UNIT 1 Flashcards
are moral principles that are concerned with the good of individuals and the good of society.
Ethics
govern our rights and responsibilities and guide moral decision-making. The term is derived from the Greek word ethos which can mean custom, habit, character or disposition.
Ethics
derived from the Greek word ethos which can mean
custom, habit, character or disposition.
Ethics covers the following dilemmas:
- how to live a good life
- our rights and responsibilities
- the language of right and wrong
- moral decisions - what is good and bad?
-takes the emotion out of decision-making
-helps nurses navigate those gray areas to provide safe and competent care to their patients.
code of ethics
provide part of the decision-making foundation for decision making when ethics are in play because these theories represent the viewpoints from which individuals seek guidance as they make decisions
Ethical theories
Broad categories of ethical theory include
deontology, teleology and utilitarianism.
states that people should adhere to their obligations and duties when engaged in decision making when ethics are in play. This means that a person will follow his or her obligations to another individual or society because upholding one’s duty is what is considered ethically correct.
deontological class of ethical theories
contains many positive attributes, but it also contains flaws. One flaw is that there is no rationale or logical basis for deciding an individual’s duties.
Deontology
A person who adheres to ____ will produce very consistent decisions since they will be based on the individual’s set duties.
deontological theory
will always keep his promises to a friend and will follow the law.
deontologist
is concerned with the consequences of actions which means the basic standards for our actions being morally right or wrong depends on the good or evil generated.
teleology
is a reason or explanation for something as a function of its end, purpose, or goal.
- It is derived from two Greek words: telos (end, goal, purpose) and logos (reason, explanation).
Teleology or finality
It is derived from two Greek words: telos (_____) and logos (___).
end, goal, purpose ; reason, explanation
is a common practice in ethics. Like the definition implies, using teleology in ethics means you consider and explain actions based on the end result.
-For instance, stealing is bad, but a teleological thinker may say, “but in the end, I’m stealing to feed my family, which is good, so the action is good.” In other words, an action’s “goodness” is based on the outcome.
Teleology
Types of Teleological Ethical Theories
Ethical egoism, Utilitarianism, Eudaimonism
is a teleological theory that posits, an action is good if it produces or is likely to produce results that maximize the person’s self-interest as defined by him, even at the expense of others.
ethical egoism
theory holds that an action is good if it results in maximum satisfaction for a large number of people who are likely to get affected by the action
Utilitarianism
is a teleological theory which posits, that an action is good if it results in the fulfillment of goals along with the welfare of the human beings. In other words, the actions are said to be fruitful if it promotes or tends to promote the fulfillment of goals constitutive of human nature and its happiness.
Eudaimonism
are based on one’s ability to predict the consequences of an action. To a utilitarian, the choice that yields the greatest benefit to the most people is the one that is ethically correct
Utilitarian ethical theories
Two types of utilitarianism
- Act utilitarianism
- Rule utilitarianism
takes into account the law and is concerned with fairness. A rule utilitarian seeks to benefit the most people but through the fairest and most just means available. Therefore, added benefits of rule utilitarianism are that it values justice and includes beneficence at the same time.
- Rule utilitarianism
subscribes precisely to the definition of utilitarianism—a person performs the acts that benefit the most people, regardless of personal feelings or the societal constraints such as laws.
- Act utilitarianism
can lead to unexpected results making the utilitarian decision maker appear unethical as time passes, as the choice made did not benefit the most people as predicted.
Uncertainty
An is concerned with achieving the maximum good. Thus, one individual’s rights may be infringed upon in order to benefit a greater number of people.
act utilitarian decision maker
ethics looks at virtue or moral character, rather than at ethical duties and rules, or the consequences of actions - indeed some philosophers of this school deny that there can be such things as universal ethical rules.
Virtue ethics
is particularly concerned with the way individuals live their lives, and less concerned in assessing particular actions.
Virtue ethics
teaches that an action is right if and only if it is an action that a virtuous person would do in the same circumstances, and that a virtuous person is someone who has a particularly good character.
virtue ethics
is concerned with the character of individual nurses and seeks ways to enable nurses to develop character traits appropriate for actions that enhance wellbeing.
virtue ethics in nursing
can be defined as an approach that emphasizes the character and disposition of a person, in contrast to an approach that emphasizes duties, rules or principles (deontology), or one that emphasizes the consequences of actions (consequentialism).
Virtue ethics
an approach that emphasizes duties, rules or principles
deontology
one that emphasizes the consequences of actions
(consequentialism).
emphasizes being rather than doing. Our being, in other words, who we truly are, influences our behavior.
virtue ethics
can be viewed as an approach of ethical deliberation about the moral character and dispositions of nurses as moral agents that enables them, as virtuous human beings, to fulfil their purpose and function as professional people.
virtue ethics in nursing
refers to the structure of one’s personality with special attention to its ethical components.
Character
is a source as well as the product of his/ her value commitments and actions
person’s character
enable the nurse to discover the relevant moral aspects of a moral dilemma and to interpret, judge and evaluate them, and to apply rules, principles and moral theories wisely to a situation in order to resolve the dilemma.
Virtues
are necessary for the realization of various types of moral obligations in nursing, including dealing with moral dilemmas.
intellectual virtues (practical wisdom) and the moral virtues (virtues of character)
Besides the cardinal virtues expounded by ancient Greek philosophers, such as the
virtues of courage, temperance, prudence and justice.
The _________ as virtues for the nurse as a moral agent.
reflection, empathy, fairness, honesty, dedication, responsibility and respect for people
In addition, the following five virtues as applicable to health professionals:
trustworthiness, integrity, discernment, compassion and conscientiousness.
demands that the health practitioner or the nurse exercise rational control over emotions.
Decision-making about moral issues in health care
are necessary for rational control, because it takes a so-called mean position between the vices or excess and deficiency.
virtues
is possible if the nurse possesses virtues. In this manner, a nurse who demonstrates these virtues in a balanced form can be seen as a virtuous nurse.
Self-control in situations of moral difficulty
Where virtues reflect the characteristic in itself, ____ refers to the quality of that virtue, especially when demonstrated in character.
virtuousness
are ethical nurses, because they have a deep desire to behave well, irrespective of the circumstances.
Virtuous nurses
encompasses empathy for and connection with people.
-is best demonstrated by a nurse’s ability to embody the core values of professional nursing.
Caring
Within the context of the Philippine society, nursing education with caring as its foundation, subscribes to the following core values which are vital components in the development of a professional nurse:
1.1 Love of God
1.2 Caring as the core of nursing
a. Compassion
b. Competence
c. Confidence
d. Conscience
e. Commitment (commitment to a culture of excellence, discipline, integrity and professionalism)
1.3 Love of People
a. Respect for the dignity of each person regardless of creed, color, gender and political affiliation.
1.4 Love of Country
a. Patriotism (Civic duty, social responsibility and good governance)
b. Preservation and enrichment of the environment and culture heritage
Nurses are held to seven ethical principles:
autonomy, accountability, veracity, fidelity, justice, beneficence and non-maleficence.
- Self-determination that is free from both controlling interferences by others and personal limitations preventing meaningful choice (such as inadequate understanding or faulty reasoning).
- the decision making process must be free of coercion or coaxing. In order for a patient to make a fully informed decision, she/he must understand all risks and benefits of the procedure and the likelihood of success.
- AUTONOMY
requires the patient to have autonomy of thought, intention and action when making decisions regarding health care procedures.
Autonomy
Patient’s Rights
- Right to medical treatment
- Right to information
- Right to choices
- Right to privacy
- Right to complaint
- Right to health education
- Right to a healthy and safe environment
- The patient has the right to receive medical and/ or surgical advice and treatment which fully meet the currently accepted standards of quality care.
- The currently accepted standards are those adopted by the Department of Health, Philippine Pediatric Society and other Specialty Societies as applicable in our hospital setting, and in the light of accepted contemporary medical practice.
- The patient shall be treated with utmost care, consideration, respect and dignity without discrimination of any kind.
- Right to medical treatment
- The right to know the identity and professional status of the individuals involved in the care, diagnosis and/or treatment of the patient.
- The right to information about what kind/ type of medical/ surgical services are available, and what are the charges/costs are involved.
- The right to be given a clear description of the patient’s medical condition, with probable/definitive diagnosis, prognosis (i.e., an opinion as to the likely future course of any illness), and of the treatment options considered, the risks and complications that may be encountered.
- The description given to the patient is within scope and level of understanding.
- The right to know the names of any medication or procedures to be prescribed, its actions, and potential side-effects given the patient’s condition.
- The right to access medical information which relates to the patient’s condition and treatment.
- Right to information
- The right to accept or refuse any procedure/medication, investigation or treatment, and to be informed of the likely consequences of doing so.
- The right to second medical and/ or surgical opinion.
- The right to refuse to take part in medical research programs.
- The right to choose doctor and or health care personnel in accordance to medical/surgical needs (applicable to private patients).
- Right to choices
- The right to have privacy, dignity, religious and cultural beliefs respected.
- The right to have information relating to medical condition be kept confidential.
- The right of a pediatric patient to the company of a parent or guardian.
- Right to privacy
- The right to make a complaint through proper channels provided for by the hospital authority, and to have complaint dealt with promptly and fairly.
- Right to complaint
- Patient’s shall have the right to seek and obtain health education or advice with regards to promotive, preventive and curative medical, surgical and rehabilitative to maintain or regain good health and healthy life.
- Right to health education
- The patient has the right to healthy and safe environment that is conductive to good health supportive of the rest and recuperation. Reasonable safety measures should be assured within the hospital facility.
- Right to a healthy and safe environment
Filipino Patients’ Bill of Rights
- The patient has the right to considerate & respectful care, irrespective of socio-economic status.
- The patient has the right to obtain from his physician complete current information concerning his diagnosis, treatment and prognosis in terms the patient can reasonably be expected to understand.
- The patient has the right to receive from his physician information necessary to give informed consent prior to start of any procedure and or treatment.
- The patient has the right to refuse treatment / life-giving measures, to the extent permitted by law and to be informed of the medical consequence of his action.
- The patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly.
- The patient has the right to expect that all communication and records pertaining to his care should be treated as confidential.
- The patient has the right that within its capacity, a hospital must make reasonable response to the request of patient for services.
- The patient has the right to obtain information as to any relationship of the hospital to other health care and to other health care and educational institutions in so far as his care is concerned.
- The patient has the right to be advised if the hospital proposes to engage on or perform human experimentation affecting his care or treatment.
- The patient has the right to expect reasonable continuity of care; he has the right to know in advance what appointment times the physicians are available and where
- The patient has the right to examine and receive an explanation of his bill regardless of source of payment.
- The patient has the right to know what hospital rules and regulations apply to his conduct as a patient.
Doctors will give you information about a particular treatment or test in order for you to decide whether or not you wish to undergo a treatment or test. This process of understanding the risks and benefits of treatment is known as informed consent.
Informed Consent
is based on the moral and legal premise of patient autonomy: You as the patient have the right to make decisions about your own health and medical conditions.
Informed consent
The legal term for failing to obtain informed consent before performing a test or procedure on a patient is called
battery (a form of assault).
Under certain circumstances, there are exceptions to the informed consent rule. The most common exceptions are these:
- An emergency in which medical care is needed immediately to prevent serious or irreversible harm
- Incompetence in which someone is unable to give permission (or to refuse permission) for testing or treatment
Components of Informed Consent
- You must have the capacity (or ability) to make the decision.
- The medical provider must disclose information on the treatment, test, or procedure in question, including the expected benefits and risks, and the likelihood (or probability) that the benefits and risks will occur.
- You must comprehend the relevant information.
- You must voluntarily grant consent, without coercion or duress.
Essential Elements of Informed Consent
- Confidentiality
- New information
- Voluntary participation
- Person/s to contact for study information
- Rights of subject, if study related injury
- Reasons for termination
- Duration of study
- Number of subjects
is the process by which people with the legal right to consent to medical treatment for themselves or for a minor or a ward delegate that right to another person.
Proxy consent
There are three fundamental constraints on this delegation:
a. The person making the delegation must have the right to consent.
b. The person must be legally and medically competent to delegate the right to consent.
c. The right to consent must be delegated to a legally and medically competent adult.
(an aged person in a coma, a two-month old child).
For the ethical and legal use of proxy consent, two conditions must be present:
a. The patient or research subject cannot offer informed consent
b. The person offering the consent ought to determine what the incompetent person would have decided where he or she able to make the ethical decision. This second condition is difficult to ascertain and may be subject to dispute.
Two Types of Proxy Consent for Adults
a. The power of attorney to consent to medical care, is usually used by patients who want medical care but are concerned about who will consent if they are rendered temporarily incompetent by the medical care. A power of attorney to consent to medical care delegates the right to consent to a specific person.
b. The living will
should be made in view of the good of the individual patient, not for the higher good of society, nor for a class good, because this would amount to manipulation of the person.
Decisions of proxy consent
means taking responsibility for one’s actions. Nurses must accept the professional and personal consequences associated with the decisions they make regarding patient care.
Accountability
is the principle of truth telling, and it is grounded in respect for persons and the concept of autonomy. In order for a person to make fully rational choices, he or she must have the information relevant to his or her decision. Moreover, this information must be as clear and understandable as possible.
Veracity
Truth telling is violated in at least two ways.
a. By the act of lying, or the deliberate exchange of erroneous information. However, the principle of veracity is also violated by omission, the deliberate withholding of all or portions of the truth.
b. By the deliberate cloaking of information in jargon or language that fails to convey information in a way that can be understood by the recipient or that intentionally misleads the recipient.
In the health care context, there are two broad applications of veracity.
a. The first relates to patient care and such issues as informed consent. Patients and families rely upon physicians and other caregivers for the information they need to make informed choices about their care. They also expect to be told the truth about their care, including any errors or untoward events. Alternatively, some patients or patients’ families do not want to be told the truth, placing the physician, nurse or other health care professional in a situation in which his or her duty to obtain informed consent is compromised by the wishes of the patient or family.
b. The second application relates more generally to professional ethics and the basic expectation that we are honest in our professional interactions. This particular application of veracity is apparent in a broad range of issues including professional relationships, documentation standards, billing practices, risk management, peer review, community relations, and regulatory reporting, and compliance.
in nursing means that nurses must be faithful to the promises they made as professionals to provide competent, quality care to their patients.
Fidelity
The idea that the burdens and benefits of new or experimental treatments must be distributed equally among all groups in society. Requires that procedures uphold the spirit of existing laws and are fair to all players involved. Reproductive technologies create ethical dilemmas because treatment is not equally available to all people.
JUSTICE
The health care provider must consider four main areas when evaluating justice:
a. fair distribution of scarce resources
b. competing needs
c. rights and obligations
d. potential conflicts with established legislation
requires that the procedure be provided with the intent of doing good for the patient involved. Demands that health care providers develop and maintain skills and knowledge, continually update training, consider individual circumstances of all patients, and strive for net benefit.
Beneficence
requires that a procedure does not harm the patient involved or others in society. Infertility specialists operate under the assumption that they are doing no harm or at least minimizing harm by pursuing the greater good. However, because assistive reproductive technologies have limited success rates uncertain overall outcomes, the emotional state of the patient may be impacted negatively. In some cases, it is difficult for doctors to successfully apply the do no harm principle.
Non-maleficence
is often invoked to explain the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end.
principle of double effect