Chapter 3 - Ethical Responsibilities - Fundamentals Flashcards
Ethics is the study of
conduct and character
Ethical theories examine
principles, ideas, systems, and philosophies that affect judgments
about what is right and wrong, and good and bad.
Common ethical theories are
utilitarianism, deontology, consensus in bioethics, and ethics of care.
Ethical principles for individuals, groups of individuals, and societies are
standards of what is right or wrong with regard to important social values and norms.
Values are
personal beliefs about ideas that determine standards that shape behavior.
Morals are
personal values and beliefs about behavior and decision‑making.
Bioethics refers to
the application of ethics to health and life.
It addresses dilemmas (stem cell research, organ transplantation, gender reassignment, and reproductive technologies [in vitro fertilization, surrogate parenting]).
Other ethical dilemmas include abortion and acquired immunodeficiency syndrome.
BASIC PRINCIPLES OF ETHICS
- ADVOCACY
- RESPONSIBILITY
- ACCOUNTABILITY
- CONFIDENTIALITY
● Advocacy:
support and defend clients’ health, wellness, safety, wishes, and personal rights, including privacy.
● Responsibility:
willingness to respect obligations and follow through on promises.
● Accountability:
ability to answer for one’s own actions.
● Confidentiality:
protection of privacy without diminishing access to high-quality care.
ETHICAL PRINCIPLES FOR CLIENT CARE
- AUTONOMY
- BENEFICENCE
- FIDELITY
- JUSTICE
- NONMALEFICENCE
- VERACITY
● Autonomy:
the right to make one’s own personal decisions, even when those decisions might not be in that person’s own best interest.
● Beneficence:
action that promotes good for others, without any self-interest.
● Fidelity:
fulfillment of promises.
● Justice:
fairness in care delivery and use of resources.
● Nonmaleficence:
a commitment to do no harm.
● Veracity:
a commitment to tell the truth.
● Ethical dilemmas are problems that
involve more than one choice and stem from differences in the values and
beliefs of the decision makers. These are common in health care, and nurses must apply ethical theory and decision-making to ethical problems.
● A problem is an ethical dilemma when:
◯ A review of scientific data is not enough to solve it.
◯ It involves a conflict between two moral imperatives.
◯ The answer will have a profound effect on the situation and the client
Ethical decision-making is a process that requires
striking a balance between science and morality.
When making an ethical decision (7):
● Identify whether the issue is indeed an ethical dilemma.
● Gather as much relevant information as possible about the dilemma.
● Reflect on your own values as they relate to the dilemma.
● State the ethical dilemma, including all surrounding issues and the individuals it involves.
● List and analyze all possible options for resolving the dilemma, and review the implications of each option.
● Select the option that is in concert with the ethical principle that applies to this situation, the decision maker’s values and beliefs, and the profession’s values
for client care. Justify selecting that one option in light of the relevant variables.
● Apply this decision to the dilemma, and evaluate the outcomes.
Ethics committees generally address
unusual or complex ethical issues.
Examples of ethical guidelines for nurses are the:
American Nurses Association’s Code of Ethics for Nurses With
Interpretive Statements (2015) and the International Council
of Nurses’ The ICN Code of Ethics for Nurses
American Nurses Association’s Code of Ethics for Nurses With Interpretive Statements (2015) and the
International Council of Nurses’ The ICN Code of Ethics for Nurses
Moral distress occurs when
the nurse is placed in a difficult situation where the actions taken are different
from what the nurse feels is ethically correct.
Nurses are an agent for clients facing an ethical decision.
Ex:s’
● Caring for an adolescent client who has to decide whether to undergo an abortion even though her parents believe it is wrong
● Discussing options with a parent who has to decide whether to consent to a blood transfusion for a child when his religion prohibits such treatment
Nurses as a decision maker for health care delivery.
Examples:
● Assigning staff nurses a higher client load than previously because administration has reduced the number of nurses per shift
● Witnessing a surgeon discussing only surgical options with a client without mentioning more conservative measures
Nursing’s roles in ethical decision-making
An agent for clients facing an ethical decision.
A decision maker for health care delivery.
- A nurse is caring for a client who decides not to have surgery despite significant blockages of the coronary arteries. The nurse understands
that this client’s choice is an example of which of the following ethical principles?
A. Fidelity
B. Autonomy
C. Justice
D. Nonmaleficence
B
An example of autonomy
A person who decides not to have surgery. In this situation, the client is exercising their right to make their own personal decision about surgery, regardless of others’ opinions of what is “best” for them.
Justice is fairness in care delivery and
in the use of resources
- A nurse offers pain medication to a client who is postoperative prior to ambulation. The nurse understands that this aspect of care delivery is an
example of which of the following ethical principles?
A. Fidelity
B. Autonomy
C. Justice
D. Beneficence
D
A. Fidelity is the fulfillment of promises. Unless the nurse has specifically promised the client a pain‑free recovery, which is unlikely, this principle does not apply to this action.
B. Autonomy is the right to make personal decisions, even when they are not necessarily in the person’s best interest. In this situation, the nurse is delivering
responsible client care. This principle does not apply.
C. Justice is fairness in care delivery and in the use of resources. Pain management is available for all clients who are postoperative, so this principle does not apply.
D. CORRECT: Beneficence is action that promotes good for others, without any self‑interest. By administering pain medication before the client attempts a potentially painful exercise like ambulation, the nurse is taking a specific and positive action to help the client
- A nurse is instructing a group of newly licensed nurses about the responsibilities organ donation and procurement involve. When the nurse explains that all clients waiting for a kidney transplant have to meet the
same qualifications, the newly licensed nurses should understand that this aspect of care delivery is an example of which of the following ethical principles?
A. Fidelity
B. Autonomy
C. Justice
D. Nonmaleficence
C
A. Fidelity is the fulfillment of promises. Because donor organs are a scarce resource compared with the numbers of potential recipients who need them, no one can promise anyone an organ. Thus, this principle does not apply.
B. Autonomy is the right to make personal decisions, even when they are not necessarily in the person’s best interest. No personal decision is involved
with the qualifications for organ recipients.
C. CORRECT: Justice is fairness in care delivery and in the use of resources. By applying the same qualifications to all potential kidney transplant recipients, organ procurement organizations demonstrate this ethical principle in
determining the allocation of these scarce resources.
D. Nonmaleficence is a commitment to do no harm. In this situation, harm can occur to organ donors and to recipients. The requirements of the organ
procurement organizations are standard procedures and do not address avoidance of harm or injury
- A nurse questions a medication prescription as too extreme in light of the client’s advanced age and unstable status. The nurse understands that this action is an example of which of the following ethical principles?
A. Fidelity
B. Autonomy
C. Justice
D. Nonmaleficence
D
A. Fidelity is the fulfillment of promises. The nurse is not addressing a specific promise when they determine the appropriateness of a prescription for the client.
Thus, this principle does not apply.
B. Autonomy is the right to make personal decisions, even when they are not necessarily in the person’s best interest. No personal decision is involved when
the nurse questions the client’s prescription.
C. Justice is fairness in care delivery and in the use of resources. In this situation, the nurse is delivering responsible client care and is not assessing available
resources. This principle does not apply.
D. CORRECT: Nonmaleficence is a commitment to do no harm. In this situation, administering the medication could harm the client. By questioning it, the nurse is demonstrating this ethical principle.
- A nurse is instructing a group of newly licensed nurses about how to know and what to expect when ethical dilemmas arise. Which of the following situations should the newly licensed nurses identify as an ethical dilemma?
A. A nurse on a medical‑surgical unit demonstrates signs of chemical impairment.
B. A nurse overhears another nurse telling an older adult client that if he doesn’t stay in bed, she will have to apply restraints.
C. A family has conflicting feelings about the initiation of enteral tube feedings
for their father, who is terminally ill.
D. A client who is terminally ill hesitates to name their partner on their durable power of attorney form.
C
5. A Delivering client care while showing signs of a substance use disorder is a legal issue, not an ethical dilemma.
B. A nurse who threatens to restrain a client has committed assault. This is a legal issue, not an ethical dilemma.
C. CORRECT: Making the decision about initiating enteral tube feedings is an example of an ethical dilemma. A review of scientific data cannot resolve the issue, and it is not easy to resolve. The decision will have a profound effect on the situation and on the client.
D. The selection of a person to make health care decisions on a client’s behalf is a legal decision, not an ethical dilemma
code of ethics is a guide for
the expectations and standards of a profession
