Legal and Ethical Case Study Nursing
D131
CHP3ETHICALPRINCIPLES.pptChapter 3
Ethical Principles
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Ethical Principles
- Basic and obvious moral truths that guide deliberation and action
- Presuppose a basic respect for persons
- Included in moral theories, although sometimes in different ways
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Respect for Autonomy
- Definition: self-governing
- Freedom to make decisions about issues that affect one’s life free from lies, restraint, or coercion.
The autonomous person
- Is respected
- Is able to determine personal goals
- Has the capacity to decide upon a plan of action
- Is free to act on choices
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Think About It
- A homeless psychotic man stops his anti-psychotic medication because it makes him sleepy.
- How do you view this man’s autonomy?
- Are there subtleties of autonomy in this case?
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Think About It
- Is autonomy good?
- Should patients be autonomous?
- How far should autonomy go?
- Can you reconcile the concepts of personal autonomy and noncompliance?
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Autonomy
- Value of autonomy is culturally dependent.
- Some cultures don’t regard all people as of equal value.
- Some cultures value social structure over individual rights.
- Respect for autonomy does not require respect for all autonomous decisions.
- Must uphold respect for self and others who might be harmed by another’s choices.
- Respect the principle rather than each action or choice.
Informed Consent
- Practical application of the principles of respect for autonomy.
- Demonstrates legal protection of personal autonomy in regard to specific medical treatments and procedures
- Contemporary informed consent is a direct outcome of past research atrocities.
Paternalism and Advocacy
- Paternalism: places power in the hands of the person who is making the decision for the patient. Implies that the decision maker knows what is best.
- Advocacy: ensures the patient’s welfare and respects the patient’s autonomy because it aims to act according to the patient’s values.
- May unwittingly cross from advocacy to paternalism
Noncompliance
- Lack of participation in a regimen that has been planned by the health care professional but must be carried out by the patient.
- Patient must have autonomous participation in plan formation
- Nurse must assess the patient’s ability to carry out the plan
- Ultimately, choices about health care practices belong to the patient.
Beneficence
- Requires one to act in a way that benefits others:
- Do or promote good
- Prevent harm
- Remove evil or harm
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Do or Promote Good
- Ask yourself:
- How does one decide what is good?
- When people disagree, who gets to decide?
- Should other ethical principles, such as truthfulness and autonomy, be violated in the process of doing good?
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Prevent Harm
- Ask yourself:
- In what instances might a nurse be compelled to prevent harm?
- How far should a nurse go to prevent harm?
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Remove Evil or Harm
- Ask yourself:
- In what type of situations would a nurse need to remove harm?
- What are the risks to the nurse?
- What characteristics does a nurse need in order to remove harm in a difficult situation?
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Nonmaleficence
- Requires one to refrain from causing harm, including:
- Deliberate harm
- Risk of harm
- Harm that occurs during the performance of beneficial acts
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Think About It
- Doing good often includes causing harm; for instance, a surgeon might save a life (doing good) by amputating a limb (causing harm).
- How does one balance good and harm?
- When the outcome is unsure, who decides?
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Veracity
- Definition: telling the truth
- Implies respect for others.
- Is required of those who support autonomy of others.
- Authorities disagree on the absolute necessity of truth telling in all instances.
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Confidentiality
- Definition: nondisclosure of private or secret information about another person
- A traditional tenet of nursing and medical ethics
- A legal mandate in nearly all cases
- Is sometimes limited by harm and vulnerability
- Flows from respect for persons and their autonomy
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Justice
- Relates to fair, equitable, and appropriate treatment in light of what is due or owed to persons
- Recognizes that giving to some will deny receipt to others who might otherwise have received these things
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Distributive Justice
- Application of the principle of justice that focuses on distribution of goods and services
- To each equally
- To each according to need
- To each according to merit
- To each according to social contribution
- To each according to the person’s rights
- To each according to individual effort
- To each as you would be done by
- To each according to the greatest good to the greatest number
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Material Rules of
Distributive Justice
- Systematic means of deciding such as:
- Give to each person equally
- Give to those who need it most
- Give to those who deserve it most
- Give to those who can pay for it
- Give to those who arrive first
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Use of Material Rules
- Which material rule is used when:
- Private hospitals turn away indigent patients?
- Immunizations are given to all fifth graders?
- A free clinic accepts only the first 30 patients?
- Scholarships go to those with low incomes?
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Class Discussion
- A patient smells of alcohol and marijuana. She drove herself to the clinic and admits to beer and a “herbal remedy” today. She refuses blood and urine tests and demands a refill of her “nerve” pills. “I’m leaving. Send me my refills in the mail.”
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Fidelity
- Definition: faithfulness and promise keeping
- Nurses must faithfully
- Uphold the profession’s code of ethics
- Practice within established scope of practice
- Practice competently
- Keep promises to patients
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Think and Discuss
- What are the ethical principles and implications?
- Should the nurse notify security of the potential hazards of patient endangering self and others?
- How does the nurse express fidelity, confidentiality, beneficence, nonmaleficence, autonomy, respect for persons, veracity, and justice in this situation?
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