Class 1 Flashcards
Code of Hammurabi (1750 BC)
Hammurabi, King of Babylon, lay out one of the first set of laws to “bring about the rule of righteousness in the land, to destroy the wicked and the evil doars; so that the strong should not harm the weak”. It even included how doctors should treat their patients. For example, if a doctor does surgery on a noble person and the surgery results in injury to the patient, there would be a ‘pay-back’ punishment for the doctor.
hippocrates: The Father of Medicine (460-370 BC)
Hippoacrtes was a Greek physician who revolutionized medicine by establishing professional standards for the practice of medicine. His thinking informed the Hippocratic Oath that contains the statement primum non nocere, meaning do no harm
Aristotle and Virtue Ethics (384-322 BC)
Aristotle was an Ancient Greek philosopher, scientist, and teacher. Aristotle believed that virtues were central to leading a good life, which is the basis of Virtue Ethics.
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Developed by aristotle
The quest to understand and live a life of moral character
Assumes that we acquire virtue by practice. By practicing being honest, brave and generous a person develops an honorable moral character.
By honing virtuous habits, people will likely make the right choice when faced with ethical challenges.
Helps us understand what it means to be a virtuous human being, gives us a guide for living life without giving us specific rules for resolving ethical dilemmas.
Example: batman to kill or not to kill joker.
Utilitarianism: kill joker, taking one life could save many more
Deontologism: do not kill joker because it is wrong to kill
Virtue ethics: would highlight the character of the person who kills the joker → “does batman want to be a person who takes enemies lives? No”
Jeremy Bentham and Utilitarianism: 1748-1832
Jeremy Bentham was a philosopher and jurist who founded utilitarianism. Utilitarianism operates under the idea that the right or ethical choice is the one that leads to the greatest happiness (or utility) for the greatest number of people.
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Determines right from wrong by focusing on outcomes (form of consequentialism)
Only framework that justifies war and army force
Does not really take into account justice or individual rights
Example: killing a living person to provide organs to provide them to 4 dying patients would be supported
Most reason based approach to determining right and wrong, but many limitations
Immanuel Kant and Deontology: 1785
Immanuel Kant was a philosopher best known for deontology and developing the categorical imperative. Deontology does not look at the consequences of actions, like utilitarianism, but the actions themselves.
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Deontology is an ethical theory that uses rules to distinguish right from wrong
Ethical actions follow universal moral laws (do not lie, do not steal, do not cheat) according to Kant
Simple to apply → follow rules and do your duty
This approach seems to fit well with our natural intuition about what is or is not ethical
Does not require us to evaluate the cost and benefits of a situation (no consequentialism) → avoids any subjectivity or uncertainty
Too rigid and can be unacceptable results
Easy to apply but it means disregarding the possible consequences of our actions when determining what is right and what is wrong
Schloendorff v. Society of the New York Hospital: 1914
This New York court case is cited as the earliest expression of legal doctrine of informed consent in the US. The plaintiff, Mary Schloendorff, claimed that she only consented to an examination of her gangrenous arm but not to the amputation of several fingers that followed the examination.
The court did not find the hospital liable but led to Justice Cardozo’s famous claim that every “human being of adult years and sound minds has a right to determine what shall be done with his own body”
Tarasoff v. Regents of the 1976 University of California: 1976
A graduate student, Poddar, sought psychiatric help for subsequent mental instability associated with his unrequited love for Tatiana Tarasoff and confided in his psychologist that he planned to kill Tararoff.
The psychologist unsuccessfully recommended for him to be committed as he was a danger to others. Shortly after, Poddar killed Tarasoff.
The Supreme Court of California held that mental health professionals have a duty to warm individuals who are being threatened with bodily harm by a patient.
Biomedical Ethics Principles by Beauchamp and Childress: 1979 (AKA PRINCIPILISM)
Tom Beauchamp and James Childress first published the four principles of biomedical ethics in 1979, which include respect for autonomy, beneficence, non-maleficence and justice.
Chambliss Nursing Study: 1980s
Daniel Chambliss conducted sociological research of hospital nurses to understand the ethical issues that arose. He placed himself in a hospital setting and discovered that nurse’s ethical dilemmas were often caused by organization and the nurse’s central place in it - the many loyalties, hierarchies of power and, the slow pace of change in systems that can impede individual practice.
This is especially pertinent as we can see similar issues when we reflect on organizational ethic
Carol Gilligan and Care Ethics: 1982
The ethics of care stems from feminist ethics and is attributed to Carol Gilligan’s “In a Different Voice: Psychological Theory and Women’s Development”.
Patient Self-Determination Act: 1991
This Act requires hospitals, nursing facilities, hospices, and other health institutions to inform patients of their rights to make decisions involving their care, it also requires health workers to ask about advance directives and to document care wishes. It focuses on preventing discrimination for those who have advance directive and ensuring that valid directives and care wishes are implemented.
Harm Reduction: 1980s to 1990s
Harm reduction refers to practices aiming to minimize negative health and social impacts associated with drug use and laws. It focuses on working with people without judgment, coercion, or discrimination. This informed Public Ethics.
Winnipeg Children’s Hospital Tragedy: 1994
This is a sad Canadian case where 12 babies died after heart surgery. The 5 years inquest, presided by Judge Murray Sinclair, showed that these deaths may have been preventable and pointed to key recommendations. Of note in this case, there were questions of competence and nurses were whistle-blowers about the competence of the main cardiac surgeon, but their concerns were ignored. To learn more about this case: https://www.pbs.org/wgbh/nova/doct
Tuskegee Syphilis Study (1932-1972)
Trial that looked at the natural course of syphilis
On black men in the state, they found the treatment but continued to conduct research on them without giving them treatment
End stage = neurocognitive degeneration
ethics definition
Process of reflection in which decisions are shaped by value, purpose, and principles → gives us sense of good, right and meaningful in our life
Ethics is a conscious reflection that gives effect to our values, principles and purpose and actions
Examines our morals and addresses things laws cannot
If our ethics change, our laws and morality should also evolve in theory
Considered a toolkit and is at the center of everyday life
morality definition
morality: informal framework of value, principles, beliefs, customs, and ways of living. Social pressure to conform to moral codes. not enforced by the state, forced to conform to moral norms. How should I live and what should I do?
Answered by Christianity, stoicism, and buddhism, etc.
Inherit from family, culture, community
Process of moral formation is unconscious
Unlike ethics; Without having to think about doing it
If we just accept ready made question we may live our whole lives under moral codes we may have rejected
law definition
law: formal rules that govern how we behave in a society
What we must and must not do
Enforceable standard of behavior
Narrow focus
Can be just or unjust
Law may be silenced with ethics and morality would not (ex: racist jokes)
4 fields of ethics
Metaethics
Normative
Descriptive
Applied
Metaethics
A field of ethics that looks at deep philosophical questions, defining moral terms and asking questions such as: “What is the meaning?” It focuses on the analysis of meaning, creating justifications for actions, and making inferences from moral concepts.
Broadly looks at what is true? What is a person? What is justice?
Big picture, theoretical
What is meaning = very broad
Normative Ethics
A field of ethics that focuses on the formulation and defense of basic principles, values, virtues, and ideals governing moral behavior. It seeks to answer questions such as: “What makes an action right or wrong?”, “What situation is good or bad?”, and “What makes someone good or bad?”
Utiliatrims, deontology are used to define normative ethics
Descriptive Ethics
A field of ethics that focuses on factual descriptions and observations. It is an empirical analysis of what people actually do, and what they perceive as being the reasons for their actions. It does not try to answer what is good or how best to live, but rather describes the current reality.
What happens = factual, description
Not necessarily value judgment to it
Calculating how many students tops to help someone hit by a car = description
How many people vote/agree to this
Applied Ethics
A field of ethics that focuses on the practical application of ethics to specific contexts. It poses questions such as: “In real life and specific contexts, what is the right thing to do?”
Focus our attention to, look at practical applications of ethics to our life, unit, studies, context.
Nurse Bernice Redmon
Nurse Bernice Redmon: first black public health nurse in canada
Went to the States to study and then came to practice in Nova Scotia because she was not allowed to study in nursing in canada
Nurse Marissa Scott
Nurse Marissa Scott: one of the first black graduates from a canadian nursing school
Ontario nurse. Churches and public nurses went to the schools to allow marissa to enter nursing school. This was in 1950.
In what ways is nursing a moral practice?
The idea of we take care of humans, who have different needs and we must decide how to allocate our time
The idea that our care is equitable without judgment no matter the patient
Moral duty to share and teach our knowledge to our patients who likely do not have that medical knowledge = power dynamic + creating a space for informed decision making, respecting that decision (autonomy) + advocate for our patients
A moral agent involves
“an obligation to ensure integrity and ethical soundness in the care we provide and in the interactions with others” (CNA 2017. Walton 2018)
Creating good and avoiding harm
How can nurses be moral agents and practice ethically?
Self reflection on biases, and values
Take accountability for your actions
Ensuring environment is safe for all
Moral understanding can shift with time = example is MAiD
compare CNA versus OIIQ
refer to notes table
ICN Values of the Nursing Profession
refer to image in notes
Defining Organizational Ethics
“The organization’s efforts to define its own core values and mission, identify areas in which important values come into conflict, seek the best possible resolution of these conflicts and manage its own performance to ensure that it acts in accord with espoused values.”
Cultural Humility
Lifelong Learning and Self-Reflection
Striving for bettering yourself
If you stop learning, you will be unsafe
Acknowledging and redressing power differentials
Reflecting from a power perspective
Institutional accountability & collaborative partnerships
Not an outcome, but a process
Striving for cultural safety to shift the power relationship
6 R’s of Indigenous Framework:
Respect, relevance, responsibility, reciprocity, representation and relationship
