This document discusses ethical issues related to quality improvement. It covers several ethical theories including utilitarianism, deontology, and virtue ethics. It also outlines ethical requirements for protecting human participants in quality improvement activities, including having social/scientific value, scientific validity, fair participant selection, and ensuring risks are balanced with benefits. Several ethical principles are discussed like respect for persons, beneficence, and protecting privacy. Requirements like informed consent, risk/benefit assessments, and institutional review board oversight are also covered.

1. Ethical Issues and
Quality
Improvement
Rachel Duffy
Eva van Swaaij
Phomolo Madome

2. Ethical Theories
Philosophical Basis for Ethical Theory:
• Professional code of ethics
• Ethics theories derived from either of 2 basic schools of
thought: naturalism or rationalism

3. Ethical Theories
• Utilitarianism (consequentialism)
-Act-Utilitarianism
-Rule-Utilitarianism
• Deontology
• Virtue ethics (character ethics)
Virtue ethics:
Compassion, discernment, trustworthiness, integrity
• Moral Particularism

4. Ethical Requirements for the Protection of Human Participants in
Quality Improvement Activities
Requirement Explanation
Social or scientific value The gains from a QI activity should justify the resources
spent and the risks imposed on participants.
Scientific validity A QI activity should be methodologically sound
(i.e., properly structured to achieve its goals).
Fair participant selection Participants should be selected to achieve a fair
distribution of the burdens and benefits of QI.
Favourable risk–benefit A QI activity should be designed to limit risks while
ratio maximizing potential benefits and to ensure that risks to
an individual human participant are balanced by expected
benefits to the participant and to society.

5. Requirement Explanation
Respect for participants A QI activity should be designed to protect the
privacy of participants and the confidentiality of
their personal information.
Independent review Accountability for the ethical conduct of QI should
be integrated into practices that ensure
accountability for clinical care.
Each QI activity should receive the kind of ethical
review and supervision that is appropriate to its
level of potential risk and project worth
Informed consent Consent to inclusion in minimal-risk QI activities is
part of the patient’s consent to receive treatment.
Patients should be asked for informed consent to be
included in a specific QI activity if the activity
imposes more than minimal risk.

6. Ethical Principles relevant to the
project/research
Respect for persons
• People have the right to self-determination and right to full-
disclosure.
• Participants will be given the right to decide voluntarily
whether to participate in the study or not.
• Participants will be allowed to ask questions, to refuse to give
information, or to withdraw from the study.
• The nature of the study, the persons right to refuse
participation, and the likely risks and benefits that would be
incurred will be fully described.
• Confidentiality will be ensured, using number codes.

7. Beneficence
• An obligation to do no Harm and maximize benefits. Persons
are treated in ethical manner when their decisions are
respected and they protected from harm, and efforts are
made to secure their well-being.
• Participants will not be subjected to unnecessary risks of harm
or discomfort (physical, emotional, social, or financial). Study
will be terminated if any kind of harm is suspected during the
study.

8. The right to privacy
• Participants privacy will be maintained throughout the study.
• Any data provided will be kept in strictest confidence.
• Anonymity & confidentiality will be maintained.

9. Protecting Study Particiants
• Informed Consent
• Risk /Benefit assessments
• Assent
• Institutional Review Board.

10. References
• Rashid M., Fan W.L., Guul S., Enoch S. (2009). Clinical Education.
How to undertake research in wound healing.Wounds uk,Vol 5, No 3.
Retrived from: http://www.wounds-uk.com/pdf/content_9299.pdf
• Orb A., Eisenhauer L., Wynaden D. Ethics in qualitative research.
JOURNAL OF NURSING SCHOLARSHIP, 2000; 33:1, 93-96. ©2001
SIGMA THETA TAU INTERNATIONAL. Retrived from:
http://www.columbia.edu/~mvp19/RMC/M5/QualEthics.pdf
• Lynn, J., Baily, M., & Bottrell, M., et al. (2007). The Ethics of Using
Quality Improvement Methods in Health Care. Annals of Internal
Medicine. 146(9. 666-673.
• Burkhardt, M. A. (2008). Ethical theory. Ethics and issues in
contemporary nursing. 24-51 Delmar Learning. Retrieved from
http://edocs.library.curtin.edu.au/eres_display.cgi?url=dc60267151.
pdf&copyright=1

11. Collaboration Process
• We divided this weeks presention into two parts-
Rachel worked on Ethical Theories and Flex
related ethics to our quality improvement issue.
Eva began working on the final presentation for
class tomorrow.

12. Research Methods
• Rachel: I used my Universities search engine and searched
using key words`Ethical theories´, and ethical theories in
nursing.