Module 1 Flashcards
Ethics definition
- the study of ideal human behavior and ideal ways of being
- systematic approach to understanding, analyzing, distinguishing matters of right and wrong, good and bad on a CONTINUUM relating to the well being of living things.
What are ideal behaviors according to aristolte vs immanuel kant
Aristotle- lead to the goal of eudaimonia, meaning high level of happiness
Immanuel Kant - acting in accordance with one’s duty
what is well being according to kant
the freedom to exercise autonomy and capability to think rationally
Is ethics static or dynamic and why
dynamic. Dynamic is called ‘doing ethics’ because even though opinions can be subjective, they still must be back up by sound reasoning.
What is the purpose of ethics
to reach ethical determinations for a religion or a profession through the use of formal theories, approaches, codes of conduct
What are morals?
specific beliefs, behaviors, ways of being derived from ethics. Morals can be judged as good or bad by ethical analysis.
Immorality
(not immortality)
someones behavior is in opposition to societal, professional, religious or cultural beliefs.
-examples are murder, fraud etc
Amoral definition and examples
Actions done without a concern for morally good behavior
-committing a murder without a conscience or without feeling bad
Nonmoral and examples
If moral standards DO NOT APPLY to the ACTS
-should i eat cereal or bread with jam for breakfast
Unethical definition
Behavior is contrary to code of conduct that is endorsed by a profession, society, community
What are the three types of ethical INQUIRY?
Normative ethics, meta-ethics, descriptive ethics
What is normative ethics?
- An attempt to decide or prescribe values, behaviors, and ways of being that are right or wrong, good or bad.
- how we SHOULD behave or OUGHT to have done
-creates an accepted moral standard
what is common morality?
-An accepted moral standard of normative ethics.
-what most people in society agree on
for example, robbing a bank is bad and a lot of people agree on it
Meta-ethics definition
Analyzing the analysis.
-what does good really mean
-what does happiness mean
-what does virtuous mean
What form of ethics is used in research
Descriptive ethics because its thought as scientific. Describe how people behave or describe their morals
What is ethical relativism and its subtypes
-belief that ethics should differ because of a society or person
- cultural relativism your morals depend on your culture so it could be wrong in our culture but right in theirs.
- ethical subjectivism individuals create their own reality. there are no moral objectivism just individual opinions. no weight as analysis or reasoning. only feeling create morals.
What is ethical objectivism
Universal moral principles exist for everyone regardless of culture, feelings, experiences etc
Define value
something of worth
Define values
someone’s evaluative judgements about what they think is good or bad
Professional values are what to nurses?
A guide on how we ought to act and behave
-The code of ethics contains professional values for nurses
What is moral reasoning
Reasoning, or the process of determining if logic is sound also while focused on moral or ethical issues.
Importance of socrates and his contributions
- Promoted critical thinking and reasoning in Athens. Promoted thinking for yourself. Accused of corrupting youth of Athens.
- Developed the Socratic Method which means to reason via dialogue and question each other
- believes the unexamined (unanalyzed) life is not worth living
Importance of Plato and his contributions
A student of Socrates. Proposed Realm of Forms and World of Appearances
- the Tripartite soul and its three faculties
- authored Allegory of the cave
- people’s interests and best job for them is because of the three faculties
Plato’s tripartite soul definition
Faculty of reason: thought & truth (head)
Faculty of spirit: love, beauty, eternal life (chest)
Faculty of Appetite: desires and emotions (gut)
Plato’s Realm of forms
Eternal, perfect, and unchanging ideals
Plato’s World of Appearances
imperfect, decaying, and changing phenomena that are EMULATING perfect forms
Plato’s Allegory of the cave
wrote about the dangers of being closed minded & powers of enlightenment
How nursing is impacted by Plato
Florence Nightingale, aka, modern nursing founder - influenced by Faculty of Spirit (compassion, love, dedication)
Aristotle and his contributions
- Aristotle was Plato’s student. had a practical approach to reasoning. Aristotle believed that in empirical inquiry and real-world observations. believed all things have an end goal or purpose
- Phronesis is WISDOM gained through education, used for deliberating ethics.
- Phronesis’ end goal is eudaimonia
- Well reasoned actions
Artistotle Eudaimonia definition
End goal of human life, encompassing happiness and well being
Aristotle excellence of character
Combine knowing whats good, and knowing how to act
-well reasoned actions should result in
Aristotle prudence and moderation
Act wise and have moderation
Aristotle Social nature of humans
People are inherently social beings whose reasoning should:
- guide them to become good citizens and friends & promote ethical behavior
St Augustine and his contributions
- Plato version of the middle ages
- ideal, unchanging truths “heavenly moral truths” put there by god
- humans have a duty to god and b/c of that they have a moral duty
- evil is the perversion of good
- city of god vs city of man
- book ‘the city of god’
st. augustine- of the city of god vs city of man, what does this mean?
city of god represents spiritual perfection (like plato’s world of forms)
city of man represents worldly imperfection (like platos world of appearances)
St. thomas aquinas contributions
- blended aristotle’s ethics with christianity
- true happiness requires loyalty to god and humans want happiness & moral fufilment
- christian virtues like humility over artistotelian virtues (pride). doing this leads to happiness and moral fufil
- god’s laws align with moral reasoning
- eudaimonia expands to christian ideals too
What did the crusades do to europe?
they brought islamic intellectualism and brought back greek text & aristotle which helped transition europe out of the dark ages
-revival of ancient greek philosophy
What was the scientific revolution?
In the middle ages, marked a diminishing influence on the catholic church and increasing reliance on science. Initiated by Copernican theory and later by Kepler and Galileo.
- view humans as autonomous rational thinkers, contrasting with church dominated thinking of the middle ages
Key developments of the scientific revolution
- enlightenment era
- Rise of reductionism
- reflection on health care
- David Hume introduced fact/value distinction
what was the enlightenment era from the scientific revolution
discovery of all knowledge. human progress celebrated
what was reductionism from the scientific revolution
compare everything to a machine.
- analyzing components to understand the overall concept
- focus on curing diseases over holistic care, while emphasizing a mechanistic approach
What is a mechanistic approach?
treating issues like mechanical problems (just the physical)
How is holistic different from mechanical
holistic emphasizes mental health, preventative care, and patient centered care in its complexity
What did David Hume contribute to ethics
introduced ‘fact/value’ distinction.
- facts are what is
- values are what ought to be
Postmodern philosophy occured why
it was a reaction to enlightenment’s emphasis on science and reason.
- rejects this belief, and encourages a more subjective, contest dependent approach to understanding behavior and morality
-while modern philosophy encourages evidence based practice and scientific reasoning, post modern philosophy values pluralistic approaches and individual/diverse narratives,
What are key points of postmodern philosophy
Pluralism - diversity of intellect and culture with a changing reality from multiple influences
Skepticism towards absolute truths - there is not a single correct understanding of reality
narrative analysis - human knowledge is derived from storytelling and diverse experience rather than a single grand theory
Care based reasoning is
often associated with a feminine perspective. focuses on interpersonal relationships, empathy, nurturing
Justice-Based reasoning
Often associated with a masculine perspective from the enlightenment era. emphasizes autonomy, fairness, and impartiality in moral reasoning
What did Lawrence Kohlberg’s research show
studied moral development in 84 boys over 20 years. Proposed six stages of moral development. he thoughts he could use this six stage scale to measure moral development in both males and females (females have bias because of sample)
- male oriented Kohlberg ethic of justice
What did Carol Gilligan contribute
he criticized Lawrence Kohlberg for his biased sample.
- In a Different Voice published to show that women moral reasoning is different but not deficient.
- female oriented Gillian ethic of care
What is virtue ethics?
focus on the excellence of character
-what sort of person should i be in order to be excellent?
-NOT what sort of things should i do to be excellent
Aristotle’s approach to virtue ethics
- Divides virtues into intellectual virtues and moral virtues
- the golden mean
- cardinal virues
what was intellectual virtues vs moral virtues
- intellectual virtue is from teaching and experience
- moral virtue is from habituation and practice
What is the golden mean
virtue lies between two extremes. courage is the mean between rashness and cowardice
What is cardinal virtues
prudence (wisdom), fortitude (courage), temperance (moderation), justice. Others are benevolence, compassion, fidelity, generosity and patience.
Modern influences on virtue ethics
- david hume emphasized virtues from human sympathy and usefulness to the community (utilitarianism aka community well being is focused)
- friedrich nietzsche proposed a radical view on will to power - focused on dominance and strength over weak feminine
- florence nightingale valued obedience as a virtue but aligned it with practical wisdom. she liked intelligent obedience rather than blind allegiance; views were shaped on greek philosophy
What is natural law theory
- Morality is determined by human nature and not by society. comes from st. thomas aquinas philosophy.
- “law of reason” implanted by god.
- Universal moral rules
- Judeo christian ethics. for example religious prohibition on homosexuality.
- rigid and biased by religion
Deontology core beliefs and key person
- based on duty regardless of the consequences
- Immanuel Kant is the key phiosopher
- Humans are rational, autonomous beings with dignity. their worth comes from acting morally even if their own emotions conflict with it.
- Ethics arises from a sense of duty only. It does not take emotions or desires into account
What was Immanuel Kant’s key concepts?
categorical imperative which means universal unconditional duties. it differs from hypothetical imperative.
He tested ethics by saying, if everyone acted this way, would it be reasonable as a universal law?
Hypothetical Imperative conditional duties are relevant for non-moral actions. for example, if I want X, I must do Y
-overly rigid and not compassionate
Consequentialism and key philosophers
- Actions are judged by the consequence/utility and by utilitarianism (focus on good for community)
- balances happiness and harm in decision making by emphasizing collective well being over individual
- Jeremy Bentham: math for pain intensity and duration
- John Stuart Mill - quality>quantity of happiness. Distinguish high pleasure from low pleasure. (for example eating a mcdonalds sandwich over a fine dining sandwich)
-criticism because you cant predict all consequences and theres too much sacrifice of individual rights
What is Casuistry
-use inductive reasoning on individual cases instead of applying universal rules to everyone
- focused on inductive reasoning
- rely on paradigm cases (other situations similar to it you treat the same)
- practical/situational rather than absolute/rigid
-Based on Judeo-christian history. individual confession to priests and being assigned a PERSONAL penance.
-used in ETHICS COMMITTEES
What is the Four Topics method?
-A casuistry based framework for ethical decision making.
- Analyzing cases through medical indications, patient preferences, QoL, and context
Advantages are adaptive to individual circumstances.
Criticisms are risks for inconsistency and variable outcomes.
What is Narrative Ethics?
Story based approach to ethics that emphasizes the personal and community narratives in moral reasoning. Focus on patient stories and their broader context. Nuance of life and their communities impacting their moral reasoning.
Advantage? Encourages empathy and understanding.
Disadvantage? Subjectivity in interpreting stories.
What is critical theory?
domination by powerful groups and the resulting oppression of marginalized groups
-focused on liberating (freeing) others from enslaving circumstances.
-core assumption of west democracy being unequal that seem natural to everyone so it goes unnoticed
Feminist ethics
- analyze ethical situations through lens of gender
- how patterns of oppressino affect women
-evolved from Gillian-Kohlberg debate
-emotions as a complement to thinking
-emotion driven moral behavior and natural partiality (caring for some more than others)
Principlism
-based on rules and duties:
- beneficence (good for others)
- autonomy (self govern)
- nonmaleficence (avoid harm)
-justice (fair distribuation)
used in the american hospital patient bill of rights and universal declaration of human rights
Eastern ethics
asian philosophies (spirituality + ethics)
achieve personal understanding, mental training
ethics is internally imposed
karma and universal connections that transcend personal suffering
Buddhism
- Founder is Siddhartha Guatama seeks to end suffering
- Four noble truths (suffering exists as part of existence, its caused by an attachment to impermanent things, which can be transcended. liberation aka eightfold path)
- ethic of virtue/Four Immeasurable Virtues
What is the eightfold path?
Right view, thinking, mindfulness, speech, action, diligence, concentration, and livelihood
What are the four immeasurable virtues?
in buddhism.
- compassion
- loving kindness
- sympathetic joy
- equanimity
Chinese ethics (Taoism)
- originated from Lao-tzu author of Tao Te Ching
-Tao is the way or path. harmony and natural order in all things. - Reject god.
- human purpose and nature are connected.
-Yin = dark
-yang = light
-yin and yang represent the balance in life
Confucianism
- Founded by K’ung Fu-tzu (confucius). teaching recorded in moral maxims.
- Li: guidance for social aspects
- Yi: right motivation
- Jen: human goodness/benevolence
- Sincerity, teamwork, balance
-Prioritize community/communitarianism over individual autonomy
What are bioethics? overview
- domain of ethics focused on moral issues in healthcare. Ex: Who lives, who dies?
- aka health care ethics
Bioethics origins
- origin: WW2 technology and medical technology advanced rapidly which caused a need for bioethics.
- this presented new challenges to the world. Life sustaining advances but now have prolonged suffering. organ transplantation now calls for ethical decision making. pharm advancement and surgery are now about resource allocation.
What was the Tuskegee Syphillis Study?
AA males not told they have syphillis to see how the syphillis would progress (life altering neurological changes)
What happened in WW2 to persons?
Heinous experiements on human subjects
National Research act 1974
established ethical guidelines for research involving people.
The Belmont report 1978
conference held for 4 days to decide the following:
- respect for persons (protection from disabled being tested on)
- beneficence
- justice
Helped build the foundation for later principles not included in the report:
* informed consent
*risk benefit assessment (whats the risk of them joining?)
*fair participant selection criteria (not exploitative of people in disadvantaged situations by offering large sums of money etc)
What did Beauchamp and Childress write about the Belmont Report in their book ‘principles of biomedical ethics’?
- respect for autonomy
- nonmaleficence
- beneficence
4.justice
What is ethical principlism? (est what use know today)
Established by Beauchamp and Childress expanding the Belmont principles into a more general framework for addressing bioethical dilemmas.
1. respect for autonomy: now includes respect PATIENT DECISIONS in CLINICAL SETTINGS.
2. Beneficence: unchanged
3. Nonmaleficence: “Do No Harm”
4. Justice: applied more broadly to CLINICAL settings
Autonomy definition
freedom to act in a self determined manner influenced by Immanuel Kant Enlightenment philosophy
-NOT emphasized in Ethic of care (focused on relationships and emotions)
-NOT emphasized in virtue ethics (prioritize character and moral habits)
Respect for Autonomy definition in clinical settings
Informed consent, support patient decisions about treatment options, allow patients to refuse treatments, provide comprehensive and truthful information, privacy and confidentiality, respect everyday living choices.
What are the limits to autonomy in a CLINICAL setting?
When an individual’s actions harm others. or Violate public health safety concerns (violent, quarantine)
Three basic elements of informed consent
- Receipt of information - was it explained at their level of education? did you use the teach back method? do they know the alternatives?
- Voluntary consent - free from coercion
- Competence - can the patient understand the information and communicate their consent
Are nurses responsible for obtaining informed consent for procedures performed by doctors?
NO, as long as we were under the assumption that the patient gave consent.
We must notify appropriate parties if informed consent is incomplete or missing. we are ethically and legally obligated to advocate that patients have the opportunity to consent or to refuse treatment.
HOWEVER, This could be a professional challenge to confront the physician and we WILL be liable legally if we don’t confront the MD and KNOWINGLY allow a patient to undergo procedure without consent.
What is the patient self determination act?
Advance directives promoting autonomy by allowing patients to choose end of life decisions
Nonmaleficence definition
DO NO HARM INTENTIONALLY
Nonmaleficence VS Beneficence & its APPLICATION
Nonmal: stop doing bad thing
Beneficience: prevent harm, remove harm, and promote good, requiring PROACTIVE efforts.
Application:
- withholding care or discontinuing treatment vs continuing treatment. what will do more harm or more good.
- medical futility: treatments that are unlikely to provide good outcome (tx is futile)
- end of life care: avoiding invasive procedures when someone is near death (nonmaleficence)
What is the rule of double effect?
when actions have both a positive and a negative consequence.
The action must:
- have a good or neutral INTENTION.
- harmful effect can’t end the good effect
Ex: admin a high dose pain med to relieve suffering but the high dose pain med makes them stop breathing
The slippery slope argument
morally acceptable practice might lead to morally unacceptable consequences
- relies on the fear of extreme outcomes. suggests a chain reaction leading to disaster but its all overhyped. alarmist and unsupported by evidence.
- argument relies on nonmaleficence to make a point
Beneficence definition
the principle of actions characterized by mercy, kindness, and charity. take actions that benefit the welfare of others. we ARE ethically obligated to do this.
-requires PROACTIVE actions to do good.
-limited by closer relationships where are biased to act more in thier own best interests.
-external constraints such as limited resources
Paternalism definition and its two types
deliberately overriding a patients autonomy. its frowned upon. (you should be truthful)
autonomy vs beneficence.
- Hard paternalism: when pt is competent
- Soft paternalism: when pt lacks competence or sufficient info to make informed decision
what is justice
fairness, treat everyone equally and resources equally. rooted in platos cardinal virtues.
What are two types of justice in health care?
Social justice focuses how benefits should be fairly distributed. fights social issues like poverty, hunger, access to basic healthcare, and alleviate WW social injustices. equal rights for all
Distributive justice is concerned with fair allocation of health care resources. Different kinds of deliveries of justice.
What are the different kinds of distributive justice
market based (those who can afford it)
social merit ( based on your social contributions)
medical need (how severe your condition is)
age (goes to younger vs older)
queing (first come first served)
random selection (equal opportunity through random selection)
Three different theories of justice
Rawl’s justice
Nozicks Entitlement justice
Daniels’ Health Care justice
rawl’s theory of justice
make decisions without knowing their social or economic standing
Nozicks entitlement theory of justice
reward only to those who deserve it from social contributions
Daniels health care justice
-built on rawls principles.
equal access to all. fair standards and benchmarks for national health care reform.
“ Is to ought” article
hume’s observation in the treatise about the transition from is to ought shows a divide, challenging validity of getting ethical conclusions from factual premises. This is center to Hume’s work, and is dubbed “hume’s law”, suggesting that moral judgements are not factual.
-reinforces the need to balance empirical facts with compassion, respect for autonomy, and nuanced moral reasoning.
ANA position statement article
the ANA position statement on human rights emphasizes the critical role nurses play in protecting the human rights in clinical settings. underscores the importance of dignity, worth, equity for all.
Nurses are supposed to follow the code of ethics for nurses. and help vulnerable patients.
caring for patients of different religions article
it emphasizes the importance of providing culturally competent care by respecting the different religions of the world.
Buddhism focuses on modesty, avoid animal products, and respect for rituals around death.
Christianity - birth control and sacraments
Islam- respect modesty, prayer schedules, diet, end of life practices
Judiasm- Honor sabbath, kosher diet, circumcising, quick buriels
Hinduism - veggie diets, body adornments
Illness as a failure article
a compassionate and nonjudgmental approach to caregiving inspired by christianity
blaming someone for the illness undermines the whole reason you are caring for them in the first place
caregivers aren’t supposed to pass judgement. aligns with beneficence and nonmaleficence
American Society of Bioethics and Humanities ASBH purpose
BIOETHICS and humanities. fosters EDUCATIONS, SCHOLARSHIPS, and professional growth
International council of nurses ICN purpose
Global nursing advocacy and policy development
ICN code of ethics aligned practice
address global health challenges, workforce shortages, health inequities
National Center for ethics (vet affairs)
primary ethics resource for veterans to improve healthcare for veterans
-end of life and mental health
-education, resources for VA staff on ethical dilemmas
National Reference Center for Bioethics Literature
acts as comprehensive resource HUB for bioethics
-scholars and vast collection of materials, journals, books, case studies
