Chapter 41 - Ethics and Values Flashcards

1
Q

Morals and Ethics

A
  • Morals
    • Private, personal, or group standards of right and wrong
    • Moral behavior, in accordance with custom, reflects personal moral beliefs
    • Morals consider in a broad, general manner what is good or bad, right or wrong (e.g., “In general, it is wrong to steal”).
  • Ethics
    • Systematic study of right and wrong conduct
    • Formal process for making consistent moral decisions
    • Ethics answers the question, “What should I do in a given situation?” (e.g., “Is it wrong to steal if you have to do it to feed your children?”).
    • Ethics uses specific rules, theories, principles, and perspectives to inquire into the justification of an individual’s actions in a particular situation.
      • It seeks to discover what we “ought” to do in certain circumstances.
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2
Q

Nursing Ethics

A
  • Bioethics
    • Application of ethical principles to every aspect of healthcare.
  • Nursing ethics is a subset of bioethics. It refers to ethical questions that arise out of nursing practice.
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3
Q

Ethical Agency

A

Also called moral agency

  • Ability to base practice on professional standards of ethical conduct and to participate in ethical decision-making.
  • Nurses have choices and are responsible for their actions.
  • An ethical agent must be able to:
    • Perceive the difference between right and wrong
    • Understand abstract ethical principles.
    • Reason and apply ethical principles to make decisions, weigh alternatives, and plan sound ways to achieve goals.
    • Decide and choose freely.
    • Act according to choice (this assumes both the power and the capability to act).
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4
Q

Compromised Ethical Agency

A

Moral distress

  • Inability to carry out a moral decision
  • Perceived constraints: Internal
    • Not enough knowledge, socialization
  • Perceived constraints: External
    • Providers; nurse administrators; other nurses
    • The law; threat of lawsuit

Moral outrage

  • Belief that others are acting immorally
  • Feel powerless
    • Cannot prevent a “wrong”
    • Respond with “whistleblowing”
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5
Q

Whistleblowing

A
  • Identification of an unethical or illegal situation
    • Can involve one person or an entire organization
  • Reporting such an action to someone in authority
  • Need accurate information
  • May have consequences; THINK before you act
  • American Nurses Association (ANA) working to protect whistleblowers

THINK:

  • Talk with an attorney or other legal representation.
  • Have concrete and credible evidence of the violation or wrongdoing.
  • Institute a survival plan, if your job is put in jeopardy or you are fired.
  • Note the nature and consequences of the problem—its type, severity, and potential impact.
  • Know your reporting options and support systems.
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6
Q

Ethical Problems for Nurses: Sources

A
  • Consumer awareness: As a result of increased consumer awareness and availability of information online, professionals now are expected to share knowledge with patients and to obtain truly informed consent for treatments.
    • In some cases, consumers are demanding treatment that is not medically needed.
  • Technological advances: With every new technology, new issues arise.
  • Multicultural population: You will work with patients and colleagues from a variety of cultural backgrounds who probably hold very different sets of values.
  • Cost containment: The emphasis on cutting healthcare costs creates many morally questionable situations.
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7
Q

Ethical Problems: Sources

A
  • Nature of the work
    • Nurses’ ethical problems
    • Nurses’ unique position in healthcare organizations
  • Nature of the profession
    • Caring vs. time spent with patients
    • Autonomy vs. escaping hard choices
    • Higher pay vs. cost effectiveness
    • Professionalism vs. caring
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8
Q

Factors in Ethical Decision Making

A
  • Developmental stage: A person’s stage of moral development affects the way they reason about moral issues.
    • We learn and internalize our morals throughout the life span, beginning in childhood.
  • Kohlberg’s research found that children go through a sequence of moral reasoning ability, proceeding through several stages.
    • Stage I: Moral reasoning is based on personal interest and avoiding punishment.
    • Stage II: Principles focus on pleasing others and following rules.
    • Stage III: Moral principles are based on universal and impartial principles of justice. This is the final level; it occurs in adulthood.
  • Gilligan
    • Challenged Kohlberg’s perspective of moral development, citing it as being male-biased.
    • Girls develop morally by paying attention to community and to relationships
    • Boys tend to process dilemmas through more abstract ideals or principles.
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9
Q

Values

A

What do you value? Person to person

Ideals, beliefs, customs, modes of conduct, qualities, or goals that are highly prized or preferred by individuals, groups, or society.

  • about the worth of something
  • Highly prized ideals, customs, conduct, goals
  • Freely chosen
  • Learned through observation and experience
  • Vary from person to person
  • Can change

People express their values through behaviors, feelings, knowledge, and decisions

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10
Q

Factors in Moral Decision Making

A
  • Attitudes
    • Feelings toward person, object, idea
    • Includes thinking and feeling component
    • Dispositions toward things affecting what a person thinks, feels and does
    • Attitudes can be cognitive (thinking), affective (feeling), and behavioral (doing)
  • Beliefs
    • Something that one accepts as true
    • Not always based on fact
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11
Q

Nurses as Ethical Agents

A
  • Moral/ethical agency means
    • Know the difference between right and wrong.
    • Understand abstract ethical principles.
    • Apply ethical principles in decision making.
    • Weigh alternatives; plan to achieve goals.
    • Decide and choose freely.
    • Act according to choice.
    • Consider value neutrality
      • means that we attempt to understand our own values regarding an issue and to know when to put them aside, if necessary, to become nonjudgmental when providing care to clients.
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12
Q

Consequentialism

A
  • The rightness or wrongness of an action depends on the consequences of the act rather than on the act itself.
    • Teleology – study of final causes
    • Utilitarianism- greatest good for greatest number
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13
Q

Deontology

A
  • Doing right or wrong regardless of consequences
    • Formalism – based on unchanging rules/principles
    • Categorical imperative – established by the philosopher Immanuel Kant (1724–1804),
      • States that one should act only if the action is based on a principle that is universal—or in other words, if you believe that everyone should act in the same way in a similar situation.
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14
Q

Feminist ethics

A
  • Reasoning uses relationships and stories rather than universal principles.
  • Feminists argue that it is impossible to avoid being influenced by one’s relationships.
  • They see that influence as positive and believe it should not be lessened by an attempt to be objective—and in any case, that objectivity is impossible anyway.
  • Addresses female perspective issues
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15
Q

Ethics of Care

A

Nurses include a responsibility to care as a part of their professional behavior.

  • Nursing’s responsibility to care in ethical situations
  • Principles combined with feelings
    • Caring central force in nursing
    • Promote dignity and respect
    • Person centered care for all
    • Cultivating responsiveness to others
    • Kindness, attentiveness, empathy, compassion, reliability are fundamental
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16
Q

Ethical Principles

A
  • Autonomy – person’s right to choose
  • Nonmaleficence – duty to prevent harm
  • Beneficence – duty to promote good
  • Fidelity – duty to keep promises
  • Veracity – duty to tell the truth
  • Justice – obligation to be fair and equal
17
Q

Professional Guidelines for Ethical Decision Making

A
  • Codes of Ethics for Nurses - read it
    • Inform public
    • Demonstrates commitment
    • Outlines major ethical considerations
    • General guidelines for professional behavior
    • Guide self-regulation functions
    • Reminder of our responsibility in caring for people
  • International Council of Nurses
    • Serves as the standard for nurses worldwide.
    • Human rights, including cultural rights, the right to life and choice, the right to dignity, and the right to be treated with respect.
  • American Nurses Association (ANA)
    • Standards of care – ensuring quality nursing care
  • Patient Care Partnership – meeting patient needs
    • American Hospital Association (AHA) published a document called Patient Care Partnership (2003).
    • Need to treat patients in an ethical manner and to protect their rights.
  • The Joint Commission – section on organizational ethics care, treatment and services and business practices
18
Q

Assessment / Analysis / Diagnosis

A

A holistic, comprehensive client assessment will help you establish the context in which ethical decisions are made.

For clients struggling with ethical issues, the following diagnoses of may apply:

  • Decisional conflict – patient uncertain of course of action
  • Moral distress – patient made decision but unable to carry it out
19
Q

Processes for Ethical Practice

A
  • Clarify your values.
  • Identify moral dilemmas.
  • Use a decision-making model.
    • M O R A L
      • Message dilemma, Outline options, Resolve dilemma, Act & apply chosen option, Look back & evaluate
  • Look for a compromise.
  • Participate on an ethics committee.
  • Improve your ethical decision making.