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1Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 8
Ethical Issues in Patient Care
2Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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
3Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
Bioethics
Ethics specific to health care
4Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
Common Ethical Principles and Their Rules
5Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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.
6Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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.”
7Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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.
8Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
Fidelity
Duty to keep one’s word. Senior leaders adhering to all contracts is an
example of leadership fidelity.
9Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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
10Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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
11Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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.
12Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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.
13Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
14Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
End-Of-Life Issues
Advanced Directive Living Will DNR
15Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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
16Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
Organ Donation List
Skin Corneas Bone Kidney Heart Liver Pancreas Lung
17Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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
18Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
19Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
20Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.
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