2. Bioethics
ā¢ Bioethics is a specific domain of ethics
that is focused on moral issues in the
field of health care
ā¢ āWho lives? Who dies? and Who
decides?ā
3. Ethical Principles
ā¢ Belmont Report
ā Respect for persons
ā¢ includes the rule to do good, and to do no harm
ā Beneficence
ā Justice
4. Ethical Principles
ā¢ Principles of Biomedical Ethics
ā four bioethical principlesāautonomy,
nonmaleficence, beneficence, and justice
5. Ethical Principles
ā¢ Ethical Principlism
ā provides guidelines that can be used to
make justified moral decisions and to
evaluate the morality of actions
ā one of the most popular tools used today
for analyzing and resolving bioethical
problems
7. Autonomy
ā Informed consent is respecting a personās
autonomy to make personal choices based on the
appropriate appraisal of information about the
actual and/or potential circumstances of a
situation
ā¢ Receipt of information
ā¢ Consent for the treatment must be voluntary
ā¢ Persons must be competent
8. Autonomy
ā Patient Self Determination Act
ā¢ The first federal statute designed to facilitate a
patientās autonomy through the knowledge and
use of advance directives
9. Ethical Principles
ā¢ Nonmaleficence is the principle used to
communicate the obligation to ādo no harmā;
the maxim or norm that āone ought not to
inflict evil or harmā
ā slippery slope argument is a metaphor that is
used as a ābeware the Ides of Marchā warning with
no justification or formal, logical evidence to back
it up; a situation that could hypothetically slip
toward a morally unacceptable situation
10. Ethical Principles
ā¢ The principle of beneficence consists of
deeds of āmercy, kindness, and charityā;
people take actions to benefit and to promote
the welfare of other people
ā paternalism is the deliberate overriding of a
patientās opportunity to exercise autonomy
because of a perceived obligation of beneficence
11. Ethical Principles
ā¢ Justice refers to fairness, treating people
equally and without prejudice, and the
equitable distribution of benefits and burdens
ā Social justice is usually thought of in terms of
how benefits and burdens should be distributed
fairly among members of a society, or ideally, how
all people in a society should have the same
rights, benefits, and opportunities
12. Ethical Dilemmas
ā¢ Ethical dilemma is a situation in which
an individual is compelled to make a
choice between two actions that will
affect the well-being of a sentient being,
and both actions can be reasonably
justified as being good, neither action is
readily justifiable as good, or the
goodness of the actions is uncertain
13. Introduction to Nursing Ethics
ā¢ Nursing ethics is relationship-based and
specifically refers to ethical issues as
they directly relate to and affect nurses
and their patients (individuals, families,
communities, or populations) in nursesā
daily work, whatever that work may be
15. Relationships
ā¢ Moral Anguish can be experienced
when nurses attempt to sort out their
emotions when they find themselves in
imperfect situations that are morally
unsatisfactory or when forces beyond
their control prevent them from
positively influencing or changing
unsatisfactory moral situations
19. Relationships
ā¢ Nurse-Physician Relationships
ā Nurses and physicians, as members of the
health care community, must work together
for the health and well-being of patients,
whether those patients are individuals,
families, groups, communities, or
populations
20. Relationships
ā¢ Nurse-Nurse Relationships
ā exist together within communities and use
similar moral language.
ā they āshare a moral narrative and
commitments [and] common
understandings of the foundations of
morality, moral reason, and justificationā
21. Introduction to Critical Thinking and
Ethical Decision Making
ā¢ In health care and nursing practice,
ethical dilemmas and moral matters are
so ever-present that nurses often do not
even realize that they are making
minute-to-minute moral decisions
22. Introduction to Critical Thinking and
Ethical Decision Making
ā¢ Critical Thinking
ā āself-directed, self-disciplined, self-
monitored, and self-corrective thinking
[that] requires rigorous standards of
excellence and mindful command of their
useā
23. Introduction to Critical Thinking and
Ethical Decision Making
ā¢ Moral Imagination
ā moral decision making through reflection
that involves āempathetic projectionā and
ācreatively tapping a situationās
possibilitiesā
24. Introduction to Critical Thinking and
Ethical Decision Making
ā¢ Moral Imagination
ā involves moral awareness and decision
making that goes beyond the mere
application of standardized ethical
meanings, decision-making models, and
bioethical principles to real life situations
25. Introduction to Critical Thinking and
Ethical Decision Making
ā¢ Reflection in Nursing Practice
ā reflection in action involves stopping to
think about what one is choosing and doing
before and during oneās actions
ā since ethics is an active process of doing,
reflection in any form is crucial to the
practice of ethics
26. Introduction to Critical Thinking and
Ethical Decision Making
ā¢ The Moral Ground Model: A Virtue-
Based Nursing Model
ā implies that nurses may start at a
groundless, uneducated state of moral
functioning
ā the nurse can move toward flourishing
moral ground by traveling along a path of
intellectual and moral virtues
27. The Moral Ground Model: A
Virtue-Based Nursing Model
ā¢ Moral Ground Model Virtues
ā Moral Virtues
ā¢ truthfulness, gentleness, compassion, loving
kindness, just generosity, courage, sympathetic
joy, equanimity
ā Intellectual
ā¢ insight, practical wisdom
28. Introduction to Critical Thinking and
Ethical Decision Making
ā¢ Nurse as Part of a Health Care Team
ā many problematic bioethical decisions will not be
made unilaterally
ā an ethics committee usually consists of
physicians, nurses, an on-staff chaplain, a social
worker, a representative of the organizationās
administrative staff, possibly a legal representative
and community representatives, and others
drafted by the team.
29. Introduction to Critical Thinking and
Ethical Decision Making
ā¢ Nurse as Part of a Health Care Team
ā also, the involved patient, the patientās family, or a
surrogate decision maker may meet with one or
more committee members
30. Introduction to Critical Thinking and
Ethical Decision Making
ā¢ The Four Topics Approach to Ethical
Decision Making
ā Case-based approach allows nurses and
other health care professionals to construct
the facts of a case in a structured format
that facilitates critical thinking about ethical
problems.
31. Introduction to Critical Thinking and
Ethical Decision Making
ā¢ The Four Topics Approach to Ethical
Decision Making
ā Cases are analyzed according to four
topics: āmedical indications, patient
preferences, quality of life, and contextual
featuresā