BIOETHICS [DECK 1] Flashcards
In 2002, - became the first modern industrialized nation to fully sanction Physician Assisted suicide.
Netherlands
In the - does not allow active- assited suicide- where the physician prescribes and administers the lethal dose.
U.S Germany
- also allows physician assisted suicide but has much less restrictive laws as it allows the process as long as there are no “self- seeking motives”
Switzerland
In 2002, - became the 2nd Western nation to legalized physician assisted suicide.
Belgium
occurs when someone other than the patient administers medication in any form with the intention of hastening the patient’s death
Euthanasia
- Law permits an adult patient with a terminal illness and the capacity for medical decision-making to self-administer oral or enteral medication when certain criteria are met.
Medical aid in dying
“It is the shared responsibility of professional nursing organizations to speak for nurses collectively in
shaping health care.”… hence it supports recommendations that nurses:
American Nurses Association (ANA)
- Is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity.
Advance directives
written, legally-recognized documents that state your
choices about health- care treatment or name someone to make such choices
for you if you are not able to do so (Reyes, 2010).
Advance directives
a federal law regarding advanced directives. The purpose of this to make people aware of their rights.
(PSDA) Patient Self- Determination Act.
evaluates and accredits
20,500 healthcare organizations, has developed standards for the documentation of patient’s wishes regarding advanced directives, which apply to the vast
majority of health care institutions.
The Joint Commission
- Appointment of health care proxy
- Make decision and guide doctors about life sustaining procedures in the
event of terminal condition, persistent vegetative state and end stage condition i.e DNR, Pain management, Organ Donation, Euthanasia.
Advance Directive
Advance Directive forms
Living Will, Health Care Proxy
Prevents unnecessary prolonged painful hospitalization
Prevents unnecessary prolonged comatose or vegetative state
Prevents burden of rising medical costs
Releases responsibility of loved ones from difficult decisions
Advance Directives
a discrepancy between the current situation and a desired state. Before you can begin to solve it, you must be able to identify and categorize it
Problem
occurs when we sense that there is a moral problem, but are not sure of the morally correct
action
Moral Uncertainty
a problem that requires a choice between two options that are equally unfavorable and mutually
exclusive
Moral/ethical dilemma
As nurses we commonly use the - model for decision making. Utilizing logical thinking and intuitive knowing, the - is a deliberate activity that provides a systematic method for nursing practice
nursing process
binds all of a person’s moral virtues into a coherent package—it creates a wholeness and stability of character that leads to trustworthiness
Moral integrity
- they hear what patients say and understand the meaning
Sensitivity, compassion, and caring
- has a sense of duty to the patient, an obligation to do whatever is necessary, within reason, to care for the patient or solve a problem
Responsibility
- suggests that a person has self-confidence that he or she can
effect change
Empowerment
Nuremberg Code of 1947
- formulated 50 years ago, in August 1947, in Nuremberg, Germany, by American judges sitting in judgment of Nazi doctors accused of conducting murderous and torturous human experiments in the concentration camps (the so-called Doctors’ Trial)
ØEthical principles for human experimentation
ØFocus on human rights and welfare
Nuremberg Code of 1947
ØStatement of ethical principles for medical research involving human participants, including identifiable human material and data; doctors doing
medical research on patients
Declaration of Helsinki
ØIn 1964, the - adopted the Helsinki Declaration as a response to concerns regarding research on patient populations.
World Medical Association
Designed with a focus on clinical research.
Declaration of Helsinki
Broader in scope, involving any and all experimentation involving human subjects.
The Nuremberg Code
ØOne of the leading works concerning ethics and health care research.
Belmont Report 1976
Belmont Report 1976 research studies.
ØIt consists of 3 principles:
beneficence, justice, and respect
ØA report created by the National Commission for the Protection of
Human Subjects of Biomedical and Behavioral Research
Belmont Report 1976
ØIt summarizes ethical principles and guidelines for research involving human
subjects
Belmont Report 1976
The - was written in response to the infamous
Tuskegee Syphilis Study, in which African Americans with
syphilis were lied to and denied treatment for more than 40 years. Many people died as a result, infected others with the disease, and
passed congenital syphilis onto their children.
Belmont Report
brought forth the creation of the National Human Investigation Board, as well as the request for the creation of institutional review boards (IRBs).
Belmont Report
protecting the autonomy of all people and treating them with courtesy and respect and allowing for informed consent.
Respect for persons
the philosophy of “Do no harm”
while maximizing benefits for the research project
Beneficence
ensuring reasonable, non-exploitative, and well-considered
procedures are administered fairly
Justice
is a systematic inter connecting scientifically generated evidence with the tacit knowledge of the expert practitioner
ØEvidence-based practice
In everything,
“Do unto others as you would have them do unto you”
Luke 6:31 and Matthew 7:12
Golden Rule
The whole is greater than its parts
The Principle of Totality
There is always an exemption to the rule
Epikia
You cannot betray yourself
No one is obliged to betray herself
(instrument to
the crime)
One who acts through as agent is herself responsible
ex: stealing from the rich to
give the poor.
The end does not justify the means-
permanent legal records that provide a comprehensive
sequential description of relevant facts, data, and information about the patient’s health status.
Documents
done to a patient is critical to determine if the expected standard of care was rendered to a particular patient.
Documentation of nursing actions
●Creating and supporting a working environment.
●Provision of high quality and cost effective
healthcare.
●Ensuring ethical behaviors among nurses.
(Udan, J.Q, HCE,2023)
ETHICAL LEADERSHIP
are individuals who display
characteristics such as empathetic interactions, ethical
behavior, and exalted manners.
Ethical leaders in nursing
encourage nurses to do the right thing. Also, they have considerable power to create and
maintain ethical processes through the ethical climate.
Ethical leaders
means both acting ethically and
setting the standard for others to do so as well. Leaders have an opportunity to inspire others not
ethical leadership
imperative to arrive
at an ethical action or intervention.
Moral decision
is having the ability to
decide which is the right course of action once we
have spotted the ethical issue.
Moral decision making
a choice between right and
wrong.
moral decision
Olson (2002) refers to the ability to discern what is morally
right from morally wrong that requires moral
reflectiveness on the meaning of goodand bad. It refers to
ability to draw conclusions from the discernment to
develop convictions.
Moral Discernment
- It involves discerning (discovering, judging) which
goals (ends, intentions) and means (actions) really are
conducive to human fulfilment and according to God’s
will.
Moral Discernment
(discovering, judging)
discerning
(ends, intentions)
goals
(actions)
means
Ø Is the ability to perceive and evaluate the quality of actions
and behaviors from the perspective of good and evil.
Ø It suggest that being morally discriminating is a way of life that
we must adopt and utilize in all aspects of our lives as a
commitment to God and to the dignity of other human beings.
Moral Discernment
a willing participation on the part of the
cooperative agent in the sinful act of the principal
Principle of Formal Cooperation
(‘‘Yes, I’m happy to drive the getaway car because I want to be
an accomplice’’) or implicit.
Formal Cooperation
in evil is always wrong. It occurs
when someone intentionally helps another person carry out a
sinful act. Eg. Abortion
Formal corporation
- The person cooperating intends, desires, or approves the
wrongdoers conduct.
Principle of Formal Cooperation
Example:
The nurse helps in the operation because she wants the operation
performed.
Principle of Formal Cooperation
Regardless of any other distinction, the cooperator is also wrong. we
cannot intend wrong conduct.
Principle of Formal Cooperation
occurs when a person’s actions unintentionally help another person do something wrong.
Principle of Material Cooperation
- It is sometimes morally acceptable and sometimes not,
depending on how closely related it is to evil. - For example, a nurse who works in an abortion operating
room, even if she does not agree with what the doctor is
doing, is too closely related to the evil to be permitted to
continue in her job.
Principle of Material Cooperation
when a person actions unintentionally help another person do something wrong.
It simply means that although we do not share the intention of the wrong doer, we are involved in the matter
or the actual doing of the action.
Principle of Material Cooperation
Ex. Antibiotics can cure but sometimes it has side effect or adverse effect.
Principle of Lesser Evil
is the principle that when faced with
selecting from two immoral options, the least immoral one should be chosen.
Principle of Lesser Evil
- In the course of caring for patients, there are situations in which some type of harm seems inevitable, and we are usually morally bound to choose the lesser of the two evils, although the lesser of evils may be determined by the circumstances. *
Principle of Lesser Evil
- The principle that when we faced with selecting from two immoral options, the one which is least immoral/ harmful option should be chosen.
Principle of Lesser Evilism
- For instance, a pregnant woman might have a condition that threatens
her life if left untreated, but the treatment itself carries a risk of
harming the fetus. - The principle of the lesser evil would guide the doctor to choose the treatment that poses the least harm, perhaps opting for a treatment that saves the mother’s life while minimizing harm to the fetus.
- Ex. Ectopic Pregnancy
Principle of Lesser Evilism
explains that an action might have two effects: one intended, and another unintended.
Principle of Double Effect
he clarified that the doctrine of double
effect is only applicable when an action is done with good intentions and with the intention to produce only one good effect.
St. Thomas
The principle aims to provide specific guidelines for determining when it is morally permissible to perform an action in pursuit of a good end in full knowledge that the action will also bring about the bad result.
Principle of Double Effect
Example: killing someone to save someone else’s life would be
morally wrong because there are two effects, death and saving
someone else’s life; even though these acts originated from one
intention. Saving a patient’s life for financial gain, for example, results in the
same good outcome as a patient whose life is saved through direct
intentions to cure their illness.
Principle of Double Effect
To attain the true goals of human life by responsible actions, in every free decisions involving an ethical question, people are morally obliged to do the
following
* Be aware of facts and the ethical norms.
*Having a morally certain judgement of conscience.
*Principle of Well-formed Conscience
*Informed consent to medical treatment is fundamental
in both ethics and law.
*Patients have the right to receive information and ask
questions about recommended treatments so that they
can make well-considered decisions about care. Ø *Successful communication in the patient-physician
relationship fosters trust and supports shared decision
making.
*Principle of Well-formed Conscience
Ø it involves making moral decisions based on a conscience that is properly educated and informed.
Ø developed through a continuous
process of learning, reflection, and adherence to moral and ethical principles.
*Principle of Well-formed Conscience
a nurse may face a situation where
they need to decide whether to respect a patient’s wish to refuse treatment or to intervene because they believe the patient does not fully understand the consequences. The nurse would:
carefully consider the ethical principles of
autonomy, beneficence, and non-maleficence, consult with colleagues,
and reflect on their professional and personal values
before making a decision.
*Principle of Well-formed Conscience
- It is a problem in the decision-making process between two possible
options, neither of which is absolutely acceptable from an ethical
perspective;
Ethical Dilemma
The situation must be carefully analyzed. In some cases, the existence of the dilemma can
be logically refuted.
Refute/ Invalidate the paradox (dilemma)
Choose the alternative that offers the greater good or the lesser evil.
Value theory approach
In some cases, the problem can be reconsidered, and new alternative solutions may arise is an approach to solve?
Ethical Dilemma
- It is is a situation in which a person faces a choice
between two or more conflicting moral principles,
making it difficult to determine the right course of
action.
Ethical Dilemma
- These dilemmas often involve complex scenarios where any decision will have significant consequences, and there is no clear right or wrong answer.
- require careful consideration,
balancing conflicting values, and often involve making tough decisions with no perfect solution.
Ethical Dilemma
ØIt is a process that involves evaluating and choosing
among alternatives in a manner consistent with ethical
principles. It requires a clear understanding of ethical
standards, the ability to analyze complex situations.
ETHICAL DECISION MAKING
Limited resources for health should be allocated to maximize the health benefits for the population served.
*Health resources that are cost effective to meet the patient’s
outcome.
Allocation of Health Resources
alternative
health interventions measures their respective costs and
benefits to determine their relative efficiency in the
production of health.
cost-effectiveness analysis (CEA)
*It is a method used to evaluate the economic efficiency of
different interventions or treatments by comparing their
costs and outcomes.
cost-effectiveness analysis (CEA)
- This approach helps decision-makers allocate resources
in a way that maximizes health benefits relative to the
costs incurred.
cost-effectiveness analysis (CEA)
are measured in monetary terms; benefits are measured in
health improvements.
Costs
*Is concerned with the distribution of benefits and costs to distinct individuals or groups.
Equity
Gather data and identify conflicting moral claims
Identify key participants
Determine moral perspective and phase of moral development of key participants
Determine desired outcomes
Identify options
Act on the choice
Evaluate outcomes of actions
PROCESS OF ETHICAL DECISION MAKING
Health care personnel are obligated to maintain confidentiality in dealing with
all information pertaining to patient’s hospitalization and care provided to each one of them.
Discretion in the access, retrieval, transmittal and storage of relevant documents and safe-keeping of all copies of valuable health records must be maintained at all times at all costs
CONFIDENTIALITY
Direct observations and objective descriptions of interventions
rendered to clients are recorded. Data are entered accurately, completely, and objectively including
unintentional errors or any inaccuracy must be recorded properly.
Objective/Factual Documentation
Refers to completion of health care notes immediately within time specific care is
rendered which reflects credibility and accuracy of health records
Timeliness
- concerns with the actual case scenario rather than interpretations or reactions on the
incident;
Factual
presents exact and correct details pertaining to the incident;
Accurate
