Moral/ Ethical Problems

Making Decision

*ETHICAL DECISION MAKING

*Objectives

*Describe and differentiate ethical dilemmas, moral uncertainty, practical dilemmas and moral distress

*Describe the process of making thoughtful decisions

*PROBLEM

*Discrepancy between the current situation and a desired state.

*Unplanned and Unexpected.

*Simple or complex, routine or moral.

ROUTINE* Involves how and when to do

something, which item to choose, who to assign to task.

* There is considerable focus on preference, economy and efficiancy.

* Usually find the resolution to the routine problem.

* Important from a personal or business standpoint but have little moral focus.

MORAL*Human stories that we

describe with value terms

*Complex and dynamic with elements of uncertainty and conflict.

* Important and defy easy solution

*They are irreversible

*PROBLEM

* Different Types of Moral Problems

*Moral Uncertainty

*Moral Dilemmas

*Practical Dilemmas

*Moral Distress

*Something is not quite right

*Unconfortable with the situation but can’t figure out the problem.

*Moral UNCERTAINTY

*Moral DILEMMAS

*DILEMMA

*Problem that requires CHOICE between two options that are EQUALLY UNFAVORABLE AND MUTUALLY EXCLUSIVE.

*Two options include conflicting moral claims

*Defy a satisfactory solution

*Moral DILEMMAS

*Present in two ways:

*According to Beauchamp and Childress: Conflict can be experienced when there is a evidenced to indicate that a certain act is morally right and evidenced to indicate that the act is morally wrong, but no evidence is conclusive.

*Example: terminal ill patient

*Morally right= preserve life

*Morally wrong= prolong suffering

*Moral DILEMMAS

*When the agent believes that one or more moral norms exist to support one course of action and one or more moral norms exist to support another course of action and the two actions is mutually exclusive.

*PRACTICAL dilemmas

*Moral claims compete with nonmoral claims.

*PRACTICAL dilemmas

*Nurse who must work overtime caring for gravely ill patient. The nurse perceive dilemma because she promise to take her children to circus.

Self interestMoral claims

NURSEDuty to care for pt (MORAL CLAIM)

Duty to the children (NONMORAL CLAIM)

*What is moral DISTRESS?

*Moral Distress

*DISTRESS

*To afflict with pain, anxiety, sorrow, trouble or worry

*“Moral distress arises when one knows the right thing to do, but institutional obstacles make it nearly impossible to pursue the right course of action” (Jameton, 1984,p.6).*Institutional obstacle: Time constraints, lack of

supervisory support, imbalance of power bet physicians and nurses, institutional policy or legal limitation.

*Moral Distress

*“ The psychological disequilibrium and negative feeling state experienced when a person makes a moral decision but does not follow through by performing the moral behavior indicated by that situation” (Wilkinson 1987-88, p.16).

*“ Moral distress is the disturbing emotional response which arises when one is required to act in a manner which violets personal beliefs and values about right and wrong” (Fenton, 1988, p.8).

*Moral distress causes…..

Moral distress can cause the following problems in the work environment: Poor communication Lack of trust Defensiveness Lack of collaboration High turnover rates

The impact on nursing practice could include any or all of the following: Physically withdrawing from bedside care Loss of the capacity to care Avoiding patient contact Failure to give good physical care Leaving the profession

Create a sense of mystery and add to the complexity of ethical problems.

*INTERVENING FACTORS

* INTERVENING FACTORS

*UNCERTAINTYLack of predictability because of insufficient evidence.

*CONTEXTPerson’s unique life circumtances

*MULTIPLE STAKEHOLDERSStakeholders are those people affected by a decision.

*POWER OF IMBALANCE

*INTERVENING FACTORS

*EXTRANEOUS VARIABLES

*OTHER RELEVANT CASESConsidered instituional policy, professional standards and law when making decisions

*URGENCYWhen death is rapidly imminent.

*Making Decision

*Four basic features constitute in every type

of decision

1. Problem must exist.

2. There must be at least two alternative solution from which to choose.

3. Every action implies uncertainty.

4. Every implemented decision, combined with the uncertainties, brings about an outcome.

Goal: move the current situation to a desired state.

*Positive Attribute of an

Affective Ethical Decision Maker

*Positive Attribute of an Affective Ethical Decision

Maker

*Moral Integrity*Binds all of a person’s moral virtues into coherent packages- it creates a wholeness and stability of character that leads to trustworthiness.

*Beauchamp and Childress describe intergity as “ soundness, reliability, wholeness and integration of moral character”.

*Sensitivity, compassion and caring*Nurse work intimately with the patients-they hear what the patient say and the meaning

*Positive Attribute of an Affective Ethical Decision Maker

*Responsibility*Has a sense of duty of the patient, an obligation to

do whatever is necessary, within reason to care for the patient or solve the problem.

*Empowerment*Capacity of people to be active participants in

matters that affect them

*Patience and willingness to deliberate*Nurse should provide safe environment and gently

assist the patient, families, colleagues as they work through the ethical decision making.

*MAKING DECISIONS

1.Recognizing a problem

2.Gathering data

3.Comparing options

4.Making a choice