHILE YOU RESPECT PATIENT Bioethics - a field of study PATIENT AUTONOMY- self- AUTONOMY, IT IS ALSO OUR concerned with the ethics and governance, treating a patient DUTY TO EXPLAIN CLEARLY philosophical implications of according to the patient desires, TO THEM WHAT ARE THE certain biological and medical within the bounds of accepted CONSEQUENCES OR EFFECT procedures, technologies, and treatment OF THEIR DECISION. treatments. ETHICS SHENNEN ERIEL OVERRIDING PATIENTS’ attendant on each. Principles of Respect for AUTONOMY (PATERNALISM) Autonomy Always respect the Autonomy - the capacity for Medical - acting without autonomy of the patient- self-determination-person's consent to benefit the patient then the particular patient is right to make choices on own and prevent harm free to choose. values Strong - benefit is stronger Such respect is not simply a than autonomy Person should be free from matter of attitude, but a way Weak - if our purpose is to coercion in deciding to act + of acting so as to recognize help patient in restoring others are obligated to protect and even promote the his/her competence to confidentiality, respect privacy, autonomous actions of the decide. and tell the truth. patient. AUTONOMY: THE DESIRE TO The autonomous person The right if patients to make BE SELF-DIRECTED may freely choose loyalties decisions about their medical that every human being of or system of religious belief care without their health care adult years and sound mind that may adversely affect. provider trying to influence the has a right to determine WHAT IS PATIENT decision what shall be done with his AUTONOMY? In the case of a child, the own body. Medical ethics - A system of principle of avoiding the harm True consent to what moral principle that applies of death, and the principle of happens to oneself is the values and judgements to the providing medical benefit that informed exercise of choice, practice of medicine (4 can restore the child to health and that entails an principles: autonomy, and life, would be given opportunity to evaluate beneficence, non maleficence, precedence over the autonomy knowledgeably the options justice.) of the child’s parents as available and the risks in surrogate decision makers. ETHICS SHENNEN ERIEL  The right to participate in To know the possible - You as the patient have the and decide on a course of risks, benefits, and costs right to make decisions action without undue influence of every procedure, about your own health and treatment or drug therapy medical conditions. SELF DETERMINATION: To accept or refuse which is the freedom to act - You must give your treatment independently. voluntary, informed consent To prepare in advance for treatment and for mist PATIENT BILL OF RIGHTS treatment directives and medical tests and to expect that these will The right to know the procedures - The legal term be honored professional status of all for failing to obtain informed To appoint a person to consent before performing a test people providing care make decisions about or procedure on a patient is To know the name of their care, if they become called BATTERY (a form of their attending doctor mentally disabled assault). To receive complete To have personal privacy information on their - For many types of To receive compassionate diagnosis and treatment interactions (for example, a care and proper To be given the prognosis physical exam with an hour management of pain for their illness doctor), Implied Consent is To seek a second opinion To review all information assumed. To ask that the hospital in their medical record ethics committee review - For more invasive tests or To have every procedure, their case for those tests or treatments treatment or drug therapy explained to them in INFORMED CONSENT with significant risks or language they alternatives, you will be Based on the moral and legal understand. asked to give Explicit premise of patient (written) Consent. autonomy: ETHICS SHENNEN ERIEL  IMPLIED CONSENT COMPONENTS OF INFORMED SIGNED CONSENT NOT CONSENT 4 COMPONENTS: NEEDED: - is provided by the behavior of the patient, e.g. A - The capacity (or ability) to - Minor, everyday, routine patient presents at make the decision procedure, i.e. blood drawing lab. outpatient and x-ray, P.E. B - Voluntarily grant consent (no - Provides an exception to the coercion/duress) - Medical emergency: immediate general rule of a patient consent is pain relief, immediate diagnosis C - Comprehension limited to these procedures and treatment of condition would contemplated when consent is D - Disclosure of information on lead to serious disability or death. given. the by medical provide with the - Must put a note in the chart as to expected benefits and risks - If in the course of authorized why you did what you did. medical intervention, a doctor WHEN TO GET SIGNED discovers a life-threatening INFORMED CONSENT: condition that requires immediate The nurse acts as client advocate to - Prior to all invasive or operative treatment and the patient is unable ensure that the following three major procedures. - For administration to consent (e.g under anesthesia), elements of informed consent have of blood the doctor may extend the been addressed: - For use of investigational drugs operation or procedure without the Knowledge - client has received or treatment. patient’s express consent. adequate information on which to Research base his or her decision - Under certain circumstances, there are exceptions to the Unapproved use Competency - an individual's informed consent rule. cognition is not impaired to an - When patient seems reluctant before examining. extent that would interfere with decision making or, if so, that the ETHICS SHENNEN ERIEL individual has a legal - Privacy Rule has decreased representative. communication and collaboration CONFIDENTIALITY among providers and Free will - an individual has given - Confidentiality of care and communication with family consent voluntarily without treatment is also an important caregivers, which may have a pressure or coercion from others. right for all patients negative impact on patient care as The Rationale for the doctrine of well as the rights of families. - Any discussion or consultation informed consent is the preservation involving a patient should be PRIVILEGED and protection of individual conducted discreetly and only COMMUNICATION autonomy in determining what will with individuals who have a need and will not happen to the person’s - A privilege is a legal rule that and a right to know this privileged body. protects communications within information. CONFIDENTIALITY AND certain relationships from - The duty of the nurse to protect compelled disclosure in a court PRIVACY - Protecting the confidential patient information proceeding, the attorney-client confidentiality of client records and communications. PATIENT PRIVACY relationship - The only individuals who have a - Protected health information is - a private statement that must be right to observe a client or have any individually identifiable kept in confidence by the recipient access to medical information are health information in oral, written for the benefit of the those involved in his or her or electronic form. communicator medical care. - Mental health and substance - Under the law, individuals have abuse records have additional PRINCIPLES OF ETHICS the right to access their medical special protection under the Beneficence - One ought to records, to have corrections made privacy rules. prevent and remove evil or harm; to their medical information may be shared. ETHICS SHENNEN ERIEL one ought to do and promote beneficence lies in determining - Need to consider rights of others good what exactly is good for another Beneficence: Obligatory and Ideal and who can best make that Beneficence: - Comes from two latin words decision.” ‘bonus’ where bene was taken - Some ethical theories like to mean “good” utilitarianism are based on the BENEFICENCE ‘DO GOOD’ principle of beneficence. This ‘Fic’ where fiche was taken to means that goodness and kind- mean ‘to act or do’. - Benefit or promote the good for deed form the substratum of the others. - Primary obligation is - Action done for the good of the utilitarian theory. service to the patient and the others public-at-large - J. Bentham and W.D Ross differ - Beauchamp and Childress and in the meaning of beneficence, yet - Duty to promote the patient’s Pesche believed that beneficence they employed the term welfare could be seen through the beneficence as a positive associated acts of kindness, - Competent and timely delivery obligation, to other, though some charity, humanity, altruism and of health care critics denied this kind of love. - Obligated to become familiar beneficence for he holds that the with the signs of abuse and beneficence is a virtuous ideal/ - The practitioner should act in neglect and to report suspected acts of charity, thus any person “the best interest” of the patient- cases. therefore is not morally deficient if the procedure be provided with he/ she failed to act beneficently. the intent of doing good to the 3 Constraints on Beneficence: patient - Need to respect autonomy- - Aiken (2004) states, “the patient and doctor may differ Practical Applications of the difficulty that sometimes arises in Principle of Beneficence: - Need to ensure health is not implementing the principle of bought at too high a price ETHICS SHENNEN ERIEL - Protect and defend the right of not different from not doing evil To each person according to others or bad things. need To each person according to - Prevent harm from occurring - “Above all, do no harm,” - make effort that will cause harm to others sure that the procedure does not To each person according to harm the patient or others in - Help persons with disabilities contribution society. - Rescue persons in danger To each person according to merit JUSTICE To each person according to NON-MALEFICENCE free-market exchange Treat others equally and fairly - One ought not to inflict evil or The four main areas that Health - Form of fairness, or as Aristotle care provider must consider when harm, where harm is understood said, “giving to each that which is evaluating justice: as threatening, defeating, or his due”. setting back some party’s interest 1. Fair distribution of scarce - Persons who are equals should resources- equality - Comes from Latin words: ‘non’ qualify to mean not; ‘malos’ from which 2. Competing – needs male is taken to mean bad/evil - Duty to be fair in their dealings and ‘faceo’ from which ‘fic’ comes with patients, colleagues and 3. Rights and obligations – merits which means do/make. society. 4. Potential conflicts with - Non-maleficence means not to In fact, our society uses a variety established legislations make or to do bad or to make evil of factors as a criteria for The principle that deals with fairness, things intentionally. distributive justice, including the equity and equality and provides for following: an individual to claim that to which - In medicine, non-maleficence they are entitled. means not to inflict harm which is To each person an equal share ETHICS SHENNEN ERIEL Comparative Justice - Making decisions based on criteria and Fidelity - Strict observance of outcomes. promises or duties. - Example: how to determine who - This principle, as well as other qualifies for one available kidney. principles, should be honored by 55-year-old male with three both provider and client. children versus a 13 year old girl. Non comparative Justice - Method of distributing needed kidneys using lottery system. Veracity - The duty to tell the truth - Truth-telling, honestly - Privacy/confidentiality - Respecting privileged knowledge - Respecting the “self” of others. - In which wisdom is much grief - If you override it you endanger doctor/patient relationship (based on trust) - You offend against the principles of autonomy. ETHICS SHENNEN ERIEL ETHICS WEEK 3 2. The degree of cooperation and the degree of scandal are taken into account. CI.: MISS IGNACIO FORMAL: agent identifies itself with purpose and evil act. - Basic principle of legitimate cooperation DOUBLE EFFECT: Is often involved to explain the - People should never do anything that is not morally permissibility of an action that causes a serious harm, such as permissible. the death of a human being, as a side effect of promoting some - The person cooperating intends, desires or approves the good end. wrongdoer and conduct. - Sometimes it is permissible to cause harm as a side effect IMMEDIATE MATERIAL COOPERATION: when the action (or double effect) of bringing about a good result even could not be performed without the help of the person assisting. though it would not be permissible to cause such a harm as means to bringing about the same good end. MEDIATE MATERIAL COOPERATION: cooperator does not share the intentions of the principal agents and participates in PRINCIPLE OF DOUBLE EFFECT circumstances that are not essential to the commission of the act. - The act itself must be morally good or neutral - The person must directly intend the good effect and only tolerate the evil effect. MORAL PRINCIPLE OF LEGITIMATE COOPERATION - The good effect must be greater than or equal to the evil WITH EVIL effect. - If we were to try to avoid any and all cooperation with - The good effect must not be obtained by means of the evil, we would be unable to act. evil effect. - Moral reasoning guided by moral principle and LEGITIMATE COOPERATION: refers to moral acceptability, enlightened by grace can guide us to choose the best not the legal meaning of conforming to a set of standards and possible good even when evil is unavoidable. requirements to be acceptable. (LEGITIMATE) COOPERATION: means working together despite CRITERIA (AQUINAS TEACHING) disagreement about the ends or means of the act. In other words, cooperation does not imply condoning the evil. A. The moral object of your action is good, and you are operating out of good intention. 1. The cooperation is not immediate B. The evil is only tolerated as a side effect of your action C. Your cooperation is only material cooperation, not formal SHENNEN ERIEL  D. Your cooperation is remote rather than proximate so it comprehensive good of the human being, including even causes minimal evil effects the spiritual good. E. Your action does not cause scandal. SOLIDARITY BS SUBSIDIARITY MORAL PRINCIPLE OF LEGITIMATE COOPERATION Solidarity- the virtue enabling the human family to share fully WITH EVIL the treasure of material and spiritual goods. - The intention is the reason why you choose to act Subsidiarity- is the coordination of society’s activities in a way - The wrongdoer is the party who initiated the that supports the internal life of the local communities. wrongdoing, directly intending the specific evil. - The closer the cooperation with the evil, the more likely - Is the principle that each level of governmental and civic the act is to cause evil results. life, including individuals and families, should be - Remote cooperation is preferrable to proximate allowed to fulfill the responsibilities for which they have cooperation. competence without interference from levels that exist - The good object that one chooses and intends when above them. performing an action that cooperates with evil, and the - Also means leaving matters that can be handled outside good effects resulting from the action, should be at least of government to civil society, the family, individuals. as great as (morally proportionate) to the foreseen evil Common good- the totality of social conditions allowing effects. persons to achieve their communal and individual fulfillment. - Even if you judge your action to be legitimate cooperation with evil, you should avoid performing it if there is likelihood of causing grave scandal. DECENTRALIZATION SUBSIDIARITY- unity or agreement of feeling or action, especially among individuals with a common interest, mutual support within the group. COMMON GOOD CENTRALIZATION SOLIDARITY- an organizing principle - The sum total of social conditions which allows people, that matters ought to be handled by the smallest, lowest or least either as groups or as individuals, to reach their centralized competent authority. fulfillment more fully and more easily. - The common good consists not only of the material or external good of all human beings; it also includes the SHENNEN ERIEL ORDINARY MEANS- reasonable hope of benefit/success; not overly burdensome; does not present an excessive risk and are STEWARDSHIP- utilizing and managing all resources God financially manageable. provides for the Glory of GOD and the betterment of His - Proportionate to the state of the patient “ETHICALLY Creation. Christian stewardship regards the obligation of INDICATED” Christians in managing and utilizing intelligently the gifts that God has given. ELEMENTS OF ORDINARY MEANS 1. Reasonable/proportionate hope of benefit/success 4 IMPORTANT PRINCIPLES (BILL PEEL) 2. Common diligence - The principle of OWNERSHIP 3. Proportionate – physical/social/financial - The principle of RESPONSIBILITY 4. Not unreasonably demanding - The principle of ACCOUNTABILITY - The principle of REWARD In sum: what is reasonable! Totality vs Wholeness EXTRAORDINARY MEANS- no reasonable hope of benefit/success; overly burdensome; excessive risk and are not is that totality is the state of being total while wholeness financially manageable is the quality of something considered as a whole. - No obligation to use it/ morally optional Syn: entirety vs integrity, unity. ELEMENTS OF EXTRAORDINARY Moral Principle of Totality and Integrity 1. Certain impossibility – physical or a moral Human body is an integral part of the human person and is therefore worthy of human dignity. 2. Great effort – excessive It must be kept whole. 3. Pain No body part should be removed, mangled or debilitated unless doing so is necessary for the 4. Exquisite and extraordinarily expensive health of a more essential body part of the body of 5. Severe dread or revulsion a whole. Human nature is an integration of body and spirit. In sum: what is inappropriate! SHENNEN ERIEL  These two dimensions can never be separated (in The preservation and protection of bodily integrity fact, separation of the spirit from the body is the Is a principle frequently invoked law and morality. It is a definition of death). normative principle that seeks to constrain what we The human body shared in the dignity of the should be allowed to do to human bodies or their human person. constituent parts. Surgeries that needlessly remove body parts or organs are immoral Tattoos and piercing are not inherently immoral, HUMAN SEXUALITY but they may be immoral if they deface the body by quantity or content. (FRs O’Rourke and Ashley) Torture is a moral evil because it seeks to First provides the basis if the human capacity for love, disintegrate the body and the spirit friendship, and community. Self-mutilation is self-hatred expresses through spite of the body. “Our capacity for affection, communication, and That chemical contraception effectively shuts sympathy in all relationships is rooted in our physical down a healthy bodily system is part of what and psychic sexuality.” makes it immoral. Second is that of human reproduction – stated concern is Even if the pro-choice argument that an embryo is primarily with “ethical questions about genital activity part of the woman’s body rather than an within marriage.” independent human person is true, it should not be removed except when its presence endangers the woman's life. PERSONALIZED SEXUALITY (FRs O’Rourke and Ashley) Responsibility in perioperative practice shown by the patient Five major values always being in mind 1. Sensual pleasures and satisfaction To ensure the patient’s safety and create a peaceful atmosphere in the operating theatre for the patient’s 2. More profoundly, the completion of the human person wellbeing. A personal ethical value to always have to through in intimate and personal union of love look and take an interest in the patient, not abandon the 3. The social necessity for the protection of children and patient in a high technological environment and preserve their education so as to expand the human community patient dignity. SHENNEN ERIEL  and ensure its continuation beyond death of individual members. 4. Even more broadly, the basis of all relationships that constitute the network of human society, 5. Symbolically, a sacramental mystery that stands for the creative love of God for all creatures and their loving response. Principle of personalized sexuality “God made us sexual not only for the survival of our species, but for the complete expression of a married person’s mutual self – giving love that finds it’s complete fulfillment not just in orgasm but in children” Natural family planning (Personalized sexuality) fosters the personal and social value of human sexuality: 4 ways 1. It places responsibility on both partners, rather than on woman alone, as do most methods in family planning. 2. It results in an enhanced sense of personal dignity. 3. It increases confidence in the strength of spousal love. 4. It enhances the experience of intimacy due to periodic intentional abstinence. SHENNEN ERIEL ETHICS WEEK 4 groups, and by family and peer THE VALUING PROCESS groups. CI: MISS MASICAMPO 1. CHOOSING (COGNITIVE)- PERSONAL VALUES: although people beliefs are chosen derive values from society and their - Freely, without outside pressure VALUES CLARIFICATION CODE OF individual group, they internalize some - From among alternatives ETHICS or all of these values as personal values. - After reflecting and considering consequences. VALUES: are enduring beliefs of - People need societal values to 2. PRIZING(AFFECTIVE)- chosen attitudes about the worth of a person, feel accepted, and they need beliefs are prized and cherished object, idea or action. personal values to have a sense of 3. ACTING(BEHAVIORAL)- individuality. - Are important because they chosen beliefs are influence decisions and acting, PROFESSIONAL VALUES: nursing - Affirmed to others including nurses’ ethical decision professional values are acquired during - Incorporated into one’s behavior making. socialization into nursing from codes of - Repeated consistently in one’s ethics, nursing experiences, teachers and life. VALUE SYSTEMS: are basic to a way of peers. life, life direction to life, and form the basis of behavior, especially behavior (ALTRUISM, AUTONOMY, SOCIAL CLARIFYING THE NURSE VALUES: that is based on decision or choices. JUSTICE, HUMAN DIGNITY, need to reflect on the values they held INTEGRITY) BELIEFS AND ATTITUDES: are related, about life, death, health, and illness. but not identical to values. People have - Awareness of personal and many different beliefs and attitudes, but VALUES CLARIFICATION: Is a process professional values is to consider a smaller number of values. in which people identify, examine and specific issues. VALUES TRANSMISSION: values are develop their own individual values. CLARIFYING CLIENT VALUES- need learned through observation and - A principle of values clarification to identify client’s values as they experience. is that no one set of values is right influence and relate to a particular - As a result, they are heavily for everyone. health problem. influenced by a person’s - Promotes personal growth by sociocultural tradition; by fostering awareness, empathy cultural, ethnic, and religious and insight. SHENNEN ERIEL The following process may help clients Identifies the facts and the ethical NURSING ETHICS: ANA has updated clarify their values: question its nursing: scope and standards of practice (2010) publication, which holds 1. List alternatives Determine the ethical principles in nurses accountable for their ethical 2. Examine possible consequences conflict conduct. of choices Explore your options 3. Choose freely ACCOUNTABILITY: answerable to 4. Feeling about the choice Act on your decision and evaluate oneself and others for own actions. 5. Affirm the choice - This structure provides questions RESPONSIBILITY: The specific 6. Act with a pattern that guide nurses in gathering all accountability or liability associated MORAL DISTRESS: the nurse may feel relevant information in the four with the performance of duties of a torn between obligations to the client, topics/boxes: medical conditions, particular role. the family and the employer. patient preferences, quality of life CODE OF ETHICS FOR NURSE: the and contextual features. Once the “What is in the client’s best interest may ethical nurse is able to explain the data such as autonomy, non- be contrary to the nurse’s personal rationale behind every action and maleficence, beneficence, and beliefs systems. recognize the standards to which of she justice are reviewed against the will be held. THE 4A’s to rise above moral distress: data to reach a decision or resolution. - Is a formal statement of a group Ask, Affirm, Assess, Act ideals to values. It is a set of ETHICS: a method of inquiry that helps - The nurse ASK whether signs of ethical principles that people to understand the morality of moral distress are present A. is shared by members of the human behavior/ the study of morality. AFFIRMS, a commitment to group addressing the distress, ASSESS - The practices or beliefs of a B. reflects their moral judgement the sources and severity of the certain group (medical ethics, over time. distress plus readiness to act, and nursing ethics) - Serves as a standard for their ACTS to implement a plan to - The expected standards of moral professional actions. reduce the distress. behavior of a particular group as PURPOSES: described in the group formal ETHICS IDEA FRAMEWORK code of professional ethics. SHENNEN ERIEL  1. Inform the public about providers, employing - Support from each family minimum standards of the institutions, and licensing bodies. member and enhance the family profession nursing conduct. - According to the nursing code of support system. 2. Provide a sign of the professions ethics, the nurse first loyalty is to - Carry out hospital policies. commitment to the public it the client-action best serves the - Protect other clients well-being serves. client needs. - Protect the nurse own standards 3. Outline the major ethical of care. considerations of the profession. STRATEGIES TO ENHANCE ETHICAL 4. Provide ethical standards for MAKING ETHICAL DECISIONS DECISIONS AND PRACTICE professional behavior. - A difficult choice exist between 5. Guide the profession in self- - Become very aware of your own actions that conflict with the regulation values and the ethical aspects of needs of one or more persons. 6. Remind nurses of the special nursing. - Moral principles of framework responsibility they assume when - Be familiar with nursing codes of exist that can be used to provide caring for the sick. ethics some justification for the action. - Seek continuing education ETHICAL PROBLEMS IN NURSING - The choice is guided by a process opportunities to stay of weighing reasons SOCIAL CHANGES: such as women’s knowledgeable about ethical - The decision must be freely movement and growing consumerism, issues in nursing. consciously chosen also expose problems. (health insurance, - Respect the values, opinions, and - The choice is affected by personal health care cost, etc.) responsibilities of other health feelings and by the particular care professionals that may be TECHNOLOGY: creates new issues that context of the situation. different from your own. did not exist in earlier times, EXAMPLES OF NURSE’S - participate in or establish ethics (respirators, parenteral feedings, organ OBLIGATIONS IN ETHICAL rounds. Ethics rounds use transplantation) DECISION MAKING hypothetical or real cases that ETHICAL PROBLEMS IN NURSING focus on the ethical dimensions of - Maximize the client’s well-being the client care rather that the - Nurse experience conflicts among - Balance the clients need for client’s clinical diagnosis and their loyalties and obligations to autonomy with family members treatment. clients, families, primary care responsibilities for the client’s well-being. SHENNEN ERIEL  - Serve on institutional ethics committees. - Strive for collaborative practice in which nurses function effectively in cooperation with other health care professionals. SHENNEN ERIEL  ETHICAL THEORIES AND In discerning the will of God, When God leads us, the usual result PRINCIPLES: are the foundations of regarding a course of action, or of is serenity (peace) and joy. ethical analysis accepting an offer or opportunity, we And yet, when it is God's will that ought to carefully ponder if it will ETHICAL PRINCIPLES: are the the time has come for moving on, make good sense based on our skills common goals that each theory tries inspite of the sadness, I also feel an and talents. to achieve in order to be successful. inner peace, a serenity. Principle 3 - Desire. SIX PRINCIPLES OF Principle 6 - Conformity to Scripture DISCERNMENT We are often suspicious of our and Tradition. desires, and not without reason. Principle 1 - State of life. This principle should be at the top When it comes to most things of the list, and you are free to put it There are many different states in regarding the Moral Law and there. life, some permanent, some long- Doctrine, our feelings and desires are lasting, some only temporary. The Word of God and the teaching largely irrelevant, and should not be of the Church has the last word in - We may be single, married, a determinative of understanding any decision. priest, a religious, young, old, God's will. healthy, or fragile in health. - Virtuous traits are acquired and Principle 4 - Organic development. developed throughout our life We may be a student, a parent, rich This principle simply articulates that experiences. or poor. God most often moves us in stages A primary problem with this Being clear about our state in life rather than in sudden and dramatic theory is that people have varying can help us discern if a call is from ways. definitions of what traits are God or not. While it is true, in most lives, there considered virtuous. are times of dramatic change, loss, One weakness of this ethical theory and gain, it is more usual for God to Principle 2 - Gifts and talents. is that it does not take into lead us gently and in stages toward consideration a person's change in It is a clear fact that people have what he wills for us. moral character different combinations of virtues and Principle 5 - Serenity talents, gifts and skills. ETHICAL DILEMMAS SHENNEN ERIEL  Defined as a problem involving a - We must examine the facts and animate and guide the choice between equally desirable or background information about discernment process. equally unsatisfactory alternatives to various choices. - the process by which a person or the different or competitive - We must study Sacred Scripture community of faith attempts to assignment of priorities and and the teachings of the Church. discover God's will for responsibilities, or to a problem understanding and responding to CONSCIENCE: is a judgment of without a satisfactory solution the dilemmas and questions that practical reason that helps us to (George & Gyprock, 2002). human beings face when seeking recognize and seek what is good and the "right" and the "good." to reject what is evil" (Catechism of the Catholic Church, no. 1778, 1796) DISCERNMENT: It is a prayerful NURSING ROLES AND pondering or mulling over the RESPONSIBILITIES ON ETHICAL choices a person wishes to consider. - DECISION-MAKING PROCESS ETHICAL DILEMMAS: occur when - It is a process that should move - The provision of excellent end-of- there is a conflict between two or inexorably toward a decision. life care requires, first and more ethical principles. It is both to understand and to foremost, an excellent knowledge are situations of conflict, in that decide of the pathophysiology of there is no right or wrong option. terminal illness or injuries. How do I know whether I am The nurse must make a choice doing the right thing? A WELL-FORMED CONSCIENCE IS between two alternatives that may AN ONGOING EXERCISE. THE - It is not always possible to know, be equally unsatisfactory. CHURCH OFFERS THE FOLLOWING but there is a greater chance that PROCESS IN FORMING ONE we can feel good about the CONSCIENCE decision we have to make if we MORAL DISCERNMENT go through a deliberate process - We must prayerfully reflect to - Maybe thru prayer, meditation, where we examine our values, discern the will of God or supplication before God, but it seek additional information, and - When examining any issue or involves two additional elements consult others. situation, we must begin by being - the turning to various sources open to the truth and what is and the use of critical thinking to right. How do I resolve ethical dilemmas? SHENNEN ERIEL  - Make sure you are constantly - Sharing confidences without 5. POLICY keeping in mind the mission of compelling professional reason the profession and - Discriminatory practices - Assaulting, causing physical EFTECTIVE CLIENT ADVOCATES observing the client's right to self- injuries, or placing clients in determination. Are assertive danger If you are still unclear about what - Sexual intimacy with clients - Recognize the rights and values to do, discuss the situation with your - Libeling or slandering a client of clients and families must take field instructor. - Withdrawing services precedence when they conflict precipitously (abandoning a with those of health care Protect the identity of the client if client) providers necessary and present the situation - Failure to warn and protect the - Are aware that conflicts may as a "hypothetical" case if you need victim of a violent crime arise over issues external help. - Work with community agencies How do I avoid rushing into ethical and lay practitioners dilemmas? ADVOCACY NURSING ( 5 WAYS TO - Know that advocacy may SUPPORT YOUR PATIENTS) require political action Develop a working knowledge of the Code of Practice 1. Get to know your patients 2. Educate your patients (by necessity they cannot be VALUES BASIC TO ADVOCACY 3. Tell your patients about their specific to every possible ethics rights - client is a holistic, autonomous violation) 4. Translate medical jargon being who has the right to make By anticipating likely trouble spots 5. Remember your responsibility to choices and decisions before they occur. your patient. - Clients have the right to expect a nurse-client relationship that is 5 WAYS NURSE PRACTITIONERS based on shared respect, trust, CAN SERVE AS ADVOCATES WHAT ARE BEHAVIORS THAT and collaboration WILL ALMOST BE VIEWED AS 1. PATIENTS - It is the nurse's responsibility to UNETHICAL? 2. THEMSELVES ensure client has access to health 3. COMMUNITIES care services that meet health - Promising “cures” for problems 4. PROFESSION needs. SHENNEN ERIEL ADVOCATE: One who expresses and holds that the most ethical choice is defends the cause of another Protect the one that will produce the greatest MORAL DECISION MAKING: other clients' rights good for the greatest number. approaches Informs clients about their rights an ethical theory that regards ethical Provides information they need to and value judgments as expressions of EGOISM/EGOTISM: an ethical theory make informed decisions feeling or attitude and prescriptions of that treats self-interest as the foundation action, rather than assertions or reports of morality. Supports clients in their decisions of anything. WHAT IS AN ETHICAL DILEMMA? Intervenes on client's behalf It is a Conflict between... ETHNOCENTRISM: is insensitive to other cultures, while cultural relativism one's personal and professional values James Rest (Rest and Narvaez 1994), a shows high cultural sensitivity. two values/ethical principles developmental psychologist who studied moral and ethical development, CULTURAL RELATIVISM: is the idea two possible actions each with reasons identified four components of moral that a person's beliefs, values, and strongly favorable and unfavorable development: practices should be understood based ETHICAL DILEMMAS on that person's own culture, rather Moral sensitivity - the ability to than be judged against the criteria of Occur when a problem exists between interpret a situation in moral and ethical another. ethical principles terms; NATURALISM: is the belief that Deciding in favor of one principle Moral judgment - the ability to nothing exists beyond the natural world. usually violates another determine a course of action in the Instead of using supernatural or context of what is just; Both sides have "goodness" and spiritual explanations, naturalism "badness" associated with them Moral motivation - the ability to select focuses on explanations that come from an appropriate course of action among the laws of nature. CAN ETHICAL DILEMMA BE multiple good alternatives; AVOIDED? UTILITARIANISM: is an ethical theory Moral character - the courage and that determines right from wrong by - You can avoid ethical dilemma! skills to follow a course of action in focusing on outcomes. It is a form of But you cannot completely avoid response to a situation. consequentialism. ethical dilemmas. SHENNEN ERIEL  - Establish the rights, a course of action with the least responsibilities, duties and negative effects ÉTHICAL DECISION MAKING decision-making abilities of all 5. choosing a position that you can Ethical reasoning is the process of the people involved defend. thinking through what one ought to do - Identify several possible IMPORTANT ELEMENTS IN in an orderly, systematic manner to alternatives and predict the MAKING MORAL DECISIONS provide justification of actions based on outcome of each, then principles. - Select a course of action - Evaluate the resolution process Ethical reasoning is used in situations INVESTIGATE the facts: we need to in which the right decision is not clear or MORAL DILEMMA discern accurately three elements of in which there are conflicts of rights and every moral act: The ethical decision-making models can duties. help you careful consider several 1) Nature of the Act ETHICAL DILEMMA IN NURSING perspectives, guide your reasoning, and 2) Intention of the person explain the reasons for your final action. The challenge of decision making One of the easiest to remember is the 3) Circumstances of the Act The sanctity of life versus the quality MORAL MODEL. INQUIRE, about moral norms affecting of life DECISION MAKING MODEL 5 your decision. Informed consent STEPS IMAGINE, consequences and Truth-telling - if the question is "Am I 1. Definition of the dilemma alternatives going to die?" This raises important 2. looking at all the relevant facts INTROSPECT, we need to understand issues about truth telling. and developing valid arguments the value or our emotions or affectivity for various courses of action ETHICAL DECISION-MAKING in making moral decisions; listen to 3. consideration of practice wisdom, PROCESS your emotions. personal beliefs and values, and - Gather relevant data in order to how these might influence the IMPLORE GOD’S HELP IN PRAYER, identify the problem final decision we ought to seek God's guidance in - Determine what type of ethical 4. developing options, exploring prayer before, during and after making dilemma exists compromises, evaluating our moral decisions. alternatives in an attempt to find SHENNEN ERIEL IMPLEMENT, One must have the courage and resolve to do what has decided upon. CONCLUSION - Making actual moral decisions is grounded on both our human nature and God's grace. - By human nature, we possess intellect and free will and by grace, we are strengthened, empowered by the Holy Spirit. - SHENNEN ERIEL