2. OBJECTIVES
At the end of this session learners will be able
to:
ā¢ Define ethical principles and theories in health
care.
ā¢ Discuss the ethical dilemmas face by nurses
and clients.
ā¢ Discuss the strategies to resolve ethical
dilemma in daily nursing practice.
ā¢ List steps of ethical decision making.
3. Ethical principles
1. Autonomy: Refers to the right to make oneās own
decisions and choices free of harm to others.
Synonyms
ā¢ Self-government
ā¢ Independence
ā¢ Self-rule
ā¢ Home rule
ā¢ Sovereignty
ā¢ Self-determination
ā¢ Freedom
4. INFORMED CONSENT
Definition
ā¢ It is an agreement by a client to accept a
course of a treatment, procedure or research
after being provided complete information
including benefits and risks.
ā¢ Obtaining informed consent is the
responsibility of the person performing the
procedure or research.
5. TYPES OF CONSENT
Types of consent
1- Expressed Consent 2- Implied Consent
ā¢ Expressed Consent may either be oral or
written.
Written consent is preferred if there are greater
risks of a procedure.
ā¢ Implied consent
Exists when the clientās nonverbal behavior
indicates agreement.
6. ELEMENTS OF CONSENT
Four Basic Elements
1. The consent must be given voluntarily.
2. The consent must be given by a
client/participant with the Capacity and
competence to understand.
3. The consent must be specific to the procedure
& Person.
4. The client/participant must be given enough
information including benefits and possible
risks.
7. IMPORTANCE OF CONSENT
ā¢ The requirement of consent reflects the ethical
principle of patientās/participantās autonomy
ā¢ It also reflects the principles of beneficence and
non-maleficence.
ā¢ It saves both health care member/researcher and
patient/participant legally in exceptional
circumstances, medical treatment must not be
administered without obtaining patientās valid
consent.
ā¢ Treatment/investigations/research performed
without consent constitutes ābatteryā
8. PATERNALISM
ā¢ Implies well intended actions of kind decision
making, leadership ,protection ,& discipline.
ā¢ Decision making on behalf of the patients
without their full consent or knowledge.
ā¢ Professionals restricts others autonomy, to
protect that person from perceived & anticipated
harm, but also promoting good in a positive way.
(Burkhardt & Nathaniel,2008)
9. 2. BENEFICENCE
ā¢ This principle means do or promote good, prevent
harm, remove evil or harm.
ā¢ Nurses need to assist clients in meeting all their needs
ā Biological
ā Psychological
ā Social
ICN says, the nurse takes appropriate action to safe
guard individual ,family ,communities when their care
is endangered by a coworker or any other person
(Burkhardt & Nathaniel,2008)
10. 3. NON-MALEFICENCE
ā¢ Non-maleficence literally means to ādo no harm.ā
ā¢ Make sure that the procedure does not harm the
patient.
ā¢ Non-maleficence āobligation not to inflict harm on
others.
(Beauchamp and Childress, 2009)
11. NON ā
MALEFICENCE
Non-maleficence
Literally- āDoing no
harmā.
ā¢ Make sure that the
procedure does not
harm the patient.
BENEFICENCE
Beneficence Literally ā
āBeing charitable or
doing goodā.
Where a Health care
provider should act in
the ābest interestsā of
the patient, the
procedure be provided
with the intent of doing
good to the patient.
12. 4. JUSTICE
ā¢ According to Salmond, āJustice means provide
everyone his shareā
ā¢ According to Plato, āJustice is a quality. In simple
words the meaning of justice is to discharge oneās
duties honestly and not to interfere in other
actions.
ā¢ So justice is concerned with human welfare.
13. RELATIONSHIP BETWEEN LIBERTY AND
JUSTICE
Liberty is the first need of justice. Every ruler who
attacks the civil liberties is considered unjust
ruler. We can not even think of one without the
other.
ā¢ Purpose of both is common.
ā¢ Liberty is the first condition of justice But
absolute freedom is against justice.
17. ABSOLUTISM
ļ¶Absolutism refers to the idea that
reality, truth, or morality is āabsoluteā.
ļ¶the same for everybody, everywhere,
and every-when, regardless of
individual culture or cognition, or
different situations or contexts.
17
18. RELATIVISM
ļ§ No universal norms of right and wrong
ļ§ One person can say āX is right,ā another can say āX is
wrong,ā and both can be right
ļ§ Relativism, roughly put, is the view that truth and falsity,
right and wrong, standards of reasoning, and procedures of
justification are products of differing conventions and
frameworks of assessment and that their authority is
confined to the context giving rise to them.
ļ§ relativism is a theory, which claims that there are no
universally valid moral principles.
ļ§ relativism theory says that the moral rightness and
wrongness of actions varies from society to society and that
there are no absolute universal moral standards binding on
all men at all times.
18
19. CLASSIFICATION OF ETHICAL THEORIES
1- Virtue based theory
2- Conduct based theory
i-Teleological
ā¢ Utilitarianism
ā¢ Hedonism
ā¢ Egoism
ii-Deontological
3- Right based theory
19
20. 1- VIRTUE BASED ETHICAL THEORY
20
Your conduct or action is ethical if you
focus on values (character)
Platoās Aristotleās Socrates
ļ± wisdom
ļ±Justice
ļ±Courage
ļ±Temperance
ā¢Golden mean
approach
ā¢Middle path
approach
Knowledge
21. VIRTUE BASED ETHICAL THEORY
ā¢ Types of virtue
Intellectual virtue:
ļ¶Associated with reasoning, ability to understand and
truth
Moral virtue:
ļ¶ virtue of character (honesty )
ļ¶A good person does the right thing at the right time for
the right reason
21
22. CONDUCT ETHICAL THEORIES
i: Teleological:
ļ¶Focus on the end
ļ¶Focus on consequences
ļ¶Donāt focus on means
ā¢ Maintains that morality of an action is determined
solely by its consequences.
ā¢ Basically, it looks on the outcomes, situation and from
that one decides what is ethical.
ā¢ Thus, from a consequentialist standpoint, a morally
right action is one that produces a good outcome, or
consequence.
22
23. i.i. UTILITARIANISM ETHICAL THEORY
ļ¶GHGN (Great happiness for great Number)
ļ¶Democracy
ļ¶Democratic concept
ļ¶What makes something good or bad, right or
wrong, is that it produces the greatest amount
of pleasure (or lack of pain) for the greatest
number of people
23
24. PRINCIPLE OF GREATEST HAPPINESS
ā¢ An action is good in so far as it produces the
greatest happiness for greatest number of
people, and bad in so far it produces more harm
than benefit for the greatest number of
individuals.
ā¢ Happiness: is intended pleasure and absence of
pain.
ā¢ Pain: unhappiness
24
25. TWO FORM OF UTILITARIAN THEORY
ļ±A: Act utilitarian
ļ±B: Rule utilitarian
ļ±A: Act utilitarianism
o It asks a person to assess the effects of all actions
o Rejects the view that actions can be classified as
right or wrong in themselves
o Example: lying is ethical if it produces more good
than bad
o Act Utilitarianism is the belief that an action is good
if its overall effect is to produce more happiness
than unhappiness
25
26. TWO FORM OF UTILITARIAN THEORY
ļ±B: Rule utilitarianism:
It asks a person to assess actions according to a set of
rules designed to yield the greatest net benefit to all
affected
ā¢ Compares act to rules
.ā¢ Rule Utilitarianism is the belief that we should adopt a
moral rule and if followed by everybody, would lead to
a greater level of overall happiness
ā¢ Does not accept an action as right if it maximizes net
benefits only once
ā¢ Example: lying is always wrong (driving rules, drink )
26
27. EXAMPLE OF ACT & RULES UTILITARIANISM
ā¢ A judge sending a murderer to prison. The judge knows
the convict will not commit any more violent crimes,
and wants to be lenient (maybe the convict is very old
or terminally ill). The judge knows that this will make
the convict family and friends very happy. Imagine that
the victimās family has forgiven the convict and will not
feel pain as a result of this decision.
ā¢ Should the judge let the convict go?
ā¢ Act utilitarianism says yes
ā¢ But rule utilitarianism says no
27
28. EXAMPLE
ā¢ A few doctors decide that a number of
experiments on a few people, even if most of
them died, would be worth it if they could find a
cure for a disease that would relieve the
suffering of millions of people. Utilitarianism
would give the approval for such because it
produces the greatest good for the greatest
number of people.
28
29. i.ii. HEDONISM ETHICAL THEORY
ā¢ Hedonism- is an ethical doctrine which claims
pleasure as norm of morality.
ā¢ Pleasurable is good
ā¢ Pain is evil is a view that good involves
happiness and pleasure, and evil as unhappiness
and pain.
ā¢ Pleasure
ā¢ When your conduct/action increases your
happiness or pleasure
29
30. HEDONISM ETHICAL THEORY
ā¢ Pleasure in the context means satisfaction
of desire; hence the greater the pleasure, the better.
30
31. A: INTELLECTUAL PLEASURE
A. Intellectual pleasure- derives from oneās
ā¢ Discovery of truth,
ā¢ Desire for knowledge
31
32. B. AESTHETIC PLEASURE
B. Aesthetic pleasure- refers to oneās interested feeling of
beholding something beautiful.
32
33. C. PHYSICAL PLEASURE
C. Physical pleasure satisfaction of luxurious or sexual
desire.
What if you attend the office at
11:00am instead of 8am???
33
34. i.iii. EGOISM ETHICAL THEORY
ā¢ Your conduct or action is ethical if it focus on
self-interest
ā¢ What makes something good or bad, right or
wrong, is that it satisfies oneās desires, or
meets oneās needs
ā¢Basic Principle:
Self-interest of person doing, considering, or
affected by the action
ā¢ One should choose the action which most
realizes or conduces to oneās own self-interest
34
35. TYPES OF EGOISM
Individual Ethical Egoism
ā¢ Judges actions only by their effects on oneās interests
ā¢ Usually rejected by moral philosophers as a defensible basis
of ethics
Universal Ethical Egoism
ā¢ Can include the interests of others when assessing oneās
actions
ā¢ Still self-centered: pursuing pleasure and avoiding pain
ā¢ āEnlightened self-interest.ā Considers the
interests of others because the person wants others to do
the same toward him or her
35
36. OBJECTIONS TO EGOISM
ļ±Not all human acts are selfish by nature, and some are
truly altruistic.
ļ±Egoism is not a moral theory at all: Egoism misses the
whole point of morality, which is to restrain our selfish
desires for the sake of peaceful coexistence with
others.
ļ±Does not resolve conflicts in peopleās interests
ļ±One party would always have the pursuit of his or her
interests blocked
36
37. ii. DEONTOLOGY ETHICAL THEORY
ā¢ Deontologism- Duty Ethics
ā¢ Greek: deon-duty
ā¢ Deontos: that which is binding, right, proper;
ā¢ Emphasis on universal imperatives such is moral laws,
duties, obligations, prohibitions.
ā¢ It is sometimes also called imperativism.
ā¢ Focus on means
ā¢ eg telling truth, Ban on killing, adherence with
religious beliefs
37
38. DEONTOLOGY ETHICAL THEORY
ā¢ It looks on oneās duties and obligations
in determining what is ethical.
ā¢ It is also known as Duty Ethics.
ā¢ An ethical act is the one that meets
obligations, responsibilities and
duties.
38
39. KANTāS THEORY
ļ±Represent deontological ethics
ļ±For him a right action consists solely in an
action that is ruled and justified by a rule
or principle.
ļ±It was the rational and autonomous
conformity of oneās will to see right the
universal moral law
39
40. RIGHTS BASED THEORY
ā¢ Does not leads to violate the rights of others
Right: a personās just claim or entitlement
ā¢ Focuses on the personās actions or the actions of others
toward the person
Types
ā¢ Legal rights: defined by a system of laws
ā¢ Moral rights: based on ethical standards
ā¢ Purpose: let a person freely pursue certain actions without
interference from others
40
41. RIGHTS BASED THEORY
ā¢ Features
ļ¶ Respect the rights of others
ļ¶Lets people act as equals
ļ¶Moral justification of a personās action
ā¢ Examples
ā¢ Legal right: right to a fair trial in the Pakistan
ā¢ Moral right: right to due process within an organization
41
42. RIGHTS BASED THEORY
ā¢ Rejects view of assessing the results of actions
ā¢ Expresses moral rights from individual's view, not
society's. Does not look to the number of people who
benefit from limiting another person's rights
ā¢ Example: right to free speech in the Pakistan stands
even if a person expresses a dissenting view
42
43. TYPES OF RIGHTS
ā¢ Negative rights: do not interfere with another
personās rights
ā¢ Positive rights: A person has a duty to help others
pursue their rights
Example
Negative: do not stop a person from whistle-blowing
Positive: coworker helps another person blow the whistle
on unethical actions
43
44. COMPARISON
Teleology Deontology Virtue Ethics
Morality is about
good outcomes
Morality is about good rules Morality is about
good people
We should make decisions
based on what will most
likely result in the outcomes
we want
We should come up with a
logical system of moral rules
and always follow it no
matter what
We should strive to become
more courageous, honest,
generous, and
compassionate.
āThe ends justify the
meansā
The means do not justify the
end
Such a person will make
good moral decisions on
their own without the need
for abstract moral rules.
Focus on desire outcomes/
consequences
Focus on the means/act
regardless of end/result
Moral link with personal
characteristics
44
45. DONATION CASE -I
ā¢ The Reluctant Donor Case: Suppose that you are famous transplant
ā¢ surgeon, and that your transplants always work. You have five patients,
ā¢ each of whom needs a transplant. One needs a heart, one a brain, two
ā¢ need one lung each, and one needs a liver. You have a patient named
ā¢ āMr. Kumarā who has come in today to find out the results from some
ā¢ lab work. You know from the results of the lab work that Mr. Kumar
ā¢ would be a perfect donor for each of your five other patients, and you
ā¢ know that there are no other available donors. So you ask Mr. Kumar if
he would be willing to be cut up and have his organs distributed. He
declines your kind offer. But you then realize that you could cut Mr.
Kumar up without his permission during some minor surgery he has
already consented to.
Is it permissible for you do so?
45
46. ā¢ State will create a new stretch
of highway
ā¢ New highway segment will circumvent towns
allowing trucks
an alternate route.
ā¢ Some wildlife habitat would
be destroyed
ā¢ Taxes will be raised
Highway Scenario case-II
47. ā Shazia earning an āAā on all work so far
ā Carla doesnāt have time to write final
report
ā¢ Shazia purchases report; submits it as
her own work
PLAGIARISM SCENARIO
CASE -III
ā¢ Shazia
ā Single mother
ā Works full time
ā Takes two evening courses/semester
ā¢ History class
ā Requires more work than normal
50. ETHICAL DILEMMAS
ā¢ Ethical dilemmas, also known as a moral dilemmas, are
situations in which there is a choice to be made
between two options, neither of which resolves the
situation in an ethically acceptable fashion.
ā¢ An ethical dilemma or ethical paradox is a decision-
making problem between two possible moral
imperatives, neither of which is unambiguously
acceptable or preferable. The complexity arises out of
the situational conflict in which obeying would result in
transgressing another.
51. ETHICAL
DILEMMAS
Ethical dilemmas are
situations where two
ethical values or
requirements seem to
be incompatible
A conflict of interest
arises when an
individual has a duty to
two or more parties
Ethical dilemmas involve
unclear choices of what
is right and what is
wrong
Any decision where
moral considerations are
relevant can potentially
give rise to an ethical
dilemma
For example: A decision
that requires a choice
between rules.
A decision where there
is no rule, precedent or
example to follow.
52. Continue
A decision that morally requires two or more courses of action,
which are in practice incompatible with each other.
A decision that should "taken in oneās self interest, but which
appears to violate a moral principle that you support. It is the
imperative to act, combined with the uncertainty of which action to
take, that causes a dilemma.
Doing morally right Bad outcome
Doing morally wrong Good outcome
In such a dilemma, choosing one moral will result in violating
another; or, doing one thing could bring positive results but is
morally wrong. A common example is āstealing from the rich to
feed the poor.ā
53. ETHICAL
DILEMMAS
Ethical dilemmas are situations
involving conflicting morals claims,
and give rise in such questions as
What ought I to do?
What harm and benefit result from
this decision or actions?
What is good (virtue) or what is duty
(right)?
Aroskar et al
54. ETHICAL DILEMMAS
IN SOCIAL WORK
ā¢ Ethical dilemma occurs when
social workers must choose
between two contradictory
ethical principles or
directives.
ā¢ Conflict may arise between
patients, families, agency
staffs, and government
regulations.
ā¢ Tensions may arise in
homecare
National Association of Social
Workers
55. SOCIAL WORKERS DILEMMA
ā¢ Social workers reported that the most common issues
were patient competence and confusion because of
the lack of advance directives
Some examples of ethical dilemmas are:
ā¢ A social worker's personal or professional values
conflict with serving their client
ā¢ A social worker's values or conduct deviate from the
professional code of ethics that governs social work.
ā¢ A social worker must decide whether to break
confidentiality for the good of their client
ā¢ An organization or colleague violates a standard of
ethical conduct
56. SOCIAL WORKERS DILEMMA AND
DECISION MAKING
ā¢ The National Association of Social Workers (NASW)
provides the Code of Ethics as a decision-making model
that all social workers use.
Function of the code is to ensure the conditions under which
social workers practice:
ā Maintaining appropriate boundaries
ā Following privacy rules
ā Obtaining proper legal consent from clients
ā Protecting confidentiality
ā¢ the code reminds social workers of their professional values
and mission. These standards benefit both social worker
and client, and, ideally, create an environment that is
conducive to progress.
57. ETHICAL DILEMMAS PHYSICIANS FACED
Three possible areas of decision making have
been Identified
1. Using all possible means to keep the patients
alive (ordinary & extraordinary means).
2. Surgeons experience ethical dilemmas in
deciding the right treatment in different
situations.
3. Taking some āpositiveā steps to hasten
individualās death.
58. ETHICAL DILEMMAS IN NURSING
ā¢ The challenge of decision making .
ā¢ The sanctity of life vs the quality of life.
ā¢ Truth-telling
A code of ethics in nursing basically states that
nurses are responsible for respecting human
rights and treating all patients with respect
while promoting health, minimizing suffering,
and preventing sickness.
59. 4 COMMON NURSING ETHICS DILEMMAS
1. Informed consent
Concerns that patients and their families have not been fully informed about their
treatments or clinical prognosis is a common ethical concern of nurses, Ulrich
reported.
2. Disclosing medical conditions
Another example of an ethical dilemma is telling the truth to a patient vs. being
deceptive,
āSometimes families request that patients not be told about their medical
condition or diagnosis. āThe nurse must consider the patient's right to know. How
does the nurse know what the family is saying is true?ā (Altman)
The nurse has an obligation to the patient and the ethical principles of
nonmaleficence and fidelityāthe obligation to prevent harm and to be faithful to
your colleagues, āThe nurseās own value of truth telling must also be considered.ā
60. 4 COMMON NURSING ETHICS DILEMMAS
3. Incompetence among peers
ā¢ Another dilemma when a nurse notes incompetence in
a fellow health care team member and struggles with
speaking up or staying silent,
ā¢ They may feel the behavior should be reported
because of the threat to patient safety but hesitate to
do so because it would worsen inadequate staffing,
ā¢ āSome dilemmas can be framed as competing
obligations, such as protecting the patient on one
hand and protecting the staff on the other. The
principles to consider are nonmaleficence and fidelity.
61. 4 COMMON NURSING ETHICS DILEMMAS
4. Broader ethical issues
ā¢ According to Felicia āLizā Stokes, JD, RN, senior policy advisor at the ANAās
Center for Ethics and Human Rights, ANA considers the top three
nursing ethics issues as:
ā¢ Creating and maintaining an ethical work environment
ā¢ Nursingās role in social justice, such as opposing capital
punishment
ā¢ Moral distress and moral resilience.
āThe Code of Ethics for Nurses with Interpretive
Statements is clear that nurses are bound in their duty to
protect human health,ā (Ruth McBain on behalf of ANA).
62. ETHICAL DILEMMA VIDEO
ā¢ https://www.youtube.com/watch?v=-
GxuvKRL7ks
ā¢ https://www.youtube.com/watch?v=oQl6b-
fN1BI
63. ETHICAL DECISION MAKING
ā¢ In the context of decision making, your ethics
are your personal standards of right and
wrong. They are your basis for making
ethically sensitive decisions.
ā¢ Ethical decision making is a cognitive process
that considers various ethical principles, rules,
and virtues or the maintenance of
relationships to guide or judge individual or
group decisions orinted actions
64. ETHICAL DECISION-MAKING MODEL
ā¢ Ethical decision-making models provide a
suggested mechanism for critical thinking and
planning for the resolution of ethical dilemmas.
An ethical decision-making model is a tool that
can be used by health care providers to help
develop the ability to think through an ethical
dilemma and arrive at an ethical decision.
ā¢ The goal of each model is to provide a framework
for making the best decision in a particular
situation with which the health care provider is
confronted.
65.
66.
67. References
ā¢ Aroskar; M.A., Davis, A., Drought, T.,
Liaschenko, J.(1997). Ethical dilemmas and
nursing practice
ā¢ https://www.noodle.com/articles/ethical-
dilemmas-in-social-work-what-to-know-
about-nasw-code-of-ethics Retrieved on 6
April 2020
68. References
1 Wake E. Commentary on Twycross A, Finley GA (2013) Childrenās and parentsā
perceptions of postoperative pain management: A mixed methods study. Journal
of Clinical Nursing 22, 3095-3108. Vol. 23, Journal of Clinical Nursing. 2014. p.
3290ā1.
2 American Academy of Pediatrics. Committee on Psychosocial Aspects of Child
and Family Health, Task Force on Pain in Infants C and A. The assessment and
management of acute pain in infants, children, and adolescents. Pediatrics.
2001;108(3):793ā7.
3 Tein AJ, Roosa MW, Michaels M. Agreement Between Parent and Child Reports
on Parental Behaviors. J Marriage Fam. 2012;56(2):341ā55.
4 Cordell WH, Keene KK, Giles BK, Jones JB, Jones JH, Brizendine EJ. The high
prevalence of pain in emergency medical care. Am J Emerg Med. 2002
May;20(3):165ā9.
5 Stevens BJ, Abbott LK, Yamada J, Harrison D, Stinson J, Taddio A, et al.
Epidemiology and management of painful procedures in children in Canadian
hospitals. CMAJ. 2011 Apr 19;183(7):E403-10.
6 Online guide to Ethics and Moral Philosophy . (1996). Kant's Ethics.
Recuperado el 22 de Febrero de 2013, de Onlie guide to Ethics and Moral
Philosophy :
http://caae.phil.cmu.edu/Cavalier/80130/part1/sect4/Kant.html
68
69. References
5 Immanuel Kant Biography ā
6 life, family, childhood, children, death, history, school, information,
born, tall, t ime. (n.d.).Encyclopedia of World Biography. Retrieved
February
7 25, 2013, from http://www.notablebiographies.com/Jo-Ki/Kant-
Immanuel.html#b
8 Immanuel Kant Biography - Facts, Birthday, Life Story -
Biography.com . (n.d.). Famous Biographies & TV Shows -
Biography.com . Retrieved February 25, 2013, from
http://www.biography.com/people/immanuel-kant- 9360144 (2011).
Kant's ethical theory. Retrieved February 24th. 2013, de
RSRevision from:
http://www.rsrevision.com/Alevel/ethics/kant/index.htm Fledderman, Ch.
(2014). Engineering Ethics. International Edition, Pearson Prentice Hall.
9 Encyclopedia Britannica, Inc. 2003. www.search.eb.com Online Ethics Center for Engineering and Science. 2004.
http://onlineethics.org
10 Fledderman, Ch. (2014). Engineering Ethics. International Edition, Pearson Prentice Hall. Encyclopedia Britannica, Inc. 2003. www.search.eb.com
11 Online Ethics Center for Engineering and Science. 2004. http://onlineethics.org
70. Ethical dilemmas
A decision that morally requires two or more courses of action,
which are in practice incompatible with each other.
A decision that should "taken in oneās self interest, but which
appears to violate a moral principle that you support. It is the
imperative to act, combined with the uncertainty of which action to
take, that causes a dilemma.
Doing morally right Bad outcome
Doing morally wrong Good outcome
In such a dilemma, choosing one moral will result in violating
another; or, doing one thing could bring positive results but is
morally wrong. A common example is āstealing from the rich to
feed the poor.ā
71. Ethical
dilemmas
Ethical dilemmas are situations
involving conflicting morals claims,
and give rise in such questions as
What ought I to do?
What harm and benefit result from
this decision or actions?
What is good (virtue) or what is duty
(right)?
Aroskar et al
72. Ethical Dilemmas
in Social Work
ā¢ Ethical dilemma occurs when
social workers must choose
between two contradictory
ethical principles or
directives.
ā¢ Conflict may arise between
patients, families, agency
staffs, and government
regulations.
ā¢ Tensions may arise in
homecare
National Association of Social
Workers
73. Social Workers dilemma
ā¢ Social workers reported that the most common issues
were patient competence and confusion because of
the lack of advance directives
Some examples of ethical dilemmas are:
ā¢ A social worker's personal or professional values
conflict with serving their client
ā¢ A social worker's values or conduct deviate from the
professional code of ethics that governs social work.
ā¢ A social worker must decide whether to break
confidentiality for the good of their client
ā¢ An organization or colleague violates a standard of
ethical conduct
74. Social Workers dilemma and Decision
making
ā¢ The National Association of Social Workers (NASW)
provides the Code of Ethics as a decision-making model
that all social workers use.
Function of the code is to ensure the conditions under which
social workers practice:
ā Maintaining appropriate boundaries
ā Following privacy rules
ā Obtaining proper legal consent from clients
ā Protecting confidentiality
ā¢ the code reminds social workers of their professional values
and mission. These standards benefit both social worker
and client, and, ideally, create an environment that is
conducive to progress.
75. Ethical Dilemmas Physicians Faced
Three possible areas of decision making have
been Identified
1. Using all possible means to keep the patients
alive (ordinary & extraordinary means).
2. Surgeons experience ethical dilemmas in
deciding the right treatment in different
situations.
3. Taking some āpositiveā steps to hasten
individualās death.
76. Ethical Dilemmas in Nursing
ā¢ The challenge of decision making .
ā¢ The sanctity of life vs the quality of life.
ā¢ Truth-telling
A code of ethics in nursing basically states that
nurses are responsible for respecting human
rights and treating all patients with respect
while promoting health, minimizing suffering,
and preventing sickness.
77. 4 Common Nursing Ethics
Dilemmas
1. Informed consent
Concerns that patients and their families have not been fully informed about their
treatments or clinical prognosis is a common ethical concern of nurses, Ulrich
reported.
2. Disclosing medical conditions
Another example of an ethical dilemma is telling the truth to a patient vs. being
deceptive,
āSometimes families request that patients not be told about their medical
condition or diagnosis. āThe nurse must consider the patient's right to know. How
does the nurse know what the family is saying is true?ā (Altman)
The nurse has an obligation to the patient and the ethical principles of
nonmaleficence and fidelityāthe obligation to prevent harm and to be faithful to
your colleagues, āThe nurseās own value of truth telling must also be considered.ā
78. 4 Common Nursing Ethics
Dilemmas
3. Incompetence among peers
ā¢ Another dilemma when a nurse notes
incompetence in a fellow health care team
member and struggles with speaking up or
staying silent,
ā¢ They may feel the behavior should be
reported because of the threat to patient
safety but hesitate to do so because it would
worsen inadequate staffing,
ā¢ āSome dilemmas can be framed as competing
79. 4 Common Nursing Ethics
Dilemmas
4. Broader ethical issues
ā¢ According to Felicia āLizā Stokes, JD, RN, senior policy advisor
at the ANAās Center for Ethics and Human Rights, ANA
considers the top three nursing ethics issues
as:
ā¢ Creating and maintaining an ethical work
environment
ā¢ Nursingās role in social justice, such as
opposing capital punishment
ā¢ Moral distress and moral resilience.
āThe Code of Ethics for Nurses with Interpretive
80. Ethical Dilemma Video
ā¢ https://www.youtube.com/watch?v=-
GxuvKRL7ks
ā¢ https://www.youtube.com/watch?v=oQl6b-
fN1BI
81. Ethical decision making
ā¢ In the context of decision making, your ethics
are your personal standards of right and
wrong. They are your basis for making
ethically sensitive decisions.
ā¢ Ethical decision making is a cognitive process
that considers various ethical principles, rules,
and virtues or the maintenance of
relationships to guide or judge individual or
group decisions orinted actions
82. Ethical Decision-making Model
ā¢ Ethical decision-making models provide a
suggested mechanism for critical thinking and
planning for the resolution of ethical
dilemmas. An ethical decision-making model
is a tool that can be used by health care
providers to help develop the ability to think
through an ethical dilemma and arrive at an
ethical decision.
ā¢ The goal of each model is to provide a
framework for making the best decision in a
83.
84. ETHICAL DECISION-MAKING
PROCESS
Article Activity
Please read the article carefully, and fill the
questions table with your own nursing practice
issues, how you identified the problem and
what was your decision for resolving that
problems
Note: please answer all the question. This is a
graded activity
85.
86. References
ā¢ Aroskar; M.A., Davis, A., Drought, T.,
Liaschenko, J.(1997). Ethical dilemmas and
nursing practice
ā¢ https://www.noodle.com/articles/ethical-
dilemmas-in-social-work-what-to-know-
about-nasw-code-of-ethics Retrieved on 6
April 2020
87. Case
A 32-year-old pregnant woman, who came for
vaginal delivery. She had two previous babies with
emergency cesarean section. The second baby was
born just a year back. Due to this doctors wanted Mrs.
X to avoid any risk and to get her baby delivered
through c- section. The staff members tried to
convince Mrs. X and her husband, but to no avail.
Finally, the patient was sent home for trail of normal
labor. Two weeks later she came up with strong pains,
but during delivery her uterus got rupture. The baby
was delivered normally, whereas, mother was
transferred to the intensive care unit for close
observation. Unfortunately a few weeks later she
died.
Sayani, A.H (2015)
6 May 2021 87
89. ā¢ In this emblematic ethical dilemma, if
couple autonomy was respected, women
were exposed to complications. While if a
health care professionalās decision was taken
into account, then patients autonomy, was
violated.
ā¢ According to Beuchamp and Childress there
is a disparity between the principle of
paternalism and autonomy.
Sayani, A.H (2015)
6 May 2021 89
90. Medical Paternalism
69 years male diagnosed with metastatic likely terminal
cancer. Based on a long relationship, the man's physician
knows that the patient has a history of psychiatric illness
and is emotionally fragile. When the patient blurts out,
"Am I OK? I don't have cancer, do I?" the physician
answers, "You're as good as you were ten years ago,"
knowing that the response is a paternalistic lie, but also
believing it justified in protecting the health and well-
being of the patient.
6 May 2021 90
91. Futility
ā¢ Medical futility is described as proposed
therapy that should not be performed
because available data have shown that it will
not improve the patient's medical condition.
James L. Bernat, 2005
6 May 2021 91
92. Cont:
ā¢ Futility in medicine is an ancient concept;
Hippocrates clearly stated that physicians
should ārefuse to treat those who are
overmastered by their disease, realizing that
in such cases medicine is powerless
Deborah L. Kasman, October 2004
6 May 2021 92
93. What can physicians do when their professional judgm
differs from preferred patient or family choices?
ā¢ First, it is important to determine who has the
moral and legal right to make medical
decisions.
ā¢ The patient has the right to make decisions
regarding his own care as long as he is
mentally competent. If a patient is deemed
mentally incompetent to make decisions, a
surrogate must be identified.
(Deborah L. Kasman, 2004)
6 May 2021 93
94. Cont:
ā¢ This surrogate can be legally assigned by the
patient prior to incapacity (a durable power of
attorney), or his next of kin.
ā¢ If there is not an identifiable surrogate by
either means, the courts must assign a morally
valid proxy who can act in the patientās best
interest.
(Deborah L. Kasman, 2004)
6 May 2021 94
95. Process to consider a treatment futile
ā¢Patientās Right ( e.g. spirituality)
ā¢Surrogate Involvement (incapable patient)
ā¢Physicians Decision
ā¢Nurse play an important role (as a bridge)
ā¢Court
ā¢Effective communication is mandatory
(Nathaniel A.K Burkhadt M.A 2008)
6 May 2021 95
96. Futility Differs for Different Age and
Case
A futile care / Procedure for one is not futile for all; it
may be a useful for anotherā¦
ļ±Child
ļ±Young
ļ±Old
ļ±Acute
ļ±Chronic
(Nathaniel A.K Burkhadt M.A 2008)
6 May 2021 96
Editor's Notes
In criminal law, this is a physical act that results in harmful or offensive contact with another person without that person's consent. 2. In tort law, the intentional causation of harmful or offensive contact with another's person without that person's consent.
transgressing: breaking social law
A dilemma is a problem offering two possibilities, neither of which is unambiguously acceptable or preferable
In such a dilemma, choosing one moral will result in violating another; or, doing one thing could bring positive results but is morally wrong. A common example is āstealing from the rich to feed the poor.ā
A dilemma is a problem offering two possibilities, neither of which is unambiguously acceptable or preferable
In such a dilemma, choosing one moral will result in violating another; or, doing one thing could bring positive results but is morally wrong. A common example is āstealing from the rich to feed the poor.ā
(HCP) should take the decision in the best interest of the patient. HCPās can pertain the theory of paternalism in those meticulous (particular) cases where no alternate non-paternalistic courses of action can be determined. Favoring elective section would not only be advantageous for HCPās own safe practice in terms of successfully patient care delivery, but also for patientsā life. Burkhardat and Nathaneil have clearly highlighted that though, this approach prohibits others from participating in decisions on the equal basis but it is used to benefit patient. Uterine rupture is an obstetrical emergency which is associated with the increase risk of maternal mortality and morbidity. C Sect is preferred in women with a double scarred uterus It is also evident from the literature that the patients that are laboring for vaginal birth after cesarean section, the chances of maternal mortality rate are 3.8 per 100,000 These findings support my stance that if the HCPās would have acted on a decision, then the death could have been prevented. principles of nonmaleficence, beneficence provide a basis for paternalistic actions towards patients.emphasize that beneficence is to do good, and prevent harm while, non-maleficence stresses on purposefully avoiding those actions that can cause harm. Examining the scenario from the angle of beneficence and non-maleficence, the knowledge and skill HCP poses, can prevent patient from risks and harm, and also save the patient's life. couples have potential to reproduce and independence to decide where, when, and how to do so not going for cesarean section is the perception of adverse psychological impact, the negative experience of a previous cesarean birth, effect on womanās future pregnancies, and perceiving instrumental birth as terrifying.
Ā Paternalism is the intrusion of a person with another individual, counter to their wish, and justified by a claim that the individual will be protected from harm.Soft paternalism is a type that is justified when an individual being interfered with is not knowledgeably. Hard paternalism is justified when and individual being interfered with is knowledgeably, while autonomy is opposite to it.
by HippocratesāI solemnly promise that I will do the best of my ability to serve humanity - caring for the sick, promoting good health, and alleviating pain and suffering.ā
utter with a sudden burst of strong feeling "I'm hungry!" the toddlerĀ blurted out.