MERCY STREET: A CASE STUDY IN MORAL

DECISION MAKING THEN AND NOW

Sister Thea Krause, CSFN, PhD, ACNP-BC

DISCLAIMER

I have no financial relationships with commercial

interests to disclose.

I am not presenting on behalf of my employer(s),

hence, I am not serving as an agent of the federal

government.

I do not have any stock or influence in the film

industry or PBS.

The only agency I can not separate from is my own –

one which, admittedly, has been inspired by many

people, places and situations.

OBJECTIVES

At the completion of this discussion participants will be able to:

recognize that moral consequences, intended or not, are imbedded in all clinical behaviors;

discuss an ethical framework based on value analysis and virtue ethics that can be used when considering moral consequences of behaviors inconsistent with ones personal value system;

apply an ethical framework to current clinical situations in which values conflict pose moral dilemmas for professional caregivers.

THE CHARACTERS

Moral dilemmas have to do with

PEOPLE.

MORAL MATURITY

Moral Maturity is marked by

depth and consistency of moral judgement;

recognition that moral judgement may be fallible;

an awareness that moral judgement is complex

Moral maturity is a requirement for a person

who is to apply a body of knowledge to

the solution of a problem;

the understanding of a situation

MORAL DEVELOPMENT

Moral development is the process through which we develop proper attitudes and behaviors toward other people in society.

Moral development is based on social and cultural norms, rules, and laws.

Piaget

Kohlberg

Gilligan

Bronfenbrenner

RELIGIOUS DEVELOPMENT

BUT….WHAT ARE ETHICS?

Simply stated, ethics refers to standards of

behavior that tell us how human beings

ought to act in the many situations in which

they find themselves.

WHAT ETHICS ARE NOT

Ethics are not the same as feelings.

Ethics are not about religion.

Ethics are not adhering to the law.

Ethics are not adoption of culturally

accepted norms.

Ethics are not science.

https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/what-is-ethics/

HTTPS://WWW.SCU.EDU/ETHICS/ETHICS-RESOURCES/ETHICAL-DECISION-

MAKING/WHAT-IS-ETHICS/

1. Well Founded Standards

2. Study and development

of ethical standards

IDENTIFYING ETHICAL STANDARDS

*If our ethics are not based on feelings, religion,

law, accepted social practice, or science, what

are they based on?

*There are two problems when identifying ethical

standards :

1. On what do we base our ethical standards?

2. How does we apply those standards to specific

situations?

SOURCES OF ETHICAL STANDARDS

Utilitarian

Rights

Fairness/Justice

Common Good

Virtue

HOW DO THE THEORIES DIFFER?

Theory Premise

Utilitarianism A perspective that judges something on the basis of its utility or

usefulness.

Rights Best protects and respects the moral rights of those affected.

Justice Claims that equals should be treated equally. Ethical actions treat all

human beings equally-or if unequally, then fairly based on some

standard that is defensible.

Common Good Interlocking relationships of society are the basis of ethical reasoning

and that respect and compassion for all others-especially the

vulnerable-are requirements of such reasoning.

Virtue Ethical actions ought to be consistent with certain ideal virtues that

provide for the full development of our humanity.

PROBLEM – DIFFERENT APPROACHES

Each of the approaches helps us determine

what standards of behavior can be considered

ethical. There are still problems to be solved,

however.

The first problem is that we may not agree on a

single approach.

The second problem is that the different

approaches may not answer the question "What is

ethical?" in the same way.

A FRAMEWORK FOR DECISION MAKING

•Recognize Ethical Issue

•Get the Facts

•Evaluate Options

•Make a Decision

•Act and Reflect

https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/a-framework-for-

ethical-decision-making/

LET’S TRY IT – A CASE FROM MERCY STREET

FRAMING ETHICAL REASONING - THEN

LET’S TRY IT – A CASE FOR TODAY’S NP

FRAMING ETHICAL REASONING - NOW

“…man's humanity to

man rather than

man's inhumanity to

man… people hunger

for compassionate

interactions so much

that it transcends all

of culture."

REFERENCES

American Society of Bioethics + Humanities. Core Competencies for Healthcare Ethics

Consultation. Second Ed. Glenview, IL: American Society of Bioethics + Humanities, 2011.

Cherry, MJ. “Re-Thinking the Role of the Family in Medical Decision-Making”, Journal of Med

Philosophy (2015) 40 (4): 451-472.

Ford, PJ and Dudzinski, D. eds. Complex Ethics Consultations: Cases That Haunt Us.

Cambridge: Cambridge University Press, 2008.

Junkerman, C, Derse, A. and Schiedermayer, D. Practical Ethics for Students, Interns, and

Residents: A Short Reference Manual, Third Ed. Hagerstown, MD: University Publishing Group,

2008.

McCullough, LB. Physicians’ Professionally Responsible Power: A Core Concept of Clinical

Ethics. Journal of Medical Philosophy (2016) 41 (1): 1-9.

Post, SG, ed. Encyclopedia of Bioethics, Third Ed. New York: Macmillan Reference USA, 2003.

Post, LF, Blustein, J. and Dubler, NN. Handbook for Health Care Ethics Committees. Baltimore,

MD: The Johns Hopkins University Press, 2007.

PBS Mercy Street - http://www.pbs.org/mercy-street/home/

Santa Clara University - https://www.scu.edu/ethics/ethics-resources/ethical-decision-

making/what-is-ethics/