Ethics Applied to Nursing: Personal vs. Professional Ethics Copyright © 2013 by Elsevier Inc. All rights reserved

Ethics Applied to Nursing: Personal vs. Professional Ethics

Copyright © 2013 by Elsevier Inc. All rights reserved.

Ethical Issues in 21st Century Health Care (p. 118 )In vitro fertilizationArtificial inseminationSurrogate motherhoodCloningOrgan donation

Including cadaver, child, and aborted fetus donations

Stem cell research/procedures

Copyright © 2013 by Elsevier Inc. All rights reserved. Slide 2

Ethical Issues in 21st Century Health Care (cont’d) (p. 118 )AbortionEuthanasiaAssisted suicideAdvance directives

Living wills, power of attorneyRight to die


Description and Scope of Ethics (p. 118-119 )Ethics is a system of standards or moral

principles that directs actions as being right or wrong.

Concerned with the meaning of words such as right, wrong, good, bad, ought, and duty.

Concerned with the ways people, either individually or as a group, decide the following:What certain actions are right or wrongIf one ought to do somethingIf one has the right to do somethingIf one has the duty to do something


Morals and Values (p. 119 )Morals

Concerned with dealing with right or wrong behavior (conduct) and character

Values Involve the worth you assign to an idea or an

actionFreely chosen and are affected by age,

experience, and maturityContinue to be modified throughout your

lifetime, as you acquire new knowledge and experience


Comparison of Legal Aspects of Nursing and Ethics (p. 119 )Nursing Ethics: the values and principles

governing nursing practice, conduct, and relationshipsResponsibilities: focused on ideal behavior,

morality, and higher standardsLegal Aspects: state statutes that apply to

licensed persons and the situations in patient care that could result in legal actionResponsibilities: focused on rules, regulations,

and obligations mandated by law


Ethical Codes of NAPNES and NFLPN (p. 119 )NAPNES Codes—National Association of

Practical Nurse Educators and ServicesNFLPN Codes—National Federation

of Licensed Practical NursesNurse Practice Acts—published by each

state


Your Personal Code of Ethics (p. 120 )You ultimately choose what your personal

code of ethics will include.Will influence your nursing ethics

When personal ethics conflict with the law, you are obligated to follow the law.

You may ethically refuse to assist with a procedure, but postprocedure you cannot refuse to give nursing care to the patient involved


Roots of Nursing Ethics (p. 120-121 )Before nursing process and critical thinking

were added to nursing curricula, those in the nursing profession did not see themselves as having something separate to contribute to patient care

Nursing ethics was primarily a modification of medical ethics and ethics of other professions at that time


What Changed? (p. 121 )Past

Study of nursing was initially disease-orientedNursing assessments did not existAdditional concerns the patient might have had

were not routinely assessedPatients were expected to follow physicians’

orders without questionThe nurse’s job was to see that the orders were

followed


What Changed? (cont’d) (p. 121 )Present

Nurses discovered that in addition to their dependent role to physicians, they had something special to contribute to the patient

Nursing process helped nurses identify additional needs that could be responded to through nursing care

Patients were encouraged to play an active part in planning and implementing their nursing care plan

Adding nursing process and critical thinking changed the nursing role and changed nursing philosophy


Ethical Decisions in Health Care (p. 121 )Began to see the patient as more than just a

diseaseWestern secular belief system

Individual autonomy: patient’s freedom to choose

Individual rights: patient’s rights are limited if they clash with the health professional’s

Ethical and legal responsibilitiesPatient advocacyAccountabilityPeer reporting


Ethics Committees (p. 121 )Multidisciplinary team assists with difficult

ethical decisionsUsually the discussions relate to new or

unusual ethical questionsPatients arrive with their cultural- and/or

their religion-based ethicsWhat the person can and cannot do in regard

to their health care has already been established by the culture of which they are a part


Western Secular Belief System (p. 121 )Individual autonomy

“Self-rule” Individuals have the capacity to think, and

based on these thoughts, make a decision freely whether or not to seek health care (the freedom to choose)


Western Secular Belief System (cont’d) (p. 121 )Individual rights

The ability to assert one’s rightsThe extent to which a patient can exert his or

her rights is restrictedAn individual’s right has become a central

theme of health care Right to consent to care Right to choose between alternative treatments Women’s rights over their own bodies Right to consent to or refuse treatment


Ethical Responsibilities of Nurses (p. 122 )Patient advocacy

The patient needs to be informed of what you will be doing with him or her (e.g., steps of a procedure)

Accountability You are answerable to yourself, to your assigned

patient, to the team leader, to the physician, and to your instructor who evaluates your work

Peer reporting Report peers for behaviors that are potentially

harmful to patientsCopyright © 2013 by Elsevier Inc. All rights reserved.line. Slide 16

Principles of Ethics (p. 122 )You can add knowledge of basic ethics to

critical thinking as you assist the RN with the nursing process

Learning about ethics is more than being able to recite the definition to pass a test. It means being able to help make ethical decisions when ethical dilemmas arise


Principles of Ethics (cont’d) (p. 122-123 )Nonmaleficence (Do No Harm): the

principle of doing the least amount of harm possible to a patient

Most beneficial treatments involve harming the patient to some extent

Examples:Skin punctureDrug side effectsPhysical manipulations


Question 1Which of the following deal with right or wrong behavior and character? 1. Ethics 2. Morals 3. Values 4. Laws


Question 2Jessica is assigned to a patient named Bill, who is AIDS-positive. She tells her charge nurse that she refuses to take care of the patient. Which is the correct statement? 1. She is entitled to refuse the patient.2. She is entitled to refuse the patient as long as it is before she enters the room.3. She may not refuse to take care of the patient.4. She may talk to her nurse manager to see what

the policies in the facility state.


Question 3Sherry is having a difficult time with a patient situation. A 2-year-old patient needs a blood transfusion and it has become a life-threatening situation. Her parents are Jehovah’s Witnesses and refuse the treatment. What hospital area should get involved in this situation? 1. Medical ethics committee2. Employee improvement committee3. Personal values committee4. Law enforcement committee


Beneficence (p. 123 )Two major nursing duties associated with

beneficence (do good):Put patient interests firstPlace the good of patients before one’s own

needs Includes organizational and other work-related

needs


Autonomy (Free to Choose) (p. 124 )Four steps of autonomous decisions

Thinking through all the facts Deciding on the basis on an independent

thought process Acting based on a personal decisionUndertaking a decision voluntarily, without

pressure from anyone else


Autonomy (Free to Choose) (cont’d) (p. 123 )Patient’s right to privacy

Choose care based on personal beliefsAccept or reject treatmentAvoid needless exposure

Personal values may be contrary to medical ethicsPatient can refuse care for religious, cultural,

or personal reasons


Fidelity (Be True) (p. 125 )Fidelity: Acting in patients’ best interests

when they are unable to make free choicesDoes not include resuscitation or paternalistic

decisionsMust differentiate between your own feelings

and those of the patientMaintain patient confidentiality


Justice (Fair to All) (p. 125 )Justice: Give patients their due and treat

each patient fairly and equally (i.e., with dignity and respect)

Avoid letting personal ethics and values interfere with patient justice


Question 4Autonomy means all of the following except: 1. thinking through all the facts.2. deciding on the basis of an independent

thinking process.3. having patients do whatever they want.4. undertaking a decision voluntarily.


Question 5Two nurses are discussing a very difficult patient on their floor in a full elevator on the way to lunch. The patient’s mother was in the back of the elevator and heard every word. This is an example of: 1. injustice.2. breaching fidelity.3. beneficence.4. nonmaleficence.


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Ethics Applied to Nursing: Personal vs. Professional Ethics Copyright © 2013 by Elsevier Inc. All rights reserved