Transcript Decision Making in Nursing Practice Exercise 护理决策课程学前测試

Defining a Moral Problem
Samantha Mei-che Pang
RN, PhD
School of Nursing
The Hong Kong Polytechnic University
Traditional and contemporary
ethical values in
biomedicine and healthcare
• Hippocratic Oath (~400BC)
• Nightingale Pledge (1893)
• International Council of Nurses Code of Ethics
(1953, last revision:2005)
• Declaration on Bioethics and Human Rights
(UNESCO 2005)
• Declaration of Helsinki, World Medical Association
(1964, last revised 2008)
• The Patient Charter (Hospital Authority Hong
Kong, 1994)
• Code of Professional Conduct for the Guidance of
Registered Medical Practitioners, Medical Council
of Hong Kong (1957, last revised 2009)
Traditional Medical Ethical Values in
the Hippocratic Oath
• I will prescribe regimen for the good of my
patients according to my ability and my
judgment and never do harm to anyone.
• To please no one will I prescribe a deadly drug,
nor give advice which may cause his death.
Do no harm and do good
Ethical values upheld in the
Nightingale Pledge (1893)
• I will abstain from whatever is deleterious and
mischievous and will not take or knowingly
administer any harmful drug.
Do no harm
Nightingale Pledge
• I will do all in my power to elevate the standard
of my profession, and will hold in confidence all
personal matters committed to my keeping, and
all family affairs coming to my knowledge in the
practice of my profession.
Respect for person: privacy & confidentiality
Nightingale Pledge
• With loyalty will I …devote myself to the welfare
of those committed to my care.
Do good
Universal Declaration on Bioethics &
Human Rights UNESCO 2005
• To provide a universal framework of principles
and procedures to guide States in the
formulation of their legislation, policies or
other instruments in the field of bioethics
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Bioethical Principles
(UNSECO 2005)
Human dignity and human rights
Autonomy and individual responsibility
Consent and persons without the capacity to consent
Respect for human vulnerability and personal integrity
Privacy and confidentiality
Non-discrimination and non-stigmatization
Respect for cultural diversity and pluralism
Benefit and harm
Solidarity and cooperation
Social responsibility and health
Sharing of benefits
Protecting future generations
Protection of the environment, the biosphere and biodiversity
Patients’ Charter,
Hospital Authority Hong Kong 1994
• Right to medical
treatment
• Right to
information
• Right to choices
• Right to privacy
• Right to complaint
Responsibilities
• Provide accurate and relevant
information
• Comply with prescribed
treatment
• Respect others’ rights and follow
hospital rules
• Keep appointment
• Do not ask for fake certification
• Do not waste medical resources
Ethical Values in Patient-Health
Professional Relationship
Trust-based,
covenantal
•Respect for
autonomy
•Informed
consent
•Patient rights
•Do good
•Do no harm
•Fidelity
•Privacy
Autonomy-based,
contractual
Ideal Scenario
Social
responsibility
Doing no
harm
Doing
good
Equity
Respect
for
autonomy
Virtuous
character
Holistic
inclusion of
patient
family
Professional
competence
Communal work Following
institutional rules
attitude
& regulations
Values &
preferences
A 60 years old man has undergone a comprehensive health assessment and is found to have
probable dementia. The family members request the attending doctor not to tell the
patient.
Mainland
Survey B
SN380
Survey A
What is the problem?
What is the ethical issue at stake?
80
70
Yes
62.9
60
60
73.2
% 40
20
0
50
No
No
idea
25.4
%
40
30
20
10
0
26.5
Define the moral problem?
• Withholding
information from the
patient
• Right of family member
to access the patient’s
medical information
without the patient’s
consent
• Respect for autonomy
Social
responsibility
Equity
Virtuous
character
Professional
competence
Doing no
Mental competence?
harm
The patient’s wish to know?
Doing
Patient vulnerability?
good
Competing ethical
Respect
for
autonomy
viewpoints:
Holistic inclusion of the patient family
and doing no harm toHolistic
the patient
inclusion
of
patient
family
Respect
for autonomy and doing good
Following
Communal work
institutional rules
attitudeto the patient
& regulations
The patient is suffered from multiple stroke, advanced dementia and is totally dependent. The
doctor has indicated Do-not-resuscitate (DNR) for the patient. The family requests to try
everything to preserve the patient’s life.
What is the problem?
What is the ethical issue at stake?
140
124
120
100
80
60
40
33
32
b
c
20
0
a
Define the moral problem
• Is the medical team
obliged to provide
medically futile
treatment upon the
patient’s family
request?
• Professional integrity
• Goal of medical care:
preserve life or prolong
dying
• The patient’s
wish/advance directive
The patient is suffered from multiple stroke, advanced dementia and is totally dependent. The
doctor has indicated Do-not-resuscitate (DNR) for the patient. The family requests to try
everything to preserve the patient’s life.
Is the patient terminally ill?
What is medical futility?
Has the patient indicated any prior wish?
What does it mean by dignified care to the patient?
Q. 15
140
124
120
100
80
60
40
33
32
b
c
20
0
a
• Ethical justification:
The set of reasons for providing moral groundings
to one’s course of action?