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Questions of Values and Ethics

Chapter 4

Introduction

In the Beginning…

There were no antibiotics.
There were no ICUs.
There were no CT scanners or MRIs.
There were just physicians and nurses who cared for people in sickness and in health.

1960s

Technological advances allowed for the development of the ICU.
New biomedical developments
Advances in surgical techniques, such as open heart surgery

New Questions

The advances created new questions for health-care professionals regarding the use of technology.
The concepts of life and death

Bioethics

A subdiscipline of ethics
The study of medical morality

Concepts of Ethics

Values
Belief systems
Morality

Value Systems

A set of related values
Intrinsic values
Extrinsic values
Personal values
Professional values

Value Formation

Values are learned.
Values change with maturity and experience.
The number of values an individual holds is not as important as what values he or she consider important.

Values Clarification

Choosing
Prizing
Acting

Belief Systems

These are organized ways of thinking about why people exist within the universe.
Their purpose is to explain such concepts as
Life and death
Good and evil
Health and illness

Ethics and Morals

Morals

Morals are an individual’s own code for acceptable behavior.
They arise from an individual’s conscience.
They act as a guide for individual behavior.
They are learned.

Ethics

Ethics deals with the “rightness” or “wrongness” of human behavior.
Concerned with the motivation behind the behavior
Bioethics is the application of these principles to life-and-death issues.

Ethical Theories

Deontological
Teleological
Principalism

Ethical Principles

Autonomy
Nonmaleficence
Beneficence
Justice
Fidelity
Confidentiality
Veracity
Accountability

Autonomy

The freedom to make decisions about oneself
Nurses need to respect clients’ rights to make choices about health care.

Nonmaleficence

Requires that no harm be caused to an individual, either unintentionally or deliberately.
Requires nurses to protect individuals who are unable to protect themselves.

Beneficence

This principle means “doing good” for others.
Nurses need to assist clients in meeting all their needs.
Biological
Psychological
Social

Justice

Every individual must be treated equally.
This requires nurses to be nonjudgmental.

Fidelity

Loyalty
The promise to fulfill all commitments
The basis of accountability

Confidentiality

Anything stated to nurses or health-care providers by clients must remain confidential.
The only times this principle may be violated are
If clients indicate harm to themselves or others
If the clients give permission for the information to be shared

Veracity

This principle implies “truthfulness.”
Nurses need to be truthful to their clients.
Veracity is an important component of building trusting relationships.

Accountability

Individuals need to be responsible for their own actions.
Nurses are accountable to themselves and to their colleagues.

Ethical Codes

These are formal statements of the rules of behavior for a particular group of individuals.
Ethical codes are dynamic.
Most professions have a “code of ethics” to guide professional behavior.

Virtue Ethics

Focus on virtues or moral character.
View helping others as charitable or benevolent.

Organizational Ethics

Focus on the workplace.
Ethical culture makes a difference.
Senior leadership must promote an ethical culture.

Ethical Dilemmas

Occur when a problem exists between ethical principles
Deciding in favor of one principle usually violates another.
Both sides have “goodness” and “badness” associated with them.

Resolving Ethical Dilemmas

Using the Nursing Process

Assessment
Planning
Implementation
Evaluation

Approach to Ethical Dilemmas

Approach

List and rank
the options.

What values are in conflict?

Use of discussion and negotiation.

Work toward
a mutually
acceptable
decision.

Implementation

Identify
decision makers.

Determine goals
of treatment.

Planning

Am I involved?

Collect the facts.

Re-evaluate
as necessary.

Determine
whether desired
outcomes have
been reached.

Evaluation

Assessment

Current Ethical Issues

Issues to Consider

Assisted suicide
Technology issues
Gene therapies
“Designer babies”
Organizational climate

Conclusion

An issue is not an ethical issue for the nurse unless he or she has been asked.
Always gather the facts prior to decision making.
Consider your personal beliefs and values.