ethical issues nml

7/29/2019 Ethical Issues NML

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TYPES OF ETHICAL DILEMMAS



• 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.



• 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



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



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.



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.



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.



“ 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)



“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?”



ETHICAL APPROACHES

The Wueste approach to Ethical Problem Solving

Uses three-pronged approach to ethical decisionmaking: CONSEQUENTIAL ETHICS,

DEONTOLOGICAL ETHICS, ASPIRATIONAL ETHICS



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.



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.



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



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



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



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



ADDRESSING ETHICAL ISSUES



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.



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



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.

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