Transcript Clinical Ethical Issues - Kerman Medical University

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Clinical Ethical Issues
Many of our ethical issues arise when dealing
with the:
-Beginning of human life
-End of human life
-Use of technology but there are other ethical.
Often they are viewed as clinical problems but
not ethical problems.
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‫مسائل اخالقی بالین‬
‫وقتی که پرستاری با ‪ 8‬بیمار بدحال کار می کند ”وقت وتالش‬
‫کاری خود“راچگونه تقسیم می کند؟‬
‫وقتی که می بینید همکارتان دربخش یک کار غیراخالقی انجام داده‬
‫چه باید بکنید؟‬
‫بیماری درگیربیماری العالج است وخانواده قراراست به اونگویند‪.‬‬
‫اگربیمارازوضعیت سالمتی خودازشما پرسید چه جوابی خواهیدداد؟‬
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‫مسائل اخالقی بالین‬
‫اصال دروغ گفتن به بیمار کار اخالقی هست؟ آیا دارونما یک‬‫دروغ است؟‬
‫ازنظراخالقی‪ ,‬پرستاری که بیماری رادوست نداردوواقعا نمی‬‫تواند به اوخدماتی ارائه دهد چه باید بکند؟‬
‫آیا بیماربایددر تصمیم گیری درمانی خوددرگیربشود؟ اگربیمار‬‫نوجوان باشد؟ اگر مسن باشد؟ اگرناتوان ذهنی باشد؟‬
‫آیاپرستاربایددستورپزشکی بیماری که می داند این دستور خطر‬‫بالقوه ای برای بیماردارد اجراکند؟‬
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Two ethical principles are Do No Harm and Do Good.
What do we mean by Harm and Good?
Health professionals have 2 basic ethical obligations:
-To extend life
-To lessen pain and suffering (do no harm).
Can they do both in this situation when morphine
may shorten patient’s life?
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In the beginning…
There were no antibiotics
There were no ICUs
There were no CT scanners and MRIs
There were just physicians and nurses who
cared for people in sickness and in health
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1960s
Technological advances allowed for the
development of intensive care units
New biomedical developments
Advances in surgical techniques, such as open
heart surgery
The advances created new questions for healthcare professionals
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Ethics
Ethics deals with the “rightness” or “wrongness”
of human behavior
Concerned with the motivation behind the
behavior
Bioethics is the application of these principles to
life-and-death issues
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Morals
An individual’s own code for acceptable behavior
They arise from an individual’s conscience
They act as a guide for individual behavior
Learned
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Ethical Principles
Autonomy
Nonmaleficence
Beneficence
Justice
Fidelity
Confidentiality
Veracity
Accountability
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Autonomy
The freedom to make decisions about oneself
Nurses need to respect clients’ rights to make
choices about health care.
Best medical interests
‫مخالف‬
Best interests
More to well-being than medical well being
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Who is autonomous ?
Understand + Form Values + Make Decisions
2 year old
80 year old
with dementia
Drunk
80 year old
You
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Respecting autonomy
 Respecting autonomy means enabling
patients to make autonomous choices:
oReasonable choices
oAdequate information
oClear explanation
oTime to consider options
oNot unduly pressurising
oBeing non-judgemental
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Nonmaleficence
Requires that no harm be caused to an individual,
either unintentionally or deliberately.
This principle requires nurses to protect individuals
who are unable to protect themselves.
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Beneficence
This principle means “doing good” for others.
Nurses need to assist clients in meeting all
their needs:
Biological
Psychological
Social
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Justice
Every individual must be treated equally
This requires nurses to be nonjudgmental
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Principles of distributive justice
(Beauchamp and Childress 2001)
To each person to:
1- Equal share
4-Societal contribution
2-Individual need
5-Merit
3-Individual effort
6-Free market exchanges
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Continually increasing health care costs
‫هزینه های سالمت ودرمان بطورمدام افزایش می یابدکه باید درنحوه‬
:‫اجرای عدالت بهداشت ودرمان وپرداخت پرسنل لحاظ شود‬
population increase
ageing population
increase demand for healthcare
new technologies, new procedures
personnel and other resources
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‫‪Issues of Justice‬‬
‫‪ -1‬وقتی که خدمات وامکانات ادامه حیات(تخت‪ ,‬دارو‪ ,‬اتاق‬
‫عمل‪ ,‬تجهیزات و‪ )...‬محدود است چه کسی باید این امکانات‬
‫رادریافت کند؟‬
‫‪ -2‬آیا پول خرج کردن برای بیماری که مرگ قریب الوقوع‬
‫دارد صحیح است؟ تاچه حدباید خرج اوکرد؟‬
‫‪ -3‬بهترین حالت نفع شخصی وعمومی کدام است؟‬
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Fidelity
Loyalty
The promise to fulfill all commitments
The basis of accountability
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Dignity: a Human Right?
Freedom from
degrading treatment
The right to life
Freedom of thought,
conscience and religion
Freedom of
The right to
expression
liberty
The right not to be discriminated
against in any of these
rights or freedoms
The right to
The right to
respect for
peaceful enjoyment
private and family life
of your property
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Confidentiality
Anything stated to nurses or health-care providers
by clients must remain confidential
The only times this principle may be violated are:
- If clients may indicate harm to themselves or others
- If the client gives permission for the information to
be shared
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Veracity
This principle implies “truthfulness”
Nurses need to be truthful to their clients
Veracity is an important component of
building trusting relationships
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Accountability
Individuals need to be responsible for their own
actions.
Nurses are accountable to themselves and to
their colleagues.
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Ethical Codes
These are formal statements of the rules of
behavior for a particular group of individuals.
Ethical codes are dynamic.
Most professions have a “code of ethics” to guide
professional behavior.
The Code of Ethics for Nurses. Why have a code?
What does it say? What purpose does it serve?
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• ICN code for nurses was formed in 1933.
• While the international code of nursing ethics
accepted in 1953.
• In 1973 the new ICN code of ethics was approved. It
identifies four major responsibilities of the nurse:
• Promote health.
• Prevent illness.
• Restore health.
• Alleviate suffering.
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Ethical Dilemmas
Occur when a problem exists between ethical
principles.
Deciding in favor of one principle usually
violates another.
Both sides have “goodness” and “badness”
associated with them.
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Ethical Dilemmas
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Dilemma Resolution
• Nursing
Process
• MORAL
Model
• Ethics
Committees
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‫رضايت نامه و برائت نامه‬
‫يعني امضاء مدركي كه بيمار قبل از تن دادن به هرگونه درماني از كليه‬
‫خطرات عمل ‪ ،‬راههاي درماني و جايگزين و خطرات آن توسط پزشك‬
‫آگاهي يابد‪(.‬تلویحی‪ ,‬اظهاری‪,‬رضایت درمواردخاص)‪.‬‬
‫برائت يعني چنانچه بيمار در طي درمان دچار عوارض يا نقص عضوي‬
‫گرديد ‪ ،‬پزشك در صورتيكه بر اساس موازين فني و علمي اقدام كرده‬
‫باشد مقصر نيست‬
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‫اگر پزشک فقط رضایت گرفته باشد‪ ،‬در صورت بروز مرگ‪ ،‬نقص‬
‫عضو یا خسارت مالی‪ ،‬ضامن است ولی اکر برائت نیز تحصیل کرده‬
‫باشد‪ ،‬عهده دار خسارت پدید آمده نیست‪.‬‬
‫فقط اصل برائت است که موجب سقوط ضمان می شود‪ .‬البته در‬
‫صورت قصور پزشکی‪ ،‬برائتی که قبل از درمان گرفته شده‪ ،‬باعث‬
‫سقوط ضمان نیست‪.‬‬
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Healthcare and Ethics
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IT’S NOT ROCKET SCIENCE?
• OR IS IT?
What do you do to
ensure dignity in care?
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Barriers to Patient Satisfaction
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Wait Times
Overcrowding
Interruptions of caring
Consultants
Radiology &Laboratory…
Patient expects something from you
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Common Patient Complaints
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Too little time for patient interaction
Does not listen
Does not explain well
Shows no sympathy
Does not understand
Incompetent
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Demographics affecting satisfaction
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Age—older pts more satisfied
Ethnicity—minorities less satisfied
Gender—females less satisfied
Socioecominc—lower socioecomic less
satisfied
• Heath status—Chronic illness less satisfied
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Increasing Patient Satisfaction
• Greet the patient with a hand shake & a
smile
• TALK to your patient, not at them
• Listen to what they have to say
• Give them the opportunity to ask
questions
• Don’t be afraid to apologize & tell patient
why they had to wait for x, y, z.
• Listen to your support staff
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How can you affect satisfaction?
• COMMUNICATE
• Utilize as well as listen to Patient
Advocates
• Put yourself in the patient’s shoes
• positive patient interaction
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The Communication Circle
MESSAGE
Source
NOISE
Receiver
FEEDBACK
The communication cycle involves an exchange of messages
through verbal and nonverbal means.
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