TYPES OF ETHICAL DILEMMAS

Dilemmas of Beneficence - dilemma that involve deciding what is good as opposed to what its harmful. Dilemmas of Autonomy- those that involve deciding what course of action maximize the patient's right of self determination.

 Dilemmas of Justice - dilemmas that involve dividing limited health care resources fairly Dilemmas of Fidelity - those that are involve honoring promises Dilemmas of Non-Maleficence - dilemmas that involve the avoidance of harm

MORAL CONFLICT
Occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is Also called as MORAL UNCERTAINTY. When duties and obligation of health care providers or general guiding principles are unclear (Jormsri, 2004

MORAL DISTRESS
Is the result of the individual knowing the right thing to do but organizational constraints make it difficult to take the right course of action When the nurses are unable to follow their moral beliefs because of institutional or other restriction. The distress occurs when the nurse violates a personal moral value and fails to fulfill perceived responsibility.

MORAL OUTRAGE
Occurs when an individual witnesses the immoral act of another but feels powerless to stop it. Occurs when someone else in the health care setting performs an act the nurse believes to be immoral. Nurses not responsible for doing wrong but perceive that they are powerless to prevent.

MORAL OR ETHICAL DILEMMA

Occurs when two (or more) clear principles apply but they support inconsistent courses of action (Laabs, 2005) Choosing between two or more undesirable alternatives and attempting to select the least damaging from the choices available. Occurs when two or more clear principles apply but they support inconsistent courses of action.

 Our tasks as ethical decision makers is to identify the best answer among the available alternatives and to see to it that we are in position to meet the challenge of justifying our ethical judgments.' (Wueste, 2005)

How do managers decide, what is right from wrong? What does the manager do if no right or wrong answer exist? what if all solutions generated seem to be wrong?

ETHICAL APPROACHES
The Wueste approach to Ethical Problem Solving Uses three-pronged approach to ethical decision making: CONSEQUENTIAL ETHICS, DEONTOLOGICAL ETHICS, ASPIRATIONAL ETHICS

Wuestes four-step process

1. IDENTIFICATION/RECOGNITION it involves in identifying all of the ethical issues and the stakeholders involved in the dilemma.
2. ANALYSIS it examines all the ethical issues and delineates the options.

3. JUSTIFICATION the decision maker must justify the decision by using all three types of ethical approaches. 4. MOVEMENT the final step moves the decision maker to take the action.

PRINCIPLES OF BIOMEDICAL ETHICS

AUTONOMY Definition: autos = self, nomos = rule
Individual rights Privacy Freedom of choice

Patient self determination of act right to self determination

BENEFICENCE Promoting welfare of people, to do good NON-MALIFENCE Do no harm JUSTICE The principle of fairness Nurses frequently face decisions in which a sense of justice should prevail (succeed) E.g. busy unit, new admission

FIDELITY The principle of promise keeping Means to be faithful to agreements and responsibilities one has undertaken Nurses have responsibilities to their colleagues and themselves Duty to be faithful to ones commitments VERACITY Is the obligation to tell the truth

CONFIDENTIALITY Keep privileged information private DOUBLE EFFECT Some actions can be morally justified even though consequences may be a mixture of good and evil Must meet 4 criteria: The action itself is morally good or neutral The agent intends the good effect and not the evil (the evil may be foreseen but not intended) The good is not achieved by the evil There is no favorable balance of good over evil

ADDRESSING ETHICAL ISSUES

Two decision making models 1- Thompson and Thompson (1985) Review the situation to determine health problems, decision needs, ethical components, and key individuals. Gather additional information to clarify the situation Identify the ethical issues in the situation. Define personal and professional moral positions. Identify moral positions of key individuals involved Identify value conflicts, if any Determine who should make the decision Identify range of actions with anticipated outcomes. Decide on a course of action and carry it out. Evaluate / review results of decision / action.

2- Cassells and Redman (1989) Identify the moral aspects of nursing care Gather relevant facts related to a moral issue. Clarify and apply personal values Understand ethical theories and principles Utilize competent interdisciplinary resources Propose alternative actions. Apply codes of ethics to help guide actions Choose and implement resolutive action. Participate actively in resolving the issue Apply state and federal laws governing nursing practice. Evaluate the resolutive action taken

A good decision is one that is in the clients best interest and at the same time preserves the integrity of all involved. Nurses have ethical obligations to their clients, to the agency that employs them, and to primary care providers. Therefore, Nurses must weigh competing factors when making ethical decisions.