VALUES and PROFESSIONAL ETHICS Ethical Challenges

Quantity may address how long a person lives or

perhaps how many people will be affected by the
Intro to Values and Professional Ethics
decision.
COURSE DESCRIPTION
Quality pertains to how well an individual lives
Deals with the concepts and principles of ethico- life, and this varies upon the definition of quality
moral and legal principles that affect the practice of life.
of nursing as profession. It further deals with
So how does the nurse support a patient
ethico-moral and legal issues that are relevant to
deciding between a therapy that will prolong life
the nursing profession
but compromise the quality of life?
 Decision Making Process is Necessary
Introduction: A case scenario
Ethical Challenges
Nurses face ethical dilemmas on a daily basis,
regardless of where they practice (Fant, 2012).
The American Nurses Association (ANA) has
developed a Code of Ethics for Nurses, which
serves as a guide for carrying out nursing
responsibilities in a manner consistent with
quality in nursing care and the ethical obligations
of the profession (ANA, 2012).
Ethical Dilema

Ethical Challenges In every sensitive event, there must be a SOUND

Yet, ethical considerations are impacted by so
many factors, such as culture, religion,
upbringing, individual values and beliefs.
These factors shape our ethical views and impact
ethical decisions that affect nurses and their
patients.
There are many ethical issues nurses can
encounter in the workplace. These include
A. quality versus quantity of life,
B. pro-choice versus pro-life, freedom versus
control,
C. truth telling versus deception,
D. distribution of resources, and
E. empirical knowledge versus personal beliefs
(Fant, 2012).
MORAL DECISION
Intro
 Our care for patients should be based on
sound judgement
(or evidence based practice!!)
 ..some of this judgement is about having a
strong sense of what is right or wrong
 ..having a strong sense of what we should
be doing and shouldn’t be doing as nurses
 ..having a strong sense of what our
priorities ought to be
 Nurses frequently have to make difficult
decisions for which there is not always a
quick, easy or ‘correct’ answer
e.g. Can Mrs X be discharged yet? Can Mr Y
manage his own medications safely? Should
Nurse A disregard the order of the doctor?
  Nevertheless, nurses still have to be able
to explain and account for these decisions
and actions
 The NMC Code can act as a guide
This can be seen as a ‘code of ethics’ – a
set of important principles to help guide nurses
(Burns, 2012)
Ethics is:
“Our concern for good behavior. We feel an
obligation to consider not only our own personal
well-being, but also that of other human being.”
(Albert Schweitzer in Certo & Certo, 2009

Review of Basic Concepts

Ethical issues in health care
Ethics
 We usually think of the ‘big’ issues
e.g. definition of life, what is a person, quality of
life, prolonging life, ending life, human rights.

 But day to day ethical issues can involve:

- Respecting people
- Treating people with dignity
- Treating people fairly
- Supporting patient’s choices
Intro
 These ‘principles’ are encompassed in the
NMC code
 The code is a useful source of ethical
principles in health care

Definitions of Ethics
The word ethics has Greek roots:
• Ta ethika, referring to philosophical inquiry into
good and evil
• Ethos, meaning personal character
(Burns, 2012)
Definitions of Ethics
A Code of Ethics is an attempt to define basic
rules, or principles for determining what
constitutes "good" or "right" behavior.
Factors Influencing Moral Decisions

In other words, to determine what we ought to do  Moral Framework

next.  Code of Ethics
 Cognitive development - May serve as a basis for the solution to the
problem
- Moral decisions require persons to think and
reason Major Moral Principles

- Reasoning is a cognitive function 1. Autonomy

- Ability to make decisions develops over the - Right to make one’s own decisions
lifespan
- Inward autonomy if individuals have the ability
 Values to make choices
- Outward autonomy if choices are not limited or
- Enduring beliefs or attitudes about the worth of imposed by others
a person, object, idea, or action
2. Nonmaleficence
- May be unspoken or even subconscious
- Duty to do no harm
- Underlie all moral dilemmas
- Harm may intentional or nonintentional
- Influence decisions and actions including
nurses’ ethical decision making 3. Beneficence: Doing good
4. Justice: Fairness

Moral Development 5. Fidelity: Faithful to agreements and

promises
- Process of learning difference between right and
wrong 6. Veracity: Telling the truth

- Begins in childhood and continues throughout

life
Values
- Moral development theories provide frameworks
A. Beliefs
to view and clarify moral and ethical dilemmas
Interpretations or conclusions that people accept
- Learning what ought and ought not to be done
as true
- Complex process that begins in childhood and
Based on faith
continues throughout life
Lasts only briefly
B. Attitudes
Moral Issues
Mental positions or feelings toward a person,
- Arouse conscience
object, or idea
- Concerned with important values and norms
Lasts over time
evoke words such as good, bad, wrong, should
and ought Values Clarification
Process by which people identify, examine, and
develop their own individual values
Moral Principles
No one set of values if right for everyone
- Statements about broad, general, philosophic
concepts Promotes personal growth by fostering
awareness, empathy, and insight
- Provide the foundation for moral rules which are
specific prescriptions for actions  Choosing (cognitive) – beliefs chosen
 Prizing (affective) – chosen beliefs prized
- Useful in ethical discussions
and cherished
- May be able to agree on principles that apply
  Acting (behavioral) – chosen beliefs Issues in the care of HIV/AIDS clients
affirmed to others, incorporated into one’s
Abortions
behavior, and repeated consistently
Organ transplantation
The following steps can help clarify values:
End-of-life decisions
1. List alternatives
Cost-containment issues (resource allocation)
2. Examine possible consequences of
choices Breaches of client confidentiality
3. Choose freely
4. Feel good about the choice Enhancing Ethical Decision-making
5. Affirm the choice Becoming aware of personal values and ethical
aspects of nursing
6. Act on the choice
Becoming familiar with nursing code of ethics
7. Act with a pattern
Seeking continuing education to remain
Ethics
knowledgeable about ethical issues in nursing
Method of inquiry that helps people to understand
Respecting the values, opinions, and
the morality of human behavior
responsibilities of other health care professionals
Practices or beliefs of a certain group
Participating in or establishing ethic rounds
Expected standards of moral behavior of
Serving on institutional ethics committees
particular group
Striving for collaborative practice
Professional Codes of Ethics
Outline the major ethical considerations of the
profession
Provide ethical standards for professional
behavior
Guide the profession in self-regulation
Remind nurses of the special responsibility
assumed when caring for the sick

Purposes of Professional Code of Ethics

To inform the public about the minimum
standards of the profession
To help the public understand professional
nursing conduct
To provide a sign of the profession’s commitment
to the public
Professional code of ethics for Filipino nurses

Something to ponder
Common Ethical Issues
Write your answer in a 1 whole yellow paper
Question 1 3. Beneficence.
When an ethical issue arises, one of the 4. Justice.
most important nursing responsibilities in
Question 4
managing client care situations is which of the
following? Which of the following statements by the
nurse would be most helpful when a nurse is
1. Be able to defend the morality of one’s
assisting clients in clarifying their values?
own actions.
1. “That was not a good decision. Why did
2. Remain neutral and detached when
you think it would work?”
making ethical decisions.
2. “The most important thing is to follow the
3. Ensure that a team is responsible for
plan of care. Did you follow all your
deciding ethical questions.
doctor’s orders?”
4. Follow the client and family wishes
3. “Some people might have made a
exactly.
different decision. What led you to make
Question 2 your decision?”
Which of the following situations is most 4. “If you had asked me, I would have given
clearly a violation of the underlying principles you my opinion about what to do. Now
associated with professional nursing ethics? how do you feel about your choice?”
1. The hospital policy permits use of internal Question 5
fetal monitoring during labor. However,
After recovering from her hip replacement,
there is literature to both support and
an elderly client wants to go home. The family
refute the value of this practice.
wants the client to go to a nursing home. If the
2. When asked about the purpose of a nurse is acting as a client advocate, the nurse
medication, a nurse colleague responds, would perform the following:
“Oh, I never look them up. I just give what
Informs the family that the client has a right to
is prescribed orders.”
decide on her own.
3. The nurses on the unit agree to sponsor a
Ask the primary care provider to discharge the
fund-raising event to support a labor strike
client to home.
proposed by fellow nurses at another
facility. Suggest the client hire a lawyer to protect her
rights.
4. A client reports that he didn’t quite tell the
doctor the truth when asked if he was Help the client and family communicate their
following his therapeutic diet at home. views to each other.
Question 3
Following a motor vehicle crash, the
parents refuse to permit withdrawal of life support
from the child with no apparent brain function.
Although the nurse believes the child should be
allowed to die and organ donation considered,
the nurse supports their decision. Which moral
principle provides the best basis for the nurse’s
actions?
1. Respect for autonomy.
2. Nonmaleficence.
CONFIDENTIALITY
Confidentiality in Documentation
 Documentation of data from health
assessment
 The client record is a legal document
 Confidentiality means that information
sharing
An Issue in ethics
 Individuals shall protect the confidentiality
 Security of records of professional
services provide.
 Access to these records shall be allowed
 Respecting patient confidentiality
 Without the trust that confidentiality brings
 young people might not seek medical care
 they might not tell you
Disclose information that identifies the patient
only if this is necessary to achieve the purpose
of the disclosure – in all other cases you should:
 disclose the information that identifies the
patient only
 Inform the patient about the possible uses
of their information
 ask for the patient’s consent before
disclosing information
 keep disclosures to the minimum
necessary.
Ethical issues - Confidentiality
• Confidentiality is a fundamental ethical
principal in health care
• a breach of confidentiality can be a reason
for disciplinary action.
• Dilemmas around confidentiality
• Issues around confidentiality
• There are also issues of confidentiality for
the ethics committee itself.
• The concept of confidentiality urges you to
keep a secret
• By which we mean knowledge or
information that a person has the right or
obligation to conceal.
• The professional obligation to keep a
secret arises from the fact that harm will
almost certainly follow if the information is
revealed.
Three Types of Secrets
 Natural secret: information which, if
revealed, is harmful by its nature.
 Promised secret: information that we
have promised to conceal which, if
broken, leads to public mistrust.
 Professional secret: knowledge which, if
revealed, will harm the client,
: The most serious of all secrets, because
its violation can cause the greatest harm.
TRUTHFULNESS
Truth is a quality of being TRUE and are
real FACTS about a situation, event, or a
person.
-Cambridge Dictionary
In a Society, Truth is the foundation for
fairness and just. ‘the truth, the whole truth
and nothing but the truth’
Truthfulness is about telling the truth to
someone who has the right to know the
truth.
The concept of truthfulness urges the
professional not to lie.
There are two aspects of truthfulness:
1. Being true to yourself
As individuals, being truthful means that
we can grow and mature, learning from our
mistakes.
2. Being true to others.
For society, truthfulness makes social
bonds, and lying and hypocrisy break them.
Effects to Truthful People
1. Understand themselves, and know their
own strengths and weaknesses. They will
not delude themselves about their
successes or failures;
2. Present themselves in a way that shows
who they really are. Their reputation will
be founded on what they are and, whether
in public or private, they will be the same;
3. Meet any commitments or promises that
they make;
4. Be accurate in their descriptions of
themselves or others, so that they do not
mislead others.
There are two possible ways not to tell the
truth:
1. Not to provide any information
2. To provide false information.
“Silence is the best policy”
 Being truthful to yourself matters
because you cannot live in line with your
values if you are pretending to yourself
that you are something else.
 Truthfulness allows you to be honest
about yourself to yourself, and to others,
and to live a life which reflects that
 Honesty is imperative in all professions,
however it is particularly significant for
individuals with nursing occupations, as
they are much of the time required to deal
with sensitive materials, manage patients
in troublesome circumstances and depend
intently on their co-workers.
 Truth be told, as indicated by an ongoing
Gallup survey, Nurses indeed earned the
best spot as far as expert trustworthiness
and ethical standards. This is just the
same old thing new, as nurses have set
first on the rundown consistently since
1999.
 If an error is made in the hospital, the best
approach to managing the consequences
of the error and minimizing anything
untoward is to identify that an error, in
fact, has occurred. If someone attempts to
“cover up” the error due to fear of
retribution (or for any other reason), there
is high probability that the outcome for the
patient will be worse. The ethical and
trustworthy approach is to directly address
the error, keeping in mind that it is most
important to attend to the health of the
patient. Developing trusting relationships
within the health care environment will be
conducive to honesty and
straightforwardness in regard to health
care practices." Adding up spice to the
problem won't solve any issues. It's a
must that for every problem, a solution
must be done and therefore not to hide
the problem that could've worsen the
situation.
 Nursing occupations depend intensely on
collaboration among partners. Over the
years, this guarantees you will get the
assistance you require when there's no
other option and that you can depend on
your collaborators to put forth a
collaborative effort. Nurses are known for
their high level of integrity.
 (from notes)

Ethics in Nursing

1. Virtue Ethics
2. Natural Law Theory
3. Deontology
4. Utilitarian
5. Ethic of Care
6. Ethical Principlism
Composed of:
- Nonmaleficence
- Autonomy
- Justice
- Maleficence
7. Bioethics

Approached to Ethics
1. Normative Ethics: Norms
2. Descriptive Ethics: What the society dictates
3. Metaethics: Logical/Scientific