Notre Dame University Ethical Theories (NURS2035) PDF

2/28/24 Law and ethics 1 WELCOME Darren Conlon, Sydney Campus E u n i c e Ta n , F r e ma n t l e a n d B r o o me C a mp u s e s School of Nursi ng and Mi dwi fery 2 ACKNOWLEDGEMENT OF COUNTRY The University of Notre Dame Australia is proud to acknowledge the traditional owners and custodians of th...

2/28/24 Law and ethics 1 WELCOME Darren Conlon, Sydney Campus E u n i c e Ta n , F r e ma n t l e a n d B r o o me C a mp u s e s School of Nursi ng and Mi dwi fery 2 ACKNOWLEDGEMENT OF COUNTRY The University of Notre Dame Australia is proud to acknowledge the traditional owners and custodians of this land upon which our University sits. The University acknowledges that the Fremantle Campus is located on Wadjuk Country, the Broome Campus on Yawuru Country and the Sydney Campus on Cadigal Country. 3 1 2/28/24 Objectives By the end of this lecture, you will be familiar with: q The important of everyday ethical action for nurses q The main ethical theories in nursing q The biomedical principles q Theories and principles informing the ICN Code of Ethics 4 Copyright statement 5 Ethical theories 6 2 2/28/24 Ethical theories Natural law q Natural law is based on the teachings of Thomas Aquinas. q Morality is to be found through reason, and is present in laws of nature and human intellect q Natural law involves rights superior to written law, q These rights are afforded to one by virtue of one’s humanity. 7 Ethical theories Natural Law Is a universal set of objective norms governing human behaviour. It asks: What actions will enable us to flourish as human beings? 8 Ethical theories Natural law q Focus: human nature and basic human goods q Claim: “there are universal basic human goods that all human beings need in order to live happy and fulfilled lives” (note: Natural law usually seen as divine; ordained by God). q Uses reason to: carefully study human nature “to reveal the basic human goods that all human beings need in order for them to live.” q Strengths and weaknesses? q Provides a broad narrative to guide ethical decision-making. q Sometimes dismissed for its focus on what is natural for human beings. 9 3 2/28/24 Ethical theories Normative ethics is the study of principles pf ethics in action q Utilitarianism q Deontology q Virtue ethics q Care ethics 10 Ethical theories Utilitarianism q Consequences or outcomes that maximise overall “happiness”. It asks: What should I do to achieve the best outcome in this situation? q A triage nurse is an example of a consequentialist 11 Ethical theories Utilitarianism q Focus: consequences of actions q Claim: The moral action is the one that produces the greatest amount of good. q Uses reason to: weigh up which course of action will produce the most “utility” (pleasure or good) overall q Strengths and weaknesses? q Attempts to ensure a good outcome q Difficulty of predicting what might be the best outcome in complex cases 12 4 2/28/24 Ethical theories Deontology q Duty, obligation and principles-based reasons for right action; divine command. It asks: What is required of me in the situation? q The Golden Rule can be seen as a deontological approach. There are rules, it is principles based. 13 Ethical theories Deontology q Focus: rightness of actions q Claim: You have a non-negotiable duty or obligation to do what is right – no matter what! q NOTE: Flipside of claiming we have duties: people have certain “rights” (e.g. UNHDR) q Uses reason to: work out duties via considering what we owe others in our relations with them (e.g. one method: ask what would happen to society if your action was permitted to all; another method: ask whether this action treats the person as an end in themselves not as a means to another end) q Strengths and weaknesses? q Offers a clear path to right action. q May mean that the outcome of an ethical conflict causes some difficulties. 14 Ethical theories Virtue ethics q Character or agent-based. It asks: What should I do if I’m aiming to become a particular kind (virtuous) person? 15 5 2/28/24 Ethical theories Virtue ethics q Focus: character traits (good: virtues; bad: vices) q Claim: Aristotle claims “practice of the virtues leads to human fulfillment and happiness” (Ozolins & Grainger, 2015, 30). It is what is good for us and makes us happy. q Uses reason to: work out which character traits count as virtues q Strengths & weaknesses? q Wider perspective: not as concerned with one-off decisions but with whether you are developing a habit of acting well; whether you are becoming a virtuous person over time. q Not specifically focused on a particular action. 16 Ethical theories Care ethics q Natural feelings of approval and empathy; listening and respecting the views of all people. It asks: What does sensitivity and responsiveness require of me? (How do we come not to care?) 17 Ethical theories Care ethics (derived from virtue ethics) q Focus: concern for the other, long-term care and attentiveness (listening and showing respect), sensitivity and empathy with the person suffering; q Claim: We are inherently relational, responsive beings and the human condition is one of connectedness or interdependence. W are not not autonomous individuals; our own flourishing is tied-up with others’ flourishing). We’re all dependent on others at some point in our lives, therefore we ought to care for others in need. q Uses reason to: uses reason alongside other capacities such as emotion, empathy and imagination q Strengths and weaknesses q Takes into account complexities of caring; also focuses on our ongoing relationships, not just one-off decision-making. q Sometimes dismissed as a ‘feminist form of ethics’ 18 6 2/28/24 Biomedical principles 19 The biomedical principles What is ethics? q Principles of morality that govern how a person behaves q The branch of knowledge that deals with morality q Ethics has an impact on every action that require choice including those of nurses q The requirement to set a minimum ethical standard has led to the codification of Nursing ethics in Australia 20 The biomedical principles Theological ethics q Theological ethics is relevant to particular religious communities. It is based in scripture (the bible/koran/torah) & the traditions of a particular religious community. 21 7 2/28/24 The biomedical principles Secular ethics q “Secular ethics” – refers to no authority but seeks to use reason alone (note: secularism is also a tradition!) q Nonetheless, there is significant common ground between religious ethics & secular ethics (e.g. The golden rule). 22 The biomedical principles The Golden rule q “[d]o to others what you would want them to do to you” q Luke 6:31 New Century Version 23 The biomedical principles Ethics is: q Broadly concerned with human flourishing q Prescriptive (should/ought - norms) q Systematic: uses reason to define what ought to be done q Universalisable (applies to everyone equally) q Of overriding importance: should override law, politics or self-interest 24 8 2/28/24 The biomedical principles The purpose of the ICN Code of Ethics is: q The ICN Code of Ethics for Nurses is a guide for action based on social values and needs. It will have meaning only as a living document if applied to the realities of nursing and health care in a changing society. 25 The biomedical principles Ethical conflicts occur when our personal values differ from those of others q On what reasoning do we base our decision? q On what reasoning is the decision of the other side based? 26 The biomedical principles Involves reasoning about how we ought to live our lives and raises questions about: q the principles of right ACTION; q Involves utilitarianism or deontology – Examples include the Golden Rule and Theological ethics. q Our MOTIVES in acting. q Deontology, duty or Intention in acting, can be different for different theories q the significance of CONSEQUENCES and which are the right ends to promote; q Utilitarianism q CHARACTER and what kinds of persons we should become. q Virtue ethics, Example: Why do we want our nurses to show patience (a virtue), because this demonstrates respect (not in itself a virtue) for others. 27 9 2/28/24 The biomedical principles Principlism q Modern bioethicists developed the bioethical principles to assist in bioethical decision-making q Principlism is an amalgamation of the relevant parts of existing ethical theories q It requires the recognition and balancing of four principles, using virtues and practical wisdom. 28 The biomedical principles Principlism q Principlism forms a coherent normative ethical model for biological investigation, and behavioural research of the rational being. q Principlism is a type of deontology (not all theories are in ,despite the literature) 29 The biomedical principles Bioethics and the bioethical principles q There are many fields of ethics that impact on nursing q One example is bioethics q Bioethics is the ethics of biological research, experimentation and technological advances including uses of human tissue 30 10 2/28/24 The biomedical principles Bioethics and the bioethical principles q The bioethical principles consist of four principles q In isolation and when viewed together no one principle carries greater weight than another 31 The biomedical principles Bioethics and the bioethical principles q However, where two or more principles apply to a given set of facts they may conflict q Where there is a conflict the principles must be weighed or balanced against each other q The principle with the greatest weight in this particular set of facts is the one that will apply 32 The biomedical principles The bioethical principles are useful because q Disagreement between moral theories q A common morality for healthcare q These offer a simpler starting-point for analysing ethical dilemmas q They offer a common ground and better chance for reaching agreement 33 11 2/28/24 The biomedical principles The biomedical principles q The biomedical principles are a branch of bioethics that deals with medical decision making q The biomedical principles are the same four principles as the bioethical principles q They also apply to nurse decision making 34 The biomedical principles Biomedical principles q Autonomy (intention, understanding and non-control) q Non-Maleficence (do not inflict evil or harm) q Beneficence (prevent & remove evil or harm, promote good: mercy, kindness, friendship, charity) q Justice (fairness, desert, entitlement) 35 The biomedical principles Autonomy: “Autos” – self “Nomos” – rule or governance q This principle focuses on protecting the patient’s right to selfdetermination and individual choice, freedom of will. A decision is autonomous when it is voluntary (not coerced), intentional, informed, & deliberative (costs & benefits weighed) q An example could be investigated by asking how hospitalisation affect autonomy? 36 12 2/28/24 The biomedical principles Autonomy q Respecting autonomy enables people to be accountable for their actions; is core to personal identity; and is associated with, but not limited to, respect for human rights & human dignity. q Autonomy does not imply that people have complete control over their actions, desires & deliberations. 37 The biomedical principles Autonomy q Autonomy is achieved along a continuum. It is affected by other people’s needs, rights; limited resources. q The goal of nursing is healing which involves recognising vulnerability and promoting a patient’s interdependence prior to independence. 38 The biomedical principles Non-maleficence requires q Refraining from action that might harm, e.g. carelessly infecting a wound (i.e. negligence) or breaching confidentiality; failing to observe a patient receiving a blood transfusion in a diligent manner. q Upholding a standard of due care. 39 13 2/28/24 The biomedical principles Non-maleficence requires q Avoiding imposing risks of harm, e.g. failing to report unsafe practice, failing to apply cot-sides to prevent falls (i.e. protect patient against harm). 40 The biomedical principles Beneficence requires q Nurses act to help those in their care and contribute to and uphold their welfare. q Upholding the welfare of patients demands more than merely avoiding doing harm (e.g. it requires compensating for loss of independence, advocating for the patient, bathing, dressing wounds, administering medication, hydrating, palliating, and educating). q Nurses bear additional obligations in beneficence to those borne by other citizens by virtue of their profession (e.g. caring for patients with infectious diseases). 41 The biomedical principles Beneficence q How do you decide what is good? When people disagree, who decides? Should other ethical principles, such as truthfulness & autonomy be violated in the process of doing good? q The issue of Therapeutic Privilege may arise (to be discussed in your Bioethics lecture) q Beneficence takes priority over non-maleficence when the benefit of treatment to the patient outweighs the burdens. 42 14 2/28/24 The biomedical principles Beneficence q Beneficence raises the problem of paternalism. q Paternalism is the interference of a state or an individual with another person, against their will, and defended or motivated by a claim that the person interfered with will be better off or protected from harm. q Justified paternalism (nursing children, the mentally impaired, the frail elderly, the vulnerable). 43 The biomedical principles Justice q The principle of justice is often reduced to that of fairness or distributive justice, to focus on the proper allocation or distribution of good and services. q What does distributive justice require? q Giving to each person equally (egalitarianism)? Giving to those who need it most? Giving to those who deserve it most? Giving to those who can pay for it? Giving to those who arrive first? 44 The biomedical principles Justice q But the notions of reparative or restorative justice (e.g. increasing attention to indigenous health issues), reconciliation and ideals of the common good are also relevant. 45 15 2/28/24 The biomedical principles Limitations of the biomedical principles q Does not offer a specific conception of the moral good of nursing or explain WHY we ought to adopt them: Why act for the good of patients? Why avoid harm? Why respect patient autonomy? q Does not provide a broader notion or concept of the human person. q Ethical theories attempt to do this; i.e. to explain to us what goodness consists in, what it is to be a good person and to provide us with a guide to good action. 46 Questions Please bring any questions you have about this lecture to your weekly tutorial 47 References International Council of Nurses. (2021). ICN code of ethics for nurses (revised). http://www.icn.ch/who-we-are/code-of-ethics-for-nurses/ Nursing and Midwifery Board of Australia. (2018). Code of conduct for nurses. http://www.nursingmidwiferyboard.gov.au/Codes-GuidelinesStatements/Professional-standards.aspx Ozolins, J.T., & Grainger, J. (2015). Foundations of healthcare ethics: Theory to practice. Cambridge University Press. Paternelism. (2017). In Stanford encyclopedia of philosophy. https://plato.stanford.edu/entries/paternalism/ Staunton, P.J., & Chiarella, M. (2020). Law for nurses and midwives (9th ed.). Elsevier. 48 16 2/28/24 49 17