Ethical Concepts in Nursing

Judy Brandell, RN, MSN FALL, 2012

Definitions
Values: attitudes, ideals, belief system of

individuals/groups that are used to guide behavior.

Morals: established rules of conduct and

standards of behavior: guide behavior to make decisions about what is right and wrong in a situation.

 Values freely chosen, influenced by upbringing,

life experiences, evolve with maturity. Represent my beliefs that I hold with high regard. Values clarification important to knowing oneself.
Brainstorm with class their most important

values use board (what values guide your daily interactions?)

quality, responsibility/accountability, courage, compassion, continuous improvement, hard work,

Mine integrity, humility, authenticity, respect,

 Morals: examples. Always tell the truth one should not lie.

Keep your promises. Do not steal.

"The difference between ethics and morals

can seem somewhat arbitrary to many, but there is a basic, albeit subtle, difference. Morals define personal character, while ethics stress a social system in which those morals are applied. In other words, ethics point to standards or codes of behavior expected by the group to which the individual belongs. This could be national ethics, social ethics,

Moral Development
Refers to the growth of a persons value and

moral system from childhood to adulthood and beyond.

There are many influencing factors.
Moral reasoning is part of moral

development.

Postconventional Kohlbergs Stages 6. Human rights 5. Independent thinking Conventional 4.Pleasing to society 3.Pleasing to others Preconventional 2. Responds to reward 1. Responds to punishment

Gilligans Stages
Theory of female moral

development: care based

May be a difference

Principle of nonviolence: Do not hurt others or self

between men and women (justice vs. care)

Points to need for

Self sacrifice is goodness

Goal is individual survival

rigorous EBP

Ethics
Ethics is concerned with which actions to take

in a situation. Ethics is a process requiring clarification of situations.

Bioethics: application to situations in health

care.

Ethical Theories 1
Deontology: Kant Moral if intent/motive good, regardless of outcome Duty Act Deontology - gather facts Rule Deontology - principles guide actions

Example: good Samaritan law Problems?

Ethical Theories 2
Utilitarianism: Hume/Bentham/Mill

Moral rightness determined by consequence Greatest good for the greatest number Examples: triage, healthcare money
Problems?

Ethical Theories 3
Virtue Ethics: Plato/Aristotle Inborn tendencies that develop through training Emphasizes the character of the decision maker Character traits regarded as virtues: Honesty, courage, compassion, fairness, integrity, etc.

Example: perseverance for patient advocacy http://www.nursingworld.org/FunctionalMenuCategorie s/MediaResources/legal/Fighting-for-Nurses-WhoSpeak-Up-for.html

Problems?

Principalism
Use of ethical principles to guide behavior:

Beneficence Nonmaleficence Justice Fidelity Veracity Autonomy (refer to PSDA, 1991) Paternalism (deciding for another)

Moral Distress
What is it? How are nurses in particular susceptible? Where are you most susceptible? What is moral outrage?

Moral Courage
Can be defined as taking action to do what is

right in spite of possible repercussions.

The phrase moral courage suggests there is

danger or fear associated with taking a right action, because of the possible personal sacrifice.

Code of Ethics for Nurses

Every profession needs a code of ethics.

Is an implied contract with society.

The Code of Ethics for Nurses with

Interpretive Statements (ANA, 2001) is the most recent revision.

Refer to the back cover of Chitty & Black

Nursing Process and the Ethical Decision-Making Model

Nursing Process Assess Ethical Model Clarify Dilemma Gather Data Analyze Plan Implement Evaluate Identify options Make a decision Act Evaluate

Dilemmas
Related to personal value systems

Involving other professionals

Regarding patient rights PSDA (1991) Related to immigration Related to migration Institutional issues Technology

Case Studies
Divide into 6 groups Discuss assigned case study Present discussion to class