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Ethical Decision Making

Bioethics examines controversial ethical issues arising from advances in biology and medicine. Common bioethical principles for nurses include autonomy, beneficence, non-maleficence, and informed consent. Nurses often face ethical dilemmas regarding quality of life, allocating scarce resources, and unethical colleagues. The case study describes a terminally ill patient who confides in a nurse about his plan to commit suicide but asks the nurse not to tell anyone about his plan.

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14 views

Ethical Decision Making

Bioethics examines controversial ethical issues arising from advances in biology and medicine. Common bioethical principles for nurses include autonomy, beneficence, non-maleficence, and informed consent. Nurses often face ethical dilemmas regarding quality of life, allocating scarce resources, and unethical colleagues. The case study describes a terminally ill patient who confides in a nurse about his plan to commit suicide but asks the nurse not to tell anyone about his plan.

Uploaded by

deneshanicholas123
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© © All Rights Reserved
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Download as PPTX, PDF, TXT or read online on Scribd
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ETHICAL

DILEMMAS
Paula Valley-Thom
Bioethics
■ Bioethics is the study of the typically
controversial ethical issues emerging from
new situations and possibilities brought about
by advances in biology and medicine. It is also
moral discernment as it relates to medical
policy and practice.
Core Bioethical Ethical Principles in
Nursing
■ Autonomy. ■ Integrity.
■ Beneficence. ■ Justice.
■ Fidelity. ■ Non-maleficence.
■ Paternalism.
■ Informed consent.
Issues in bioethics
■ Quality of life (it's not for us to decide if this is anyone's quality
of life or not)
■ Futile care (ex. residents practicing codes on nearly dead
patients)
■ Allocating scarce resources (ex. there's only 1 IV bag on the
floor and 2 patient's that need it right away, who gets it?)
■ Nursing shortage (mandatory overtime, you cannot leave if they
need you, it's abandoning your patients!)
An ethical dilemma
■ An ethical dilemma involves the need to choose
from among two or more morally acceptable
courses of action, when one choice prevents
selecting the other; or, the need to choose
between equally unacceptable alternatives
(Hamric, Spross, and Hanson, 2000).
Ethical issues of most concern

The five most frequently cited ethical issues reported by the


nurses surveyed were:
■ Protecting patients’ rights and human dignity;
■ Providing care with possible risk to your health (eg. TB, HIV,
violence);
Respecting/not respecting informed consent to treatment;
■ Staffing patterns that limit patient access to nursing care;
■ Use/non use of physical/chemical restraints.
(Johnstone, Da Costa, and Turale, 2004)
Personal issues faced by nurses
A combined analysis of reports revealed the following
■ Staffing patterns that limited patient access to nursing care;
■ Prolonging the dying process with inappropriate measures;
■ Working with an unethical/incompetent/impaired colleague;
■ Caring for patients/families who are
uninformed/misinformed;
■ Providing care with possible health risk; and,
■ Not considering a patient’s quality of life
Common Ethical Situations for Nurse Managers

■ Honesty vs. Withholding Information – Family members may want to


withhold medical information from the sick to protect their emotions.
However, patients have the right to know about their medical conditions.
■ Science vs. Spirituality – Healthcare, which is science-based and results-
driven, can impede on religious or personal beliefs. Some religions
restrict medical interventions and lifesaving techniques.
■ Healthcare Needs vs. Resource Allocation – The rising cost of healthcare
is increasingly putting nurse managers at odds with budgeting
constraints and
Common Ethical Situations for Nurse Managers

■ Healthcare Needs vs. Resource Allocation – The rising cost of


healthcare is increasingly affecting budgeting constraints and
patient needs. A large number of medical facilities have scarce
resources which puts patients at risk for not getting the care
they need.
■ Autonomy vs. Beneficence – Nurses are required to administer
prescribed medicine, but patients, at the same time, can refuse
them. Patient autonomy can go against medical directives,
despite clearly defined needs. Patients have a right to refuse all
medical care.
Common Ethical Situations for Nurse
Managers
■ “Using ethical principles to arrive at a solution should
be done in an atmosphere of caring, respect,
openness, and honesty. This process should be based
on a sound ethical, decision-making model, using the
best evidence-based-practice guidelines available,”
the ANA explains.
Seven-step guide to ethical decision-making (Davis
1999)
1. State the problem: For example, "there's something about this
decision that makes me uncomfortable" or "do I have a conflict of
interest?".
2. Check the facts: Many problems disappear upon closer examination
of the situation, while others change radically.
3. For example, persons involved, laws, professional codes, other
practical constraints
4. Identify relevant factors.
5. Develop a list of options.: Be imaginative, try to avoid "dilemma";
not "yes" or" no" but whom to go to, what to say.
Seven-step guide to ethical decision-
making (Davis 1999)
6. Test the options. Use some of the following tests:
■ harm test: Does this option do less harm than the alternatives?
■ publicity test: Would I want my choice of this option published
in the newspaper?
■ defensibility test: Could I defend my choice of this option
before a congressional committee or committee of peers?
■ reversibility test: Would I still think this option was a good
choice if I were adversely affected by it?
Seven-step guide to ethical decision-making
(Davis 1999)
7. Make a choice based on steps 1-5.
8. Review steps 1-6. How can you reduce the likelihood that
you will need to make a similar decision again?
■ Are there any cautions you can take as an individual (and
announce your policy on question, job change, etc.)?
■ Is there any way to have more support next time?
■ Is there any way to change the organization (for example,
suggest policy change at next departmental meeting)?
The case description
■ The patient Mr Green is a 57 year old gentleman with aggressive prostate cancer
who took care of by the nursing team in the oncology department of a general.
Mr Green was diagnosed with prostate cancer seven years ago but refused
medical and surgical treatment at the time. On the last admission Mr Green was
told that he may only have 4–6 weeks to live after a cystoscopy showed further
extensive growth of the tumor.
■ Further surgical/medical intervention would not be appropriate in this case and
that a palliative care regimen was the next step. At this point the patient reported
to the health care team that he had resigned himself to the fact that he was going
to die.
■ Mr Green pulled one of the author's colleagues aside and confided to the nurse
that he planned to kill himself and that is was a secret that the nurse was not to
tell anyone.
References
■ Duquesne University School of Nursing (n.d.) Ethical Issues and Solutions for Nurse Manager.
Retrieved from shttps://onlinenursing.duq.edu/blog/ethical-issues-solutions-nurse-managers/

■ Johnstone, M., Da Costa, C., and Turale, S. (2004) Registered and enrolled nurses’ experiences
of ethical issues in nursing practice. Retrieved at http://www.ajan.com.au/Vol22/Vol22.1-4.pdf

■ The Pennsylvania State University( 2018). Orientation to Energy and Sustainability Policy: A
Seven Step Process for Making Ethical Decisions. Retrieved from https://
www.e-education.psu.edu/emsc302/node/170

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