Major Bioethical Principles PDF

MAJOR BIOETHICAL PRINCIPLES AND THEIR APPLICATIONS TO THE CARE OF THE SICK Chanda Joy V. Chavez, RN Objectives At the end of this session the student will be able to:  Define ethical principles  Characterize the different major bioethical principles  Determine justifying...

MAJOR BIOETHICAL PRINCIPLES AND THEIR APPLICATIONS TO THE CARE OF THE SICK Chanda Joy V. Chavez, RN Objectives At the end of this session the student will be able to:  Define ethical principles  Characterize the different major bioethical principles  Determine justifying conditions in resolving situations Ethical Principles  Principle in its context is the foundation of all truth.  It is conceived as an agreement of thought and reality, an eventual verification of hypothesis and or doctrines.  Laws and moral ethics are principles  Abiding with such principles can avoid detrimental consequences of unethical actions NOTE: Principles are basic truth that guide decision analysis and making Ethical Principles  Appropriate identification, analysis, interpretation, and resolution of health problems or issues are made possible and facilitated by way of reference to relevant ethical principles  Mappes and De Gracia (2002) suggested four major set of principles: 1. Respect for autonomy 2. Non-maleficence 3. Beneficence 4. Justice Ross Ethics (review)  Dr. Ross proposed seven classifications of prima facie duties: 1. Duties of fidelity 2. Duties of reparation 3. Duties of gratitude 4. Duties of beneficence 5. Duties of non-maleficence 6. Duties of justice 7. Duties of self-improvement Major Bioethical Principles 1. Respect for Autonomy and Paternalism 2. Fidelity 3. Veracity 4. Confidentiality 5. Non-Maleficence 6. Beneficence 7. Justice 8. Communitarianism 9. Casuistry Autonomy v. Paternalism Autonomy Paternalism  Self-determinance  Authoritarianism  Decision is made by self  Decision are made by  Actions and consequences those on top are the responsibility of  Actions are determines by self authorities and consequences are the responsibility of the subordinates Autonomy Ø Four basic principles under ethics of respect for other people: 1. Autonomy 2. Fidelity 3. Veracity 4. Avoidance of killing Ø These principles deals on actions such as right and wrong, not based on consequences they produce, but their inherent content Autonomy Ø Interpreted as the rule or governance of one’s self Ø Respect for autonomy means then that a person should always allow another person to decide for him/ herself. Ø This extends to taking actions from self-driven decisions based on personal beliefs, values, virtues, and traditions Ø Primordial right to personal accountability, self- determination and self-governance. Ø Example: Refusal to participate in research Autonomy Ø Clinical setting: “Giving the right of an independent decision-maker to determine for him/herself what will be done to his/her body”. Ø Informed consent – a patient is given a substantial opportunity to autonomously choose a course of action in regard to plans for health care. The choice includes the right to refuse interventions, to ask for recommendations, and finally choose from available therapeutic alternatives Liberty-Limiting Principles (Mappes and DeGrazia) The liberty of a person can be justifiably restrained to: Ø Harm principle – deter the person from harming others Ø Offense principle – prevent the person from hurting or offending others Ø The principle of paternalism – prevent the person from harming himself/ herself Ø The principle of legal moralism – prevent the person from acting immorally Ø The principle of extreme paternalism – benefit himself/ herself Ø The social welfare principle – benefit others *Patient’s Bill of Rights Patient’s Bill of Rights Adopted by America (Review) 1. Considerate and respectful care. 2. Upon request, the name of the Physician responsible for coordinating your care. 3. The name and function of any person providing healthcare services. 4. Obtaining from the physician complete, current information concerning diagnosis and prognosis in terms that can be understood. 5. Receiving from the physician information necessary to give informed consent prior to the start of any procedure or treatment, or both and which, except for an emergency situation not requiring an informed consent, shall include as a minimum the specific procedure or treatment, or both, the medically significant risk involved, and the probable duration of incapacitation, if any. 6. Refusal of treatment to the extent permitted by law and to be informed of the medical consequences of such action. Patient’s Bill of Rights Adopted by America (Review) 7. Privacy to the extent consistent with providing adequate medical care. 8. Privacy and confidentiality of all records pertaining to treatment, except as otherwise provided by law or third party payment contract. 9. A response by the hospital in a reasonable manner to the patient’s request for services customarily rendered by the hospital with his/ her treatment. 10. Information by the physician or his delegate of the patient’ continuing healthcare requirements following discharge, and notice before transferring to another facility if there is a need for such transfer. 11. The identity, upon request, of other hospital care and educational institutions that the hospital has authorized to participate in the treatment. 12. Upon request, an explanation of the patient’s bill, regardless of source of payment. 13. Information of the hospital rules and regulations as they apply to the patient’s conduct. Paternalism Ø The interference with, limitation of, or usurpation of individual autonomy justified by reasons referring exclusively to the welfare or needs of the person whose autonomy is being interfered with, limited, or usurped. Ø A manner of treating individuals in the way that a parent treats his/her child. (Beauchamp & Walters, 1994) Ø Actions to keep individual from harm (paternalism) Ø Actions intended to benefit the doer of the action (extreme paternalism) Ø Interference of autonomy is always the benefit of the individuals and those of others Ø Example: Coercing a patient to take meds, refusal of patient results in patient harm. Coercing benefits the patient by alleviating pain Fidelity Ø The concept of fidelity is simply the extent of relationship of one person to another Ø Trustworthiness Ø Keeping promises Ø Being faithful Ø Example: A nurse being faithful and true to their professional responsibilities Veracity Ø Being truthful Ø Being honest Ø The importance of truth-telling is taught to children in multiple ways. Ø Truth-telling is based on trust – One person cannot tell the truth if such person do not trust the other. In the same manner that a patient will trust a nurse with unrestricted certainty that the latter will perform as expected. Ø Example: Being honest about a patient’s diagnosis, prognosis, treatment options and the risks and benefits of those options Veracity Ø Truth-telling however can be delayed – esp. if the truth is life-threatening or the patient decides to shun the truth Ø A nurse can employ the use of non-truth by deliberately omission of information, providing incomplete or falsified information. Ø Non-truths can also be implied in the manner of how the truth was conveyed creating false impression. Ø White-lies: intended to do no harm to a patient. This is justified when the teller utters such lies to prevent harm, promote good or when the truth is not welcomed by the recipient/s. Ø White lies are told to brighten up a dismal situation, to express appreciation for undesired assistance, to minimize insignificant issues that when blown out with create chaos. Ø Example: Delaying news about a family member’s demise following accident involving the patient and his/ her family Confidentiality Ø A primary ethical principle that must be maintained by the nurse throughout one’s professional practice. Ø The healthcare system demands from a professional nurse to uphold the importance of confidentiality. A breach in confidentiality can result to harms to a patient, the nurse, the institution, and the nursing profession as a whole. Ø It can be define in a variety of ways such as: ü Keeping the secrets of the patients ü Controlling access to sensitive personal information ü Holding in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling ü Keeping something classified, restricted, undisclosed, secret or private Confidentiality Ø What information should be withheld? q Personal information q Sensitive condition/ illness/ disease/ disorder q Genetic information q Anonymous comments that may harm another Ø Who can access confidential information? v The patient is the priority in deciding who can have access to such information. However, if the confidential information is necessary for the decision making process of the significant others especially of the patient is incapacitated to decide, the nurse may choose to disclose the confidential information. Non-Maleficence Ø “Do no harm” (Munson, 2004) Ø Avoidance of inflicting injury, harm or pain to others. Ø Loaded with multifarous implications in the healthcare profession like avoiding negligent and harmful care, and with decisions that pertain to withdrawing or continuing medication to the patient. Ø “Do not do unto others what you do not want others do unto you”. – Confucius Ø “Do not do to others that which would cause you pain if done to you”. – Mahabharata Ø Example: A nurse deficient in certain skill or experience but pretends to be skillful and knowledgeable so that it cause injury or harm to his/ her patient. The nurse is guilty of failing the demands of principle of non- maleficence Beneficence Ø A broad term applied to a cluster of duties that require abstention from harm and positive assistance. Ø Requires nurses to abstain from injuring others, specifically the patients, and to protect the patient’s legitimate interest like the prevention and expulsion from harm. Ø Doing good deeds, showing kindness and charity to others Ø Taking actions that will promote the welfare of other people Ø Associated with the virtues of kindness, benevolence, altruism and humanitarianism Ø Described as healing with attention to the psychological, social, and spiritual dimensions of the disease, injury, or physical problems. Ø Example: Assisting in ADL of a patient too weak to do so Beneficence 4 Elements to help express the substance of the 3 major components of principle of beneficence beneficence  One ought not to inflict evil or  Do or promote good harm  Prevent harm  One ought to prevent evil or harm  Remove evil or harm  One ought to remove evil or harm  One ought to do or promote good Justice Ø Derived from the latin word jus which mean right Ø Rendering of what is due or merited Ø The habit that enables one to give each and every human person his/ her own right Ø Associated with the concepts of fairness, rightfulness, deserved reward or punishment and equity Ø The principle requires that social benefits, like health care services, and social burdens like payment of taxes must be distributed equally among all in accordance with the demands of justice. Ø It implies that a nurse has the duty to perform without regard to race, color, creed or social status and gender. Ø Example: Nurse-to-patient – caring required by duty; patient-to-hospital – paying bills Justice 2 kinds of justice: 1. General legal justice equity and common legal justice Refers to human person’s wishes and proper actions in consonance with the common good 2. Particular justice commutative justice and distributive justice Particular legal justice - pertains to wishing and doing what is right in relation to another person who is accounted as an individual with an inherent right to his/ her own private good. Commutative justice – deals with the fairness of the exchange Distributive justice – sharing the wealth of a nation Justice Principles of distributive justice: To each person 1. An equal share 2. According to individual need 3. According to acquisition in a free market 4. According to individual effort 5. According to societal contribution 6. According to merit Note: The implementation of these principles will depend on the availability of funds or resources from those tasked to account what is due to a person Example: PCSO extending financial aid to cancer, kidney failure, heart disease, etc.: when, what and how much the will receive Justice Principles of distributive justice: To each person 1. An equal share 2. According to individual need 3. According to acquisition in a free market 4. According to individual effort 5. According to societal contribution 6. According to merit Note: The implementation of these principles will depend on the availability of funds or resources from those tasked to account what is due to a person Example: PCSO extending financial aid to cancer, kidney failure, heart disease, etc.: when, what and how much the will receive Communitarianism Ø Accentuates the relationship of an individual to its community Ø This involves the community as one unit in the decision making process. Thus, actions taken by members of the community is the responsibility of the community. Ø Emphasis: 1. individual rights are coupled with communal responsibility; 2. communal good is more important than individual good; 3. there should be a balance between the welfare of the community and that of the individual; 4. solutions to important questions necessitate a distributed communal deliberation or understanding. Example: Smoking ban Casuistry Ø Case-based reasoning Ø The circumstances surrounding the health of a person can be appropriately considered as the building blocks of the case Ø Cases that have been handled or resolved before serves as paradigms for analogical considerations Ø Example: The physician and relatives of a Persistent Vegetative State (PVS) patient will use casuistry (critically, conscientiously and religiously studying previous case). A relief in the burden of making a blameless decision since previous cases can offer help as paradigms. Justifying conditions to resolve a situation: 1. Choose one principle over the other. 2. The moral purpose must be attainable or capable of being realized. 3. There is no possibility of giving preference or importance to conflicting prima facie duties. 4. The opted solution must yield to the lowest degree of infringement. 5. The minimal effect of infringement should be seriously undertaken. Examples of conflicts between ethical principles: Ø Respect for autonomy (respect for peoples decision and values) v. nonmaleficence (do not harm people) = healthcare givers should give in to patient’s decision Ø Beneficence (help people) v. justice (treat similar cases alike and fairly distribute benefits and burdens) = “greatest good to the greatest number of people” Sample question: A 5 year-old girl came to the clinic for her scheduled immunization. You are aware that the procedure will cause discomfort during administration, but the benefits are far greater for the child and the community. Which principle is involved in this situation? A. Fidelity B. Non-maleficence C. Casuistry D. Beneficence Answer: A 5 year-old girl came to the clinic for her scheduled immunization. You are aware that the procedure will cause discomfort during administration, but the benefits are far greater for the child and the community. Which principle is involved in this situation? A. Fidelity B. Non-maleficence C. Casuistry D. Beneficence END THANK YOU