Introduction to Bioethics,Nursing Ethics, and EthicalDecision Making
Bioethics• Bioethics is a specific domain of ethicsthat is focused on moral issues in thefield of health care• “Who lives? Who dies? and Whodecides?”
Ethical Principles• Belmont Report– Respect for persons• includes the rule to do good, and to do no harm– Beneficence– Justice
Ethical Principles• Principles of Biomedical Ethics– four bioethical principles—autonomy,nonmaleficence, beneficence, and justice
Ethical Principles• Ethical Principlism– provides guidelines that can be used tomake justified moral decisions and toevaluate the morality of actions– one of the most popular tools used todayfor analyzing and resolving bioethicalproblems
Autonomy• The freedom and ability to act in aself-determined manner
Autonomy– Informed consent is respecting a person’sautonomy to make personal choices based on theappropriate appraisal of information about theactual and/or potential circumstances of asituation• Receipt of information• Consent for the treatment must be voluntary• Persons must be competent
Autonomy– Patient Self Determination Act• The first federal statute designed to facilitate apatient’s autonomy through the knowledge anduse of advance directives
Ethical Principles• Nonmaleficence is the principle used tocommunicate the obligation to “do no harm”;the maxim or norm that “one ought not toinflict evil or harm”– slippery slope argument is a metaphor that isused as a “beware the Ides of March” warning withno justification or formal, logical evidence to backit up; a situation that could hypothetically sliptoward a morally unacceptable situation
Ethical Principles• The principle of beneficence consists ofdeeds of “mercy, kindness, and charity”;people take actions to benefit and to promotethe welfare of other people– paternalism is the deliberate overriding of apatient’s opportunity to exercise autonomybecause of a perceived obligation of beneficence
Ethical Principles• Justice refers to fairness, treating peopleequally and without prejudice, and theequitable distribution of benefits and burdens– Social justice is usually thought of in terms ofhow benefits and burdens should be distributedfairly among members of a society, or ideally, howall people in a society should have the samerights, benefits, and opportunities
Ethical Dilemmas• Ethical dilemma is a situation in whichan individual is compelled to make achoice between two actions that willaffect the well-being of a sentient being,and both actions can be reasonablyjustified as being good, neither action isreadily justifiable as good, or thegoodness of the actions is uncertain
Introduction to Nursing Ethics• Nursing ethics is relationship-based andspecifically refers to ethical issues asthey directly relate to and affect nursesand their patients (individuals, families,communities, or populations) in nurses’daily work, whatever that work may be
Relationships• Moral suffering occurs when nursesexperience a disquieting feeling ofanguish, uneasiness, or angst
Relationships• Moral Anguish can be experiencedwhen nurses attempt to sort out theiremotions when they find themselves inimperfect situations that are morallyunsatisfactory or when forces beyondtheir control prevent them frompositively influencing or changingunsatisfactory moral situations
Relationships• Nurse-Patient-Family Relationships– Unavoidable Trust-Patients, in most cases, haveno option but to trust nurses and other health careprofessionals when the patient is at the point ofneeding care
Relationships• Nurse-Patient-Family Relationships– Human Dignity-Patients, in most cases, have nooption but to trust nurses and other health careprofessionals when the patient is at the point ofneeding care
Relationships• Nurse-Patient-Family Relationships– Patient Advocacy-Nurses try to identify unmetpatient needs and then follow up to address theneeds appropriately
Relationships• Nurse-Physician Relationships– Nurses and physicians, as members of thehealth care community, must work togetherfor the health and well-being of patients,whether those patients are individuals,families, groups, communities, orpopulations
Relationships• Nurse-Nurse Relationships– exist together within communities and usesimilar moral language.– they “share a moral narrative andcommitments [and] commonunderstandings of the foundations ofmorality, moral reason, and justification”
Introduction to Critical Thinking andEthical Decision Making• In health care and nursing practice,ethical dilemmas and moral matters areso ever-present that nurses often do noteven realize that they are makingminute-to-minute moral decisions
Introduction to Critical Thinking andEthical Decision Making• Critical Thinking– “self-directed, self-disciplined, self-monitored, and self-corrective thinking[that] requires rigorous standards ofexcellence and mindful command of theiruse”
Introduction to Critical Thinking andEthical Decision Making• Moral Imagination– moral decision making through reflectionthat involves “empathetic projection” and“creatively tapping a situation’spossibilities”
Introduction to Critical Thinking andEthical Decision Making• Moral Imagination– involves moral awareness and decisionmaking that goes beyond the mereapplication of standardized ethicalmeanings, decision-making models, andbioethical principles to real life situations
Introduction to Critical Thinking andEthical Decision Making• Reflection in Nursing Practice– reflection in action involves stopping tothink about what one is choosing and doingbefore and during one’s actions– since ethics is an active process of doing,reflection in any form is crucial to thepractice of ethics
Introduction to Critical Thinking andEthical Decision Making• The Moral Ground Model: A Virtue-Based Nursing Model– implies that nurses may start at agroundless, uneducated state of moralfunctioning– the nurse can move toward flourishingmoral ground by traveling along a path ofintellectual and moral virtues
The Moral Ground Model: AVirtue-Based Nursing Model• Moral Ground Model Virtues– Moral Virtues• truthfulness, gentleness, compassion, lovingkindness, just generosity, courage, sympatheticjoy, equanimity– Intellectual• insight, practical wisdom
Introduction to Critical Thinking andEthical Decision Making• Nurse as Part of a Health Care Team– many problematic bioethical decisions will not bemade unilaterally– an ethics committee usually consists ofphysicians, nurses, an on-staff chaplain, a socialworker, a representative of the organization’sadministrative staff, possibly a legal representativeand community representatives, and othersdrafted by the team.
Introduction to Critical Thinking andEthical Decision Making• Nurse as Part of a Health Care Team– also, the involved patient, the patient’s family, or asurrogate decision maker may meet with one ormore committee members
Introduction to Critical Thinking andEthical Decision Making• The Four Topics Approach to EthicalDecision Making– Case-based approach allows nurses andother health care professionals to constructthe facts of a case in a structured formatthat facilitates critical thinking about ethicalproblems.
Introduction to Critical Thinking andEthical Decision Making• The Four Topics Approach to EthicalDecision Making– Cases are analyzed according to fourtopics: “medical indications, patientpreferences, quality of life, and contextualfeatures”
A particular slide catching your eye?
Clipping is a handy way to collect important slides you want to go back to later.