Health Care 7
Ethics-Basic
Concepts
LEC 1
NCM 108
SHEILA MARIE P. OCONER, RN MAN
Nurses are exposed to daily
work and experience exposed
them to events of birth, death
and sufferings
Nurses must decide on the
morality of their own actions
in ethical issues
Nurse Client Relationship
Support and advocate
clients
Assist families when
facing difficulty choices
Nurses need to develop
sensitivity to the ethical
dimensions of the nursing
practice
VA LU E S
VALUES
• Are enduring beliefs
or attitude about the worth
of a person, object, idea or
action
• They influence
decisions and actions
including nurses ethical
decision making
Values are derived from
• Work
• Family
• Religion
• Politics
• Money
Value System
• Are basic to the
ways of life, give
direction to life and
form the basis of
behavior based on
decisions and choices
• Beliefs and
attitudes are related
but not identical to
values
.
• People have
many belief and
Beliefs or Opinions
Are interpretations or conclusions that
people accept as true. They are based on
faith rather than fact and not necessarily
involve values
A belief is an internal feeling that
something is true, even though
that belief may be unproven or irrational
Values Transmission
Values are learned through observation
and experience, they are influenced by
a person’s socio cultural environment-
that is by social traditions, culture,
ethnics and religious groups and by
family and peer groups
Personal Values
Derived values from society and their
individual subgroups which were
internalized
Professional Values
Nurses professional values are acquired
during socialization into nursing from
codes of ethics, nursing experience,
teachers and peers.
VALUES CLARIFFICATION
Is a process by which
people identify, examine
and develop their own
individual values
A principle of values
clarification is that no one
set of values is right for
everyone
Promotes personal growth
by fostering awareness,
empathy and insight and
a important step for
nurses to take in dealing
with ethical problems
CLARRIFYING NURSES VALUES
Nurses and nursing students need to
reflect on the values they hold about
life, death, health and illness. Nurse
holds both personal and professional
values
CLARRIFYING CLIENT VALUES
Plan effective client-centered care,
nurses need to identify client’s
values as they influence and relate to
a particular health problems.
The following process may help clients
clarify their values:
1. Lists all alternatives
2. Examine possible consequences of
choices
3. Choose freely
4. Feeling about the choice
5. Affirm the choice
ETHICS
Refers to a method of inquiry that helps people
to understand the morality of human behavior
Study of morality
The practice of beliefs of a certain groups like
medical ethics, nursing ethics
The expected standard of moral behavior of a
particular group to describe in the groups formal
professional cod of ethics
BIOETHICS
Ethics applied to human life or health decisions
NURSING ETHICS
Refers to ethical issues that occur in the
nursing practice
Health ethics Health care ethics
(a.k.a “medical ethics”) is the
is the branch of ethics that application of the core
deals with ethical issues in principles of bioethics
health, health care, medicine (autonomy, beneficence,
and science. nonmaleficence, justice) to
medical and health care
It involves discussions about decisions. It is a
treatment choices and care multidisciplinary lens through
options that individuals, which to view complex issues
families, and health care and make recommendations
providers must face. regarding a course of action.
It requires a critical reflection
upon the relationships between
health care professionals and
those they serve, as well as the
programmes, systems, and
structures developed to
improve the health of a
population.
Morality
MORALITY OR MORALS
Similar to ethics and many people use the
terms interchangeably
Refers to private, personal standards of
what is right or wrong in conduct, character and
attitude
Its difference to Laws, Laws reflect the
moral values of the society and offer guidance
in determining what is moral
Moral Development
Process of learning to tell the difference
between right or wrong and of learning what
ought and ought not to be done
Moral Frameworks
Nurses use moral theories in
developing explanation for their ethical
decisions and actions and in discussing
problem situations with others.
THEORIES
Consequence-based (Teleological ) Theories
It looks to the outcomes (consequences) of
an action in judging whether that action is right or
wrong
Teleological theories focus on issues of
fairness
Utilitarianism
One form of consequentialist theory, views
a good act as one that is the most useful-that is
one brings the most good and the least harm to
the greatest number of people. This is the
principle of utility
This approach is often used in making
decisions about the funding and delivery of health
Utilitarianism is a
normative ethical theory
that places the locus of right
and wrong solely on the
outcomes (consequences) of
choosing one action/policy
over other actions/policies.
As such, it moves beyond the u·til·i·ty
scope of one's own interests
and takes into account the the state of
interests of others. being
useful,
Ex
Rather spend time with profitable,
friends or
Better spend quality time beneficial.
Principle-based
(deontological) Theories
• Involve logical and formal
processes and emphasize
individual rights, duties, and
obligations.
• The morality of an action
is determined not by its
consequences but by whether it
is done according to an
important objective principle
The theory of deontology states we are morally
obligated to act in accordance with a certain set of
principles and rules regardless of outcome.
In religious deontology, the principles derive from
divine commandment so that under religious laws,
we are morally obligated not to steal, lie, or cheat.
Relationship-based
(caring) Theories
• Stress courage,
generosity, commitment
and the need to nurture
and maintain
relationships.
• Caring theories judge
actions according to
perspective of caring and
responsibility
• Caring theories
promote the common good
or the welfare of the group
MORALE PRINCIPLES are statements about broad,
general, philosophical concepts and provide the
foundation for moral rules which are specific prescription
for actions
The ethical principles that nurses must adhere to
Justice is fairness. Nurses must be fair when they
distribute care, for example, among the patients in the
group of patients that they are taking care of. Care
must be fairly, justly, and equitably distributed among
a group of patients.
Beneficence is doing good and the right thing for the
patient.
Nonmaleficence is doing no harm, as stated in the
historical Hippocratic Oath. Harm can be intentional or
unintentional.
Accountability is accepting responsibility for one's own
actions. Nurses are accountable for their nursing care
Fidelity is keeping one's promises. The nurse
must be faithful and true to their professional
promises and responsibilities by providing high
quality, safe care in a competent manner.
Autonomy and patient self-determination are
upheld when the nurse accepts the client as a
unique person who has the innate right to have
their own opinions, perspectives, values and
beliefs. Nurses encourage patients to make
their own decision without any judgments or
coercion from the nurse. The patient has the
right to reject or accept all treatments.
Veracity is being completely truthful with
patients; nurses must not withhold the
whole truth from clients even when it may
lead to patient distress
Confidentiality prevents the unauthorized
use or disclosure of information, ensuring
that only those who are authorized to access
information can do so.
Privacy is a closely related concept that's
most often associated with personal data. ...
The objective of privacy is the confidentiality
of personal data
Patients' rights vary in different countries and in different
jurisdictions, often depending upon prevailing cultural and
social norms. Different models of the patient-physician
relationship—which can also represent the citizen-state
relationship—have been developed, and these have
informed the particular rights to which patients are entitled
Patient's bill of rights is a list of guarantees for those
receiving medical care. It may take the form of a law or a
non-binding declaration. Typically a patient's bill of rights
guarantees patients information, fair treatment, and
autonomy over medical decisions, among other rights
Informed consent is a process of communication whereby a
patient is enabled to make an informed and voluntary decision
about accepting or declining medical care.
The most important goal of informed consent is that the patient has an
opportunity to be an informed participant in her health care decisions. ...
The nature of the decision/procedure. Reasonable alternatives to the
proposed intervention. The relevant risks, benefits, and uncertainties
related to each alternative.
The most important goal of informed
consent is that the patient has an opportunity
to be an informed participant in her health
care decisions. ... The nature of the
decision/procedure. Reasonable alternatives
to the proposed intervention. The relevant
risks, benefits, and uncertainties related to
each alternative.
A legally authorized representative as “any
individual person, judicial body or other body
of individuals who are legally authorized
under state and federal law to consent to
research participation on behalf of a
designated person.”
A proxy is a person who is designated by
another to represent that individual at a
meeting or before a public body. It also refers
to the written authorization allowing one
person to act on behalf of another.
Living wills and other advance directives are written, legal
instructions regarding preferences for medical care if the person
are unable to make decisions for him/herself.
Advance directives are guide choices for doctors and caregivers if
the client is terminally ill, seriously injured, in a coma, in the late
stages of dementia or near the end of life.
Advance directives aren't just for older adults. Unexpected end-of-
life situations can happen at any age at any time so it's important
for all adults that this document are prepared ahead of time.
By planning ahead, client get the medical care they want and avoid
unnecessary suffering and relieve caregivers of decision-making
burdens during moments of crisis or grief. It also help reduce
confusion or disagreement about the choices chosen behalf of the
client
Power of attorney
Is a medical or health care power of attorney is a type
of advance directive in which designates a person to
make decisions in behalf of the person and he/she
can not do so. In some states this directive may also
be called a durable power of attorney for health care
or a health care proxy.
The person chosen to make decisions on in behalf
may be called one of the following:
•Health care agent
•Health care proxy
•Health care surrogate
•Health care representative
•Health care attorney-in-fact
•Patient advocate
The person to be designated may be a spouse,
other family member, friend or member of a faith
community or may also choose one or more
alternates in case the person you chose is unable
to fulfill the role.
Living will
A living will is a written, legal document that states
medical treatments that the patient would and
would not want to be used to keep him/her alive,
as well as preferences for other medical
decisions, such as pain management or organ
donation.
Address a number of possible end-of-life care
decisions in the living will
•Cardiopulmonary resuscitation (CPR) restarts the heart
when it has stopped beating
•Mechanical ventilation takes over your breathing if unable to
breathe on your own..
•Tube feeding supplies the body with nutrients and fluids
intravenously or via a tube in the stomach..
•Dialysis removes waste from your blood and manages fluid
levels if the kidneys no longer function..
•Antibiotics or antiviral medications can be used to treat
many infections. If in near the end of life, how would infections
be treated aggressively or would rather let infections run their
course?
•Comfort care (palliative care) includes any
number of interventions that may be used to keep
patient comfortable and manage pain while
abiding by other treatment wishes.
•Organ and tissue donations for transplantation
can be specified in the living will. If organs are
removed for donation, while patient u will be kept
on life-sustaining treatment temporarily until the
procedure is complete..
•Donating your body for scientific study also can
be specified. Contact a local medical school,
university or donation program for information on
how to register for a planned donation for
research.
Do not resuscitate and do not intubate orders
This does not included or needed to be written in
an advance directive or living will to have do not
resuscitate (DNR) and do not intubate (DNI) orders. To
establish DNR or DNI orders, inform the doctor about
this preferences. The doctor will write the orders and
include them in the medical record.
Even there is a establish living will that includes the
patient’s preferences regarding resuscitation and
intubation, it is still a good idea to establish DNR or
DNI orders each time the patient is admitted to a
new hospital or health care facility.
References
https://www.mayoclinic.org/healthy-
lifestyle/consumer-health/in-depth/
living-wills/art-20046303
