Week 6 Flashcards
define ethics
- a branch of philosophy that deals with questions of right and wrong , and of ought and ough not in our interactions with others
- how broad societal issues effect health and wellbeing
- extends past “big ticket items” –> relevant in all interactions between providers, pts, and families
what are the 4 main ethical principles
- autonomy
- beneficence
- non-maleficence
- justice
what is autonomy
- ensuring the informed pt’s right to participate in medical decision making
what is beneficence
- clinicians act in the best interests of their patients
- promote wellbeing & do good
what non-maleficence
- do no harm, including physically and psychosocial
what is justice
- all people are to be treated well and fairly
- and also that health resources are used equitably
what is relational ethics?
- overarching and underlying process that guides all clinical practice in palliative care
- ethics of the everyday
what is an ethical dilemma
when we:
- know what the issue
- know what the 2 competing courses of action are
- understand that choosing one course of action means that we cannot pursue the other
- both courses of action have merit –> equally important reasons for doing or doing not something
what is ethical distress
when we:
- know what the issue is
- know or believe to know what course of action to take
- but cannot take the action that we think is the right thing due to barriers
what are potential barriers in ethical distress (2)
- environmental factors
- moral courage
what are some sources of ethical distress (5)
- causing harm to pts
- treating pts as objects
- constraints related to policy
- inadequate staffing lvls
- issues related to resources
what are some consequences of ethical distress (2)
- negative emotions and behaviors
- burnout
what are some examples of negative emotions and behaviors experienced w ethical distress (5)
- frustration
- anger
- guilt
- anxiety
- self blame
what should you do when experiencing emotional distress (2)
- identify the situation
- try identify solutions
describe decision making for minors in canada
- no set age
- varied and individualized
- uses the “concept of maturity” –> assessment of capacity to participate in decision making is made on a case by case basis
(quebec = age 14)
what is an exception to the “concept or maturity” for decision making for minors in canada
- MAiD –> must be 18
what are some examples of potential scenarios that might cause ethical challenges (7)
- DNR
- withdrawing or withholding treatment
- pain mngmt at end of life
- requests from family to withhold info
- palliative sedation
- assisted dying
- artifical nutrition and hydration
what is the principle of double effect
used to explain a situation in which we know an action has two effects:
- one anticipated and wanted
- one that is anticipated and unwanted
what is the key to understanding if an action that related to the principle of double effect is permissable (ethically acceptable)
- the intent of the action
- if the intent is a good outcome = permissable
what are 2 examples of the principle of double effect
- pain management at the end of life
- palliative sedation
describe how pain mngmt at the end of life is an example of the principle of double effect
- use of aggressive titration of opiods at end of life to manage symptoms = desired outcome
- may hasten death = undesired outcome
- justified bc the meds are intended to achieve pain relief, not hasten death
what is palliative sedation
- admin of meds (typically aggressively titrated) to help manage intractable symptoms such as pain, SOB, sufferring, etc.
- involves giving meds to make a pt less aware , providing comfort that cannot be achieved otherwise
describe how palliative sedation is an example of the principle of double effect
- desired outcome = relief of intractable symptoms
- undesired outcome = hasten death
- justified as long as we want to relieve suffering (intent), not hasten death
what is the criteria for palliative sedation
- death foreseeable or immenent –> min of 2 weeks of less
what is MAiD
- occurs when an authorized HCP provides or administers meds that causes the individuals death at the request of the individual
what is the criteria for MAiD (6)
- have a serious and incurable illness, disease, or disability
- in advanced state of decline
- sufferring unbearably
- 18 or older
- informed consent
- make a voluntary request without outside influence
describe the relation between MAiD and palliative care
- palliative care does not aim to hasten death
- but important to remember our role as nurses
why might an ethical dilemma occur with requests from family to withhold info from the pt
- stems from wanting to respect the family’s wish
- but also upholding our professional to be honest w pts and respect their autonomy
what should you do if the family requests that you withhold info from the pt (5)
- respond to the family w empathy (the request usually comes from a place of love & care for the pt, or maybe trying to protect them)
- find out more from the fam –> what would the pt want
- find out more from the pt –> how much info do they want, what is their understanding, how do they want info delivered
- develop & continue a therapeutic relationship w the fam & pt
- delve deeper into the request: try & understand where they are coming from
what should you consider regarding artificial nutrition & hydration (5)
- helpful vs harmful
- goals of care
- pt and fam wishes
- diagnosis –> helpful or harmful
- point of disease trajectory
when addressing ethical issues, what tools should you use (7)
- self reflection
- 4 ethical principles (maximize beneficence, decrease harm)
- the healthcare team (diff viewpoints)
- CNA code of ethics
- ethical frameworks
- instituional ethics committee
- palliative care team
what is the role of the instituional ethics committee
- helpful for challenging situations where despite our best efforts, too difficult to navigate situation
- do not take over decision making but guide convo
what reflective questions can you ask yourself when addressing ethical issues (6)
- what are my beliefs and values
- what are my fears
- what are my attitudes
- what are my biases
- are my relationships w others in this care situation supportive & nurturing?
- am i being pateint? compassionate?
what is an approach to dealing w ethical dilemmas
- time limited trial
when is a time limited trial useful
- helpful in situations where two parties are in disagreement over the use of a particular med interventions, and whether a specific interventions would be of benefit to the pt
- when it is unclear if an intervention should be initiated and the outcome is uncertain
describe how a time limited trial works
- the healthcare team and pt agree to a trial of treatment over a specified period of time to see if the pt improves or deteriorates according to agreed-on clinical outcomes
- if the agreed on outcome is met, treatment continues
- if it is not, then treatment is withdrawn
discussion prior to a time limited trial includes
- what is the goal of the intervention (ex. decrease dyspnea)
- what is the time frame that intervention will be trialed
what are ethical frameworks
- additional tool for when nurses are faced w a particular issue
- set of guiding and reflective questions that help facilitate discussion
- many different frameworks available
what are example questions included in Oberle and Raffin’s Model of ethical framework (lots, im assuming we dont have to memorize?)
- what relationships are inherent in this situation?
- who is significant in this care situation, and how could they be involved?
- are my relationships with others in this care situation supportive and nurturing?
- what are the goals of care in this situation?
- are these goals shared by the person in care, the nurse, and others?
- what are my beliefs and values?
- what values in the Code are inherent in this situation?
- what values are imp for others in the situation, including other HCP?
- do individuals involved have diff values? do these differences create conflict?
what is moral courage
- the willingness to take a controversial stand or one that challenges the healthcare organization or those in it, even when a person’s job may be jeopardized.
- nurses who have moral courage & act on it are less likely to feel moral distress
what is the canadian nurses association (CNA) code of ethics
- document for all nurses that provides guidance for ethical relationships, behaviors, and decision making
- nurses are to practice in accordance to the code of ethics
- discusses ethical duties
according to the code of ethics, nurses: (4)
- work to relieve pain and sufferring
- allow pts to live and die with dignity
- encourage pts to discuss their wishes & goals
- provide a palliative approach to care throughout the lifespan and illness trajectory (from time of diagnosis)
