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1-which of the following behaviors may be (1) ethical but illegal, (2) legal but unethical, (3) illegal and unethical, and (4) legal and ethical.A. Working in a clinic that performs abortionsb. Respecting the wishes of a client suffering from ALS that he be permitted to die with dignity and not placed on “breathing machines”c. Respecting the health surrogate’s wishes regarding termination of life support of her friendd. Observing a coworker take out two tablets of oxycodone as ordered for pain management for his patient but keeping one for himself, administering only one tablet to the patient.2-differentiate among the following: deontological theories, utilitarianism, and principlism.3-what do you think about health-care professionals disclosing information to clients about a poor prognosis, even though the information may cause severe distress.4-What do they think about health-care professionals disclosing information to clients against family wishes?5. You see a colleague use another nurse’s password to access the medication administration system and take out a narcotic. What would you do?6.Your colleague’s child fell and was brought to the emergency department. She comes back up to the unit and tells you that they cleaned and debrided the wound, and she needs to change the dressings twice a day using a wet to dry method. You see her go into the supply system and remove the dressings and saline using a patient’s identification number. What would you do?7. You are caring for a patient who has a terminal disease. He asks you if he is dying. Would you tell him? If yes, how? If no, what might you say? .8-You are administering hydromorphone to a patient. The patient asks you what you are administering. Would you tell the patient about the medication?
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Chapter 4
Questions of Values and
Ethics
Copyright © 2015. F.A. Davis Company
Introduction
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In the Beginning…




There were no antibiotics.
There were no ICUs.
There were no CT scanners or 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 the ICU.
• New biomedical developments
• Advances in surgical techniques, such as open
heart surgery
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New Questions
• The advances created new questions for
health-care professionals regarding the use of
technology.
• The concepts of life and death
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Bioethics
• A subdiscipline of ethics
• The study of medical morality
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Concepts of Ethics
• Values
• Belief systems
• Morality
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Value Systems





A set of related values
Intrinsic values
Extrinsic values
Personal values
Professional values
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Value Formation
• Values are learned.
• Values change with maturity and experience.
• The number of values an individual holds is not
as important as what values he or she consider
important.
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Values Clarification
• Choosing
• Prizing
• Acting
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Belief Systems
• These are organized ways of thinking about why
people exist within the universe.
• Their purpose is to explain such concepts as
– Life and death
– Good and evil
– Health and illness
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Ethics and Morals
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Morals
• Morals are an individual’s own code for
acceptable behavior.
• They arise from an individual’s conscience.
• They act as a guide for individual behavior.
• They are learned.
Copyright © 2015. F.A. Davis Company
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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Ethical Theories
• Deontological
• Teleological
• Principalism
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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.
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Nonmaleficence
• Requires that no harm be caused to an individual,
either unintentionally or deliberately.
• 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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Fidelity
• Loyalty
• The promise to fulfill all commitments
• The basis of accountability
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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 indicate harm to themselves or others
– If the clients give 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.
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Virtue Ethics
• Focus on virtues or moral character.
• View helping others as charitable or benevolent.
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Organizational Ethics
• Focus on the workplace.
• Ethical culture makes a difference.
• Senior leadership must promote an ethical culture.
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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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Resolving Ethical Dilemmas
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Using the Nursing Process




Assessment
Planning
Implementation
Evaluation
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Approach to Ethical Dilemmas
Approach
Assessment
Planning
Implementation
Evaluation
Am I involved?
Determine goals
of treatment.
Work toward
a mutually
acceptable
decision.
Determine
whether desired
outcomes have
been reached.
Collect the
facts.
Identify
decision makers.
Use of
discussion and
negotiation.
Re-evaluate
as necessary.
What values
are in conflict?
List and rank
the options.
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Current Ethical Issues
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Issues to Consider





Assisted suicide
Technology issues
Gene therapies
“Designer babies”
Organizational climate
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Conclusion
• An issue is not an ethical issue for the nurse unless
he or she has been asked.
• Always gather the facts prior to decision making.
• Consider your personal beliefs and values.
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