Transcript ETHICAL THEORIES AND BIOETHICS

ETHICAL THEORIES AND
BIOETHICS
N243-NURSING ADMINISTRATION IV
Krizzia Eve Mamuad
Ariani Arista Pertiwi
JAN. 9, 2009
OBJECTIVES
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Identify core bioethics terms and basic
ethical principles for the nurse
administration in health care agencies
Explain relevant concepts and theories of
ethics
Define critical aspects of an ethics
committee and the role of the nurse
administrator
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Identify major ethical dilemmas as they
relate to managing health care services
Evaluate common ethical conflicts
associated with the current practice
environment
Create an understanding of laws
influencing care management
Discuss the Ethical decision-making
models
Create a dialogue about values and ethical
conflicts in nursing
Discussion
• What is your opinion about the
video?
• What are ethical principles have
been violated?
• What will you do if you were one of
the team?
ETHICAL KEY TERMS
• ETHICS
– the discipline in the
judgment of rightness or
wrongness, unfairness or
fairness, virtue or vice
- Formal study of ways of
conceptualizing and
understanding the moral life
•NORMATIVE ETHICS
- area of inquiry that seeks to
determine which approach or
action is the most ethically
desirable in a given situation
•HEALTH CARE ETHICS
– biomedical / bioethics
 VALUE
-any object or quality that is
found to be desirable or
worthwhile ; beliefs, purposes
and attitudes that are freely
chosen, prized and acted on
 RULE
-a specific prescriptive action
guide, expressed as an
imperative
 PRINICPLE
-an action guide that is more universal and
general than a rule or value
-Framework; skeleton of ethical decision
making
-Provides boundaries that should not be
exceeded without justified reasons
 THEORY
-an organized explanation of a particular
phenomena; with principles as its basic
components; basic assumptions believed
to be true based on evidence
ETHICAL
PRINCIPLES
 AUTONOMY
-quality or state of being self governing
; the capacity of an agent to
determine its own actions through
independent choice within a system of
principles and laws to which one is
dedicated (Ballou, 1998)
-authority, accountability and liability
for one’s decisions and actions
BENEFICENCE
-An obligation to positively benefit another
balanced against risk
- “promote good”
-viewing person as autonomous
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NON MALEFICENCE
-avoidance of intentional harm or the risk
of inflicting harm on someone
-an obligation to “do no harm”
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 JUSTICE
-Giving people what is owed,
deserved or legitimately claimed
-Norm of being fair to all, giving equal
treatment
-An obligation to distribute benefits
(goods), and burdens (risks or
harms) and cost equally
 FIDELITY
-Being loyal and faithful to
commitments and accountable for
responsibilities
 VERACITY
-Norm of telling the truth and not
intentionally deceiving or misleading
clients
ETHICAL PRINCIPLES AND
CORRESPONDING RULES
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AUTONOMY
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BENEFICENCE
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keep promises, mainatain
confidentiality, be truthful,
avoid coercion, preserve
dignity, provide informed
consent
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be kind, merciful, competent,
safe and helpful (prompt
treatment of pain, non
abandonment, promotion of
health and well being)
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NONMALEFICENCE
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JUSTICE
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– refrain from inflicting
harm of any type
especially in the form of
suffering, death or
disability
-provide
indicated
treatment regardless of
differences; allocate
resources according to a
logical, fair and
objective method
ETHICAL
THEORIES
UTILITARIANISM
of Jeremy Bentham And John
Stuart Mill
 -normative ethical theory that
advocates bringing about the greatest
good for the greatest number of
people.
 -an act is right if it produces the
greatest possible value over disvalue;
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-theory
CONSEQUENTIALISM
 consequences
of the act are of
primary concern
 An
act is ethical if it produces
desired outcomes ; the right act is
the one that produces the best
overall outcome
KANTIAN DEONTOLOGY
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-proposed
by a German philosopher,
Immanuel Kant in 1781
 an
act is right when the agent
behaves according to prescribed
duties and obligations that preserve
the dignity of each person
(“DEONTO” = DUTY)
 REJECTED
UTILITY as a primary
moral principle
 AUTONOMY
 both
is the supreme value
the intent and how people
achieve the end result are important
 rightness
and wrongness of
human actions is totally
independent of the goodness
or badness of consequences
MAXIMS OF KANT
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an act is morally right if and
only if it is universalizable.
an act is morally right if and
only if the agent performing it
refrains from treating any
person solely as mean to an
end.
TELEOLOGIC STYLE
 comes
from the Greek root
meaning “knowledge of the end”
 -assigns
duty and obligations
based on the consequences of the
act (extrinsic nature)
CONTRACTARIAN THEORY
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-morality
involves a social
contract, which provides the
principle of what an
individual can and cannot
do
“MORAL GUIDANCE
IS MOST NEEDED
WHEN TIMES ARE
HARDEST AND
TEMPTATION IS
THE GREATEST”
(RACHELS 1995)
Ethical Decision
Making Models
Aiken (1994)
Five Step Ethical Decision-Making
Process
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First step:
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Second Step:
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Collect, analyze, and interpret as much
information as possible about the
dilemma
State the dilemma as clearly as is
possible
Third Step:
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List and consider all possible courses of
action to choose among
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Fourth step:
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Analyze the advantages and
disadvantages of each course of action
Final step:
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Make a decision
Crisham (1985)
MORAL model
Linking judgment
Choice
Action
considering alternatives in view of moral
principles
• Massaging the dilemma by defining
and describing conflicts and
interests
• Outlining options by brainstorming
to discover alternative solutions
• Reviewing criteria and resolving the
dilemma
• Affirming a position and
acting on the judgment
• Looking back to evaluate the
effectiveness of the process
MORAL
model
Research
Based Tool
Framework for Bioethical
Decision Making
• Relevant patient and family
demographics, including pertinent
social data
• Medical facts, including course of
illness, diagnosis, prognosis, quality
of life information, and a statement as
to patient’s or family’s understanding
of these data
• Name of the legally designated
decision maker
• Persons who should be present for
the discussion of options
• How the available options are
justified ethically: the specifications of
the ethical norms involved and the
pros and cons associated with each
option
• The most ethically sound option and
justification for it
Nursing process as a framework for
Ethical Decision Making
(Reigle, 1996)
• Assessment: composed of problem
identification and information
gathering
• Plan: selection of strategy for
resolution
• Implementation: putting the agreedon moral plan into effect
• Evaluation: analysis of the process
and the efficacy of the plan
Values
clarification
Approach to
Problem
Resolution
(Fry, 1994)
• What is the story behind the
values conflict?
• What is the significance of the
values involved?
• What is the significance of the
conflict to the parties involved?
• What should be done?
Task of Mediators in
Resolving Bioethical Disputes
Assessment phase
investigate and characterize the
conflict, identify the parties, and
reach agreement on medical fact.
Development Phase
Distinguish and clarify the relevant
legal and ethical principles and make
sure that all parties understand the
facts and the rights of parties in the
same way
Resolution Phase
Help patient and family think through
the options, articulate values to
caregivers, and ensure that agreedon solution is carried out accordingly.
Factors influence nurse
decision making
• Time
• Resources
• Values
– Personal
• Personal value related to caring in nursing
care
– Professional
• ANA’s Code for Nurses
– Organizational
• Cost containment, making profit
Developing a Health Care
Ethics Program
• Education
• Consultation
• Policy development
Thank You