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Chapter 8

Ethical Issues in Patient Care

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Ethics

Science that deals with the principles of right and wrong and of good and bad, and governs our relationships with others

It is based on personal beliefs and values

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Bioethics

Ethics specific to health care

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Common Ethical Principles and Their Rules

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Beneficence

Duty to do good to others. To maintain a balance between benefits and harm; to

provide all patients, including terminally ill, with caring attention; and to treat every patient with respect and courtesy.

Requires that care providers contribute to the health and welfare of the patient and not merely attempt to avoid harm to the patient or client.

An example is carefully adhering to infection control principles for all patients.

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Nonmaleficence

Principle of doing no harm Observe safety rules and precautions and

keep skills up to date Prohibits deliberate harm Demands weighing risks with the benefits of

treatment Nurses who maintain their skills are practicing

the principle of “doing no harm.”

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Autonomy

Respect for individual liberty and the person’s right to self-determination.

Informed consent is an example of adherence to the principle of autonomy.

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Fidelity

Duty to keep one’s word. Senior leaders adhering to all contracts is an

example of leadership fidelity.

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Veracity

Obligation to tell the truth As a professional, this would be a

requirement to admit mistakes promptly or to not lie to a patient about bad news

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Respect for Others

Right of people to make their own decisions Such as not telling a patient what he “should do”

but allowing him to make his own decision

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Justice

Principle of fairness in which an individual receives what is due, owed, or legitimately claimed

Treat all parties equally, regardless of economic or social background

Requires that individuals be given what they deserve or can legitimately claim

All patients receiving the same level of culturally competent care is an example.

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Ethical Dilemma

Ethical decision making is required when there is an ethical dilemma.

Ethical dilemmas occur when there is a conflict between two or more ethical principles.

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End-Of-Life Issues

Advanced Directive Living Will DNR

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Organ Donation

A personal choice – can be declared and posted on driver’s license

At the time of death, family members may not be in agreement

There is no cost to the donor family Many religions have specific views on

whether organ donation and transplantation is acceptable

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Organ Donation List

Skin Corneas Bone Kidney Heart Liver Pancreas Lung

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Organizational Ethics

Each nursing unit should set an ethical tone and guarantee that all patient rights are respected

Managers must practice ethical leadership The rights of staff must be protected There must be a professional work environment Staff members must be able to work in an

environment where they are free to report issues of concern

Hospitals have created departments of corporate compliance to oversee the reporting, documentation, and continued improvement of areas of organizational ethical concern

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Institutional Review Board (IRB)

A panel that is formally designated to approve, monitor, and review biomedical and behavioral research involving humans in order to protect the rights and welfare of the subjects

Performs oversight for research conducted on human subjects that are scientific and ethical