Transcript Health care ethics

Foundations in Evidence Based
Practice
 Introduction to Ethics
Introduction to ethics
 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
Introduction to ethics
 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?
 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
Achievement of practice outcomes includes
consideration of ethical issues
Domain 1 Professional and Ethical Practice
1.3 Demonstrate an awareness of, and apply ethical principles to, nursing
practice.
Outcomes:
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1.3.1 Demonstrate respect for patient and client confidentiality
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THIS OUTCOME IS ONLY ABOUT CONFIDENTIALITY. IT IS NOT ABOUT
HOW YOU RESPECT PATIENTS GENERALLY
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1.3.2 Identify ethical issues in day to day practice
What is an ‘ethical issue’?
 When you have to judge what is right or wrong
 Choosing between options
 Deciding whether to do something or do nothing
 Should I or shouldn’t I?
 Weighing up the potential impact of your decisions or actions
 A dilemma – making a difficult choice
Ethical issues in health
care
 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:
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Respecting people
Treating people with dignity
Treating people fairly
Supporting patient’s choices
 These ‘principles’ are encompassed in the NMC code
 The code is a useful source of ethical principles in health care
Another source of ideas in
health care ethics
 Principles of Biomedical Ethics (Beauchamp
and Childress, 2001)
They discuss:
 4 key principles
 supplemented by 4 rules
4 Key Ethical Principles
 autonomy
 beneficence
 non-maleficence
 justice
Autonomy
 Respect a person’s right to make their own decisions
 Teach people to be able to make their own choices
 Support people in their individual choices
 Do not force or coerce people to do things
 ‘Informed Consent’ is an important outcome of this principle
Beneficence (to do good)
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Our actions must aim to ‘benefit’ people – health, welfare, comfort, wellbeing, improve a person’s potential, improve quality of life
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‘Benefit’ should be defined by the person themselves. It’s not what we think
that is important.
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Act on behalf of ‘vulnerable’ people to protect their rights
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Prevent harm
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Create a safe and supportive environment
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Help people in crises
Non – maleficence (to do no
harm)
 do not to inflict harm on people
 do not cause pain or suffering
 do not incapacitate
 do not cause offence
 do not deprive people
 do not kill
 Both Beneficence and Non-maleficence underpin EBP
Justice
 Treating people fairly
 Not favouring some individuals/groups over others
 Acting in a non–discriminatory / non-prejudicial way
 Respect for peoples rights
 Respect for the law
Justice
Distributive Justice – sharing the scarce resources in society in a fair and
just manner (e.g. health services, professional time)
 How should we share out healthcare resources?
 How do we share out our time with patients?
 Deciding how to do this raises some difficult questions
Patients should get…..
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an equal share ?
just enough to meet their needs ?
what they deserve ?
what they can pay for ?
4 ethical rules
 Veracity – truth telling, informed consent, respect for
autonomy
 Privacy – a persons right to remain private, to not
disclose information
 Confidentiality – only sharing private information on a
‘need to know basis’
 Fidelity – loyalty, maintaining the duty to care for all no
matter who they are or what they may have done
Ethics
2 broad philosophical theories
 1) consequentialism – taking the
consequences of our actions into
consideration
 2) deontology – basing our actions on a set of
principles or duties
Consequentialism
 Actions are right or wrong according to the balance of
their good and bad consequences
 the right act is the one that produces the best overall
result
 Utilitarianism (what action has the greatest utility -
use/benefit/positive outcome) is a type of
consequentialism
Utilitarianism
 most prominent consequence-based theory
 based on the principle of utility
 actions ought to produce the maximal balance of positive
value (e.g. happiness) over disvalue (e.g. harm)
Deontology
 Duty or principle based theory
 An act is right if it conforms to an overriding moral duty
For example – do not tell lies, do not kill.
 E.g. Christian ethics – The Ten Commandments
But Christian ethics are not important for some people in the world
so moral duties vary between cultures and societies
 A moral duty or principle is one that is:
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laid down by god / supremely rational being
or is in accordance with reason / rationality
or would be agreed by all rational beings
 The NMC Code of Conduct is a product of Deontological ethics – it
guides action based on a set of principles/duties.
References
Beauchamp T and Childress J (2001) Principles of Biomedical Ethics 5th
Edition Oxford University Press
Hunt G (1994) Ethical Issues in Nursing Routledge. London
Seedhouse D (1998) Ethics the heart of Health Care Wiley. Winchester.
Watt H (2000) Life and Death in Health Care Ethics Routledge. London
http://www.iep.utm.edu/e/ethics.htm#SH2a
http://www.nursingethics.ca/articles.html
http://www.freedomtocare.org/iane.htm
http://www.lib.flinders.edu.au/resources/sub/healthsci/azlist/ethics.html