Confidentiality: When is it appropriate to release information and to whom? What should happen in the case of a mistake? Who is responsible for maintaining confidentiality? What about in small towns? Totally electronic systems – who can access, where is it stored, how safe is the information. Patient information for research and quality improvement monitoring. Does this breach confidentiality? Do the implemented measures truly hide individual identity?Life Preserving measures/Life Saving Measures: When should they be used and when should they cease? Who has the right to make these decisions? When does wealth or social status effect the decisions?Supply distribution: When there is limited supplies who will receive the treatment and who will not? Who decides and what is it based on?Life vs. Choice: Should people have the choice to have an abortion or not? At what point is it murder? When is a fetus considered a human being? What are the mother’s rights? Where does the father’s opinion fit in? Does religion have a right to dictate the decision?Patient vs health care choice: Who has the right to direct care? When opinions differ who makes the final decision even if not recommenced? Ie. Refusing treatment or option for alternative methods.Power of Attorney: In an ageing world, at what point is an elderly person suffering from dementia unfit to make decisions? How about an individual with disabilities? When are they considered fit or unfit to make decisions for themselves? Who has the right to decide when an individual is unfit?
What are ethical theories?Based on the individual ethical ideology, ethical theories allow a person to find an answer to an issue, to make a morally right decision, or to justify a decisionEthical theories challenge what we think is right and wrongWhat types of theories exist and how are they applied?1. Utilitarianism- When good consequences result, actions are morally right- Focuses on the consequences rather than the motive or intrinsic nature of an actionE.g. A nurse can use 10 paper towels every time to dry her hands which will ↓ infection transmission, but are her actions good?2. Duty ethicsNot the consequences, but the inherent good in people makes actions morally rightIt is the individual’s “duty” to make morally right decisions based on “rules”E.g. Nurses have the “duty” to know about current infections, prevention, and treatment Not working when you are sick3. Virtue ethics - The focus is on being a good character E.g. Placing yourself at risk to help an infectious patient because you are charitable and a good person4. Medical ethics - Concerned with moral questions raised by the practice of medicine and by health careBased on the values of:Autonomy: The right for a patient to refuse treatment E.g. from a nurse if she has not washed her handsHonesty: Giving patients informed consentBeneficence: Making decisions in the best interest for each patient, regardless of life experience and backgroundNon-malficence: “Do no harm” E.g. Always wash hands before providing careRespect: Treating each patient with dignityJustice: Providing each patient with similar careReferencesThe Canadian Encyclopedia. (2012). Medical ethics. Retrieved April 25, 2012, from http://www.thecanadianencyclopedia.com/articles/medical-ethicsLudwick, R., & Silva, M.C. (2006). Ethics: What would you do? Ethics and infection control. Online Journal of Issues in Nursing, 12(1), doi 10.3912/OJIN.Vol12No01EthCol01Malm, H., May, T., Francis, L.P., Omer, S.B., Salmon, D.A., & Hood, R. (2008). Ethics, pandemics, and the duty to treat. American Journal of Bioethics, 8(8), 4-19Oxford University Press. (2008). A framework for ethical analysis. Retrieved April 25, 2012, from http://fds.oup.com/www.oup.com/pdf/13/9780199214303.pdfOxford University Press. (2012). Oxford dictionary. Retrieved April 25, 2012, from http://oxforddictionaries.com/definition/utilitarianismStanford Encyclopedia of Philosophy. (2012). Virtue ethics. Retrieved April 25, 2012, from http://plato.stanford.edu/entries/ethics-virtue/
Protection from exploitation; sometimes the information collected by researchers can be used against nurses e.g if they don`t wash hand and the problem of diarrhoea gets worse, non compliance to hand washing can be used against those nurses who were observed not washing wash. This can affect client -patient relationship and the co-workers relationships.Informed consent: both nurses and patients may feel uniformed about the research, e.g when collecting information from the patients cards, ( about were they acquired diarrhoea) the patient may no be informed about the research going on and this can bring conflicts between the nurses/ researcher and patients.Confidentiality; privacy can be invaded when someone penetrates in a person`s privacy. Invasion of privacy include; physical presence of unwanted persons( e.g patients can feel that the researcher invade their privacy by being there) unwanted observation ( e.g using cameras for observation, both nurses and patients can feel that the observation that the use of camera it invade their privacy, because the cameras never get tired and they can reveal everything (e.g nurses not giving patients enough care). Dispersion of private information; e.g collecting data on how many patients acquired diarrhoea prior to admission into the hospital and those who acquired it in hospital need the use of patients card which can lead to the researcher ending up viewing the client private information like HIV status.Appropriate: Is the hand washing program appropriate to Viet Nam hospitals? Are the changes able to be implemented in a poor and under developed health care system? Can the program be tweaked so not to cause undue demands from the system? Yes, can be adapted appropriately.
Despite the identified ethical issues of patient exploitation, the quality of informed consent and possible breaches in confidentiality of both patients and staff, the risk for these issues can be minimized with proper preparation. The hand washing program has the ability to be adapted to the capacity of the health system in which it is being implemented in order to reduce cost/demand. By implementing the program we are fulfilling the ethical duty to protect patients from harm. In this case, harm comes in the form of staff, patients and families not washing their hands and increasing diarrhea transmission. Conclusion: This program should be implemented.
Ethics of Hand Washing:Is Hand Washing an Ethical Solution toreducing Diarrhea Transmission? Thuy Trang Nguyen Thi Hloliphani Juta Jasmine Paul Lara Kesteloo
Ethical Topics in Health Care • Confidentiality • Life preserving measures/Life Saving measures • Supply distribution • Life versus choice • Patient choice versus health care choice • Power of Attorney
What are Ethical Theories?• Based on the individual ethical ideology, ethical theories allow a person to find an answer to an issue, to make a morally right decision, or to justify a decision• Ethical theories challenge what we think is right and wrong What types of ethical theories exist and how are they applied? Utilitarianism Duty Ethics (Deontology) Virtue Ethics Medical Ethics
What are Ethical Challenges to Hand Washing? Exploitation Informed Consent Confidentiality Appropriate
Is Hand Washing EthicalCons Pros • Exploitation • Low level of risk if proper • Informed Consent measures taken • Breach of Confidentiality • Simple measures • Potential for program expansion and modification • Duty to protect patients from harm dictates that action must be taken
References• Bartter, K.( 2001). Ethical Issues in advanced nursing practice. Edinburgh: Elsevier science limited.• The Canadian Encyclopedia. (2012). Medical ethics. Retrieved April 25, 2012, from http://www.thecanadianencyclopedia.com/articles/medical-ethics• Ludwick, R., & Silva, M.C. (2006). Ethics: What would you do? Ethics and infection control. Online Journal of Issues in Nursing, 12(1), doi 10.3912/OJIN.Vol12No01EthCol01• Malm, H., May, T., Francis, L.P., Omer, S.B., Salmon, D.A., & Hood, R. (2008). Ethics, pandemics, and the duty to treat. American Journal of Bioethics, 8(8), 4-19• Oxford University Press. (2008). A framework for ethical analysis. Retrieved April 25, 2012, from http://fds.oup.com/www.oup.com/pdf/13/9780199214303.pdf• Oxford University Press. (2012). Oxford dictionary. Retrieved April 25, 2012, from http://oxforddictionaries.com/definition/utilitarianism• Rumbold, G.( 1999). Ethics in Nursing Practice. 3rd edition. Philadelphia: Elsevier limited• Stanford Encyclopedia of Philosophy. (2012). Virtue ethics. Retrieved April 25, 2012, from http://plato.stanford.edu/entries/ethics-virtue/
Search Process• Researched common ethical theories and chose four based on relevance and how and well-known each theory was• To determine how well-known each theory was, we looked to philosophy-specific journals and accredited websites, as these seemed to give relevant information• From here revised theories to suit chosen health issue• Used both online dictionary sources (Oxford dictionary) to define ethical theories, as well as scholarly databases (CINAHL, Google scholar) to further develop and apply theories to health issue
Collaboration Process • Met once to discuss each partner’s portion of the presentation, as two group members are completing the class through distance • Met with the course instructor to ensure both group members would contribute equally and video conference into remaining three classes • Each group member was available for questions, and support when needed