Ethics

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Chapter 22 Ethics and Values

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Ethics and Values Defined 

Ethics 



The study of conduct and character. It is concerned with determining what is good or valuable for individuals and society at large.

Values 

Personal beliefs about the worth of a given idea, attitude, custom, or object that set standards that influence behavior.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Basic Terms in Health Ethics Autonomy

Commitment to include patients in decisions

Beneficence

Taking positive actions to help others

Nonmaleficence

Avoidance of harm or hurt

Justice

Being fair

Fidelity

Agreement to keep promises Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Professional Nursing Code of Ethics 





A set of guiding principles that all members of a profession accept Helps professional groups settle questions about practice or behavior Includes advocacy, responsibility, accountability, and confidentiality

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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The ANA Code of Ethics 



The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Case Study 



Anna Moreno is an 82-year-old African American widow and retired schoolteacher. She lives with her 55-year-old daughter and three teenage grandchildren. Her daughter Lucille is a single mother and a full-time nurse. Anna assists with the care of her grandchildren when her daughter is at work. She also volunteers at the library and at her church. She has diabetes and high blood pressure, both controlled with diet and medication.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Quick Quiz! 1. Your patient is about to undergo a controversial orthopedic procedure. The procedure may cause periods of pain. Although nurses agree to do no harm, this procedure may be the patient’s only treatment choice. This example describes the ethical principle of A. Autonomy. B. Fidelity. C. Justice. D. Nonmaleficence.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Ethics and Philosophy Deontology Defines actions as right or wrong Utilitarianism Proposes that the value of something is determined by its usefulness Feminist Ethics Focuses on the inequality between people Ethics of Care Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Case Study (cont’d) 



Lucille accompanies her mother to the physician’s office for a routine visit. When her mother steps out to have some lab work done, Lucille asks to speak privately to the nurse, Mary Ann, and reveals some serious concerns. Lucille had received a call from the manager of the library where her mother volunteers. The manager described finding Ms. Moreno in the janitor's closet one day, confused and tearful. Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Nursing and Values 







Ethical dilemmas almost always occur in the presence of conflicting values. To resolve ethical dilemmas, one needs to distinguish among values, facts, and opinion. Sometimes people have such strong values that they consider them to be facts, not just opinions. Sometimes people are so passionate about their values that they provoke judgmental attitudes during conflict. Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Values Clarification Rank Statement Statement Statement Rank Life has has aa predestined predestined course. course. Preparing for the future is an 11 22 33 44 Life The individual individual should should follow follow that important activity and reflects The maturity.maturity. course. reflects that course. Vague answers answers are are sometimes sometimes Vague answers are 11 22 33 44 Vague preferred because because they they avoid avoid dishonest and confusing. preferred embarrassment and and embarrassment confrontation. confrontation. Punctuality and efficiency are 11 22 33 44 characteristics of a of person are characteristics a who is both and person who intelligent is both intelligent concerned. and concerned. When in severe pain, it is important to remain strong and not to complain too much.

Punctuality is is not not as as important important Punctuality as maintaining maintaining aa relaxed relaxed as atmosphere, enjoying enjoying the the atmosphere, moment, and and being being with with family family moment, and friends. friends. and When in in severe severe pain, pain, itit is is better better 11 22 33 44 When to talk talk about about the the discomfort discomfort and and to express frustration. frustration. express

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Values Clarification (cont’d) Statement

Rank

Statement

Addressing someone by his or her first name shows friendliness.

1 2 3 4 Addressing someone by his or her first name is disrespectful.

Direct questions are usually the best way to gain information.

1 2 3 4 Direct questioning is rude and could cause embarrassment.

Direct eye contact shows interest.

1 2 3 4 Direct eye contact is intrusive.

Ultimately the independence 1 2 3 4 The needs of the individual of the individual must come are always less important before the needs of the family. than the needs of the family.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Case Study (cont’d) 



The manager expressed growing concern about Ms. Moreno’s ability to finish tasks, such as reshelving books and taking phone messages. She recommended that Lucille get an evaluation of her mother’s mental status. Lucille tells the nurse that she is not at all convinced that her mother is having mental problems.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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How to Process an Ethical Dilemma    

  

Step 1: Ask if this is an ethical dilemma. Step 2: Gather all relevant information. Step 3: Clarify values. Step 4: Verbalize the problem. Step 5: Identify possible courses of action. Step 6: Negotiate a plan. Step 7: Evaluate the plan.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Institutional Resources 



Ethics committees are usually multidisciplinary and serve several purposes: education, policy recommendation, and case consultation. Any person involved in an ethical dilemma, including nurses, physicians, health care providers, patients, and family members, can request access to an ethics committee.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Issues in Health Care Ethics Quality of life: central to discussions about endof-life care, cancer therapy, physician-assisted suicide, and DNR Genetic screening: What are the risks and benefits to individuals and to society of learning about the presence of a disease that has not yet caused symptoms, or for which a cure is not yet available?

Care at the end of life: interventions unlikely to produce benefit for the patient

Access to care: As a nurse, you will certainly deal with ethical issues related to access to care. Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Ethics and Access to Care 





The number of uninsured in the United States grew from 39 million people in 2000 to more than 46.3 million people by 2008—more than 15% of the total population. Many of the uninsured are women and children. Although two thirds of the uninsured are poor, nearly 80% come from working families.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Quick Quiz! 2. If a nurse decides to withhold a medication because it might further lower the patient’s blood pressure, the nurse will be practicing the principle of A. Responsibility. B. Accountability. C. Competency. D. Moral behavior.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Nurses Collaborate With Other Professionals 



Consensus building: an act of discovery in which “collective wisdom” guides a group to the best possible decision A nurse’s point of view offers a unique voice in the resolution of ethical dilemmas.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Culturally Competent Care: End-ofLife Decisions 



  



Acknowledgment of and respect for cultural differences Willingness to negotiate and compromise when world views differ Being aware of one’s own values and biases Using communication skills that enhance empathy Knowing cultural practices of patient groups regularly seen Understanding that all patients are individuals who may not share the same views as others within their own ethnic group

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Case Study (cont’d) 

From Mary Ann’s perspective, Lucille seems angry and defensive about the manager’s report. She even accuses the manager of discrimination against older adults. She adamantly refuses offers of a physical or mental evaluation for her mother, or even to discuss the issues with her mother. Instead, she requests that the nurse write a letter that validates her mother’s good health.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Moral Distress Moral distress describes the anguish experienced when a person feels unable to act according to closely held core values.

Because moral distress is a shared experience, efforts to alleviate distress are most successful when they are also shared.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Ethical Issues on Aging 





Older people usually are not as familiar with the concept of autonomy as are people from younger generations. As people age, they develop clinical conditions that affect the communication process. Some patients become incapacitated by stroke or disease. Most older adults take multiple medications, some of which affect cognitive skills in subtle ways. Consensus about medical goals for the older adult is hard to achieve.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Quick Quiz! 3. A nurse is working with a terminally ill adult patient. The nurse decides to tell the adult children that they need to decide how to advise their father about taking analgesics during the terminal phase of his illness. This step of processing an ethical dilemma is A. Articulation of the problem. B. Evaluation of the action. C. Negotiation of the outcome. D. Determination of values surrounding the problem.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Case Study (cont’d) 



After all, Lucille argues, her mother’s blood pressure is normal, and her blood glucose levels are within normal limits. Mary Ann realizes that this situation is complex. She will need to get the help of others to sort out the best response to Lucille’s request. 

Is this an ethical dilemma for Mary Ann?

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Case Study (cont’d) 

Mary Anne has determined that the situation is an ethical dilemma. Now she must:  

Step 2: Gather all information relevant to the case. Step 3: Examine and determine her own values and opinions about the issues.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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Case Study (cont’d)  Step  Step

4: State the problem clearly. 5: Consider possible courses of action.  Step 6: Negotiate the outcome.  Step 7: Evaluate the action.

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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