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7/29/2019 Ethical Issues NML
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7/29/2019 Ethical Issues NML
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TYPES OF ETHICAL DILEMMAS
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• 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.
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• 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
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MORAL CONFLICT
Occurs when an individual is unsure whichmoral principles or values apply and may eveninclude uncertainty as to what the moral
problem isAlso called as MORAL UNCERTAINTY.
“When duties and obligation of health care providers or general guiding principles are
unclear” ( Jormsri, 2004
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MORAL DISTRESS
Is the result of the individual knowing theright thing to do but organizationalconstraints make it difficult to take the rightcourse of action
When the nurses are unable to follow theirmoral beliefs because of institutional orother restriction.
The distress occurs when the nurse violates apersonal moral value and fails to fulfillperceived responsibility.
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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.
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MORAL OR ETHICAL DILEMMA
Occurs when two (or more) clear principlesapply but they support inconsistent coursesof action (Laabs, 2005)
Choosing between two or more undesirablealternatives and attempting to select theleast damaging from the choices available.
Occurs when two or more clear principlesapply but they support inconsistent coursesof action.
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“ 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)
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“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?”
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ETHICAL APPROACHES
The Wueste approach to Ethical Problem Solving
Uses three-pronged approach to ethical decisionmaking: CONSEQUENTIAL ETHICS,
DEONTOLOGICAL ETHICS, ASPIRATIONAL ETHICS
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Wueste’s 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.
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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.
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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
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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
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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 one’s commitments
VERACITY
• Is the obligation to tell the truth
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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
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ADDRESSING ETHICAL ISSUES
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Two decision – making models
1- Thompson and Thompson (1985)
Review the situation to determine health problems,decision needs, ethical components, and keyindividuals.
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.
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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
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A good decision is one that is in the client’s 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.