Lecture thirteen: Why ethics

Question 1

Why is ethics important?

Answer 1

To have a determination of right and wrong.

Underlines and helps determine social issues such as
- Understaffing
- Patients advocacy
- Constraveral issues (Abortion)
- informed consent with children
- Social inequities and more

Question 2

What is personal values?

Answer 2

Personal beliefs and ideals about what matters. Guides our decisions and behaviours.

Question 3

What is ethics?

Answer 3

The study of what we should do and why

• Ethics is NOT religion alough religion may inform beliefs
• Ethics is NOT the law although the two often interrelate
• Ethics is NOT following orders, hospital policy or institutional practices

Ethics is how we “think about, understand and examine how best to live a moral life”

Question 4

What is bioethics?

Answer 4

Bioethics Is human behaviour in the life sciences and healthcare.

Bioethics is the study of ethical, social, and legal issues that arise in biomedicine and biomedical research.

In general terms what is right and wrong

Question 5

What is clinical ethics?

Answer 5

Clinical ethics is how we justify our decisions and actions at the bedside

More specifically what is right and wrong.

Question 6

What is applied ethics?

Answer 6

Applied ethics is the application of ethical principles to controversial issues such as termination of pregnancy or end of life choice

Question 7

What is morality?

Answer 7

Morals – Principles or habits relating to right or wrong conduct, based on an individual’s own compass of right and wrong

Is the distinction between right and wrong behaviour.

Is acting upon that ethical judgement- Choosing to do the right thing

Starts with self reflection and checking our own motives

Like all clinical skills, this is learnt and practiced over time

No philosophically significant difference between the terms ethics and morality

Question 8

What are the two branches of ethics?

Answer 8

Normative ethics and descriptive ethics

Question 9

What is normative ethics?

Answer 9

Concerns with right or good action/ what SHOULD HAPPEN

Base an ethical decision on a principle in the NCNZ ‘code of conduct for nurses’

Question 10

What is descriptive ethics?

Answer 10

Concerned with WHAT DOES happen

In reality, how a nurse bases an ethical decision on their believed about the ‘right’ thing to do.

For example, as a nurse, you adhere to non-maleficence. Do no harm. However, a patient may want to end their life and they wish you to withhold their food- This goes against non-maleficence as you are “doing harm” by assisted passive euthanasia. Arguably, however, withholding food would be beneficence as the patient wishes to pass away. So what do you do?

Question 11

What does domain 1- Professional responsibility (NCNZ competencies) outline a nurse must do

Answer 11

• Must be “accountable of their own actions and decisions”, while promoting an environment that…
• … maximises health consumer safety, independence, quality of life and health
• Accepts responsibility for ensuring that his / her nursing practice and conduct meet the standards of the “professional, ethical and relevant legislated requirements”

Question 12

What does domain 2- Management of nursing care (NCNZ competencies) outline a nurse must do

Answer 12

Ensures the health consumer has adequate explanation of the effects, consequences and alternatives of proposed treatment options

e.g. informed consent is a legal and ethical requirement. Rights of health consumers

Question 13

What are the 3 basis’s (assumptions) of the NZNO code of ethics

Answer 13

1. Relationships are based on mutual respect for culture, religion, gender, sexual orientation, ethnicity etc
2. Respect for the individual, whānau, group, iwi, hapū and community encompasses partnership and collaboration
3. Relationships / interactions seek an equitable outcome for the individual, whānau, group, iwi, hapū and community.

The purpose of nursing is to uphold and improve the health of all of these.

Question 14

What is deontology?

Answer 14

kant believed that humans have intrinsic worth that makes them valuable

Deontology promotes absolute rules that are right or wrong in a situation e.g. never lie

Kant’s ‘categorical imperative’ – ‘act in such a way that you are happy to see all people act ALL of the time’
– Examples - don’t kill, you ought to help those in need, don’t steal,

Question 15

What is Utilitarianism?

Answer 15

Utilitarianism states that whenever we have a choice between alternative actions we should choose the one that has the best overall consequences for everyone concerned

Question 16

What is the International Council of Nurses (INC) four key elements of ethical conduct?

Answer 16

1) Nurses and people
2) Nurses and practice
3) Nurses and profession
4) Nurses and coworkers

Question 17

What are the four founding ethical principles of clinical decision making?

Answer 17

1. Autonomy – self determination
2. Beneficence – above all, do good
3. Non-maleficence – above all, do no harm
4. Justice - fairness

Question 18

What is Autonomy?

Answer 18

Self-determination. Autonomy is
embedded in our Code of Health &
Disability services Consumers’ Rights

• Patient or client can freely make their own BEST CHOICE in a healthcare decision
• The right to have personal beliefs taken into account
• The right to be informed of treatment options and their consequences, before consenting
• Disclosing diagnoses and treatment plans
• Teleology - the end justifies the means
• Deontology - the end does NOT justify the means (because of a person’s intrinsic worth)

Question 19

What is beneficence?

Answer 19

Above all, do good
* Taking ‘positive action’ that promotes the benefit of others

• Requires a weighing up of benefit versus possible harm
• Examples
  – Obvious benefits of early analgesia after surgery
  – Resuscitation – may be less clearcut
• Beneficence depends on context and an individual’s perception of good and harm

– What about mandatory vaccination?

Question 20

What is Non-maleficence?

Answer 20

Above all, do NO HARM

Avoiding intentional injury, neglect or shortcuts
Minimizing harm (where some harm is unavoidable)

Much of nursing is based in non-maleficence, e.g.
* bedrails up
* maintaining confidentiality
* allergy checks
* avoiding ‘key parts’ in medication administration
* smoking cessation advice

Question 21

What is Justice

Answer 21

• Fairness - making a decision based on equality and equity
• Equity – distributing benefits and burdens fairly
  – Distributive justice – how we allocate the health dollar fairly
  – Rights based justice – respect for people’s rights
  – Legal justice – respect morally acceptable laws
• Some circumstances require different resource allocation to achieve equity
  – e.g. targeted vaccination drive for vulnerable populations (migrant
  workers, Maori & Pacifica) OR lowering the age for free mammograms
  for ‘at risk’ populations

Question 22

What is Veracity?

Answer 22

Veracity – telling the truth

Avoiding lies or withholding part of the truth. e.g., withholding some information around a diagnosis

Question 23

What is Fidelity?

Answer 23

Fidelity – faithful to promises / agreements

We enter into agreements with our employer and our patients
May be implicit - patients expect that we are competent
May be explicit – “I’ll be back in ten minutes with more pain relief”

Fidelity includes confidentiality & privacy
* Confidentiality – acting ethically with personal information
* Privacy – ethical conduct with personal matters / examinations

Question 24

What are the ten quick steps to the privacy code
john edwards/ privacy commissioner

Answer 24

1. Only collect what you need
2. Get it from the person concerned
3. Tell them what you’re doing
4. Be considerate when collecting it
5. Take care of it once you’ve got it
6. People can see their info if they want to
7. People can ask to have it corrected
8. Check it before you use it
9. Get rid of it once you’re done
10. Only use it for the reasons you said

Question 25

Whats guardianship?

Answer 25

We have an ethical responsibility to respect and protect the
environment and its resources e.g. PVC recycling

Question 26

Whats professionalism and ethics?

Answer 26

Nurses are accountable for individual decisions but ALSO answerable to their regulatory body

Question 27

Whats a feminist vased approach?

Answer 27

• Critique patterns of oppression especially in relation to women and the poor
• Emancipation and equality are central
• Promotes social policy that supports ALL persons as deserving of respect and the opportunity to make legitimate
  choices about conditions that affect their lives

Question 28

What makes a situation and ethical dilemma?

Answer 28

2 or more clear moral principles apply but each supports a different course of action

Ethical distress – you know the right thing to do but personal or institutional factors make it difficult to follow this course of action