Ethical IssuesPROFESSIONALISM IN FAITH COMMUNITY NURSING

Objectives: - Identify ethical issues in Faith Community Nursing practice. - Discuss the elements of ethical-decision making. - Apply ethical decision-making to faith community nursing

practice situations that involve ethical issues.

Ethical Issues

What is an ethical issue?I. Definitions:

1. An issue is a matter in dispute2. An ethical issue is a matter in dispute because

of a conflict of moral valuesa) Resolutions needs ethical deliberation

and/or ethical decision-makingb) Ethical issues are often controversial topics,

value-laden

3

Ethical Issues

3. An ethical issue is NOT an ethical dilemma or a situation of ethical uncertainty, or a situation of ethical distress.a) Ethical issue – situation where 2 equal course of

action/judgment, person uncertain which to pursueb) Ethical uncertainty – ethical dimension of the

situation are uncertain or unknown & unclear which moral values and ethical principles should be applied

c) Ethical dilemma – moral values are known, ethical principles are known, action has been decided, however, constraint prevents action

Values◦ Definition – Values are worthwhile standards or qualities of a

person or a social group.◦ Values come from many sources – culture, family, peer group,

work, religious beliefs, education, etc.◦ Values are expressed in language or in standards of conduct that

a person endorses.◦ Values represent a person’s set of beliefs about they believe to

be true.

How do our values influence us?

Some values are more important to us than others.◦ We organize our values into some system of

prioritization of importance to us◦ Some values get prioritized higher with our value

system◦ Our value system is fairly stable, over time, but the

system changes as a result of life experiences and reassessment of one’s values

Values have motivational power

◦ They guide a person’s choices.◦ Our choices, actions and judgments often protect our values.◦ The position we take on controversial issues is usually motivated

by our values.◦ Understanding one’s values is the first step in preparing to make

ethical decisions.

Value Classifications◦ Moral values◦ Non-moral values◦ Cultural Values◦ Religious Values◦ Professional Values◦ Personal Values

Values in FCN practice?◦ Conflicts of values…

◦ End-of-life decisions◦ Termination of treatment◦ Deciding who should be proxy decision makers

◦ Protecting of values…◦ Deciding when it is no longer safe for elderly parishioners to live at home◦ Protecting parishioner confidentiality◦ Protecting good will◦ Balancing ‘doing good’ vs. ‘doing harm’◦ Unintended pregnancy◦ Assisted reproduction practices

Values in FCN practice◦ Justice and equality…

◦ Access to treatment or health care◦ Developing outreach to homeless◦ Treatment of LGBT parishioners◦ Treatment of HIV or AIDS parishioners

Ethical Principles:◦ Beneficence◦ Nonmaleficence◦ Justice◦ Autonomy◦ Veracity◦ Fidelity◦ The sanctity of human life

Elements of Ethical Decision Making:

Knowledge of personal values and beliefs:◦ Understand the nature of values and values conflict◦ Identify personal values and their origins

Knowledge of ethical principles:◦ Principles are guides to decision to take ethical action◦ Justify and provide sound moral reasons

Elements of Ethical Decision Making:

Knowledge of ethical concepts of nursing:Advocacy – speaking on behalf of or helping the patient discuss needs, interests, choices

Accountability – being answerable to someone for something one has done in a particular role.

Cooperation - active participation, collaboration and reciprocity with others to obtain or to achieve something.

Caring – involvement with another that expresses concern about how they are experiencing their world.

Nursing Code of Ethics◦ Defined as “a conventionalized set of rules or expectations devised for a

select purpose”

◦ International Council of Nurses

◦ Almost all codes of ethics for nurses in the world agree on:◦ Practice competence◦ Protection of patient confidentiality◦ Nondiscrimination of patients◦ Ethical accountability of the nurse

Standards for ethical decisions:◦ Know church teaching/faith beliefs◦ Know FC position on ethical issues◦ Recognize congregants face decision that may conflict with faith teachings

◦ Know what your role is:◦ Support and inform parishioners, provide the church’s presence at difficult

times

◦ FC/PN role is helped when:◦ Know your own faith beliefs◦ Acknowledge where own faith beliefs differ from the faith community served,

seek counsel & guidance from faith leader, know when to remove yourself from a situation

Integration of knowledge is necessary to begin ethical analysis and make ethical decisions.

Knowledge of personal values &

beliefs

Knowledge of ethical principles

Knowledge of ethical concepts of

nursing

Knowledge of ethical standards

for nursing practice

Ethical Analysis & Ethical Decision

making

Ethical Analysis: One Method 1. What is the “story” behind the value conflicts?

◦ Discover how the conflicts are described by the parties experiencing the conflict:◦ Each of the parties describes the factual info (who did what)◦ Each of the parties describes their values (why the situation is seen as an

ethical problem)◦ Each of the parties describes the conflicts of values they perceive

2. Clarify the conflicts and the values involved:◦ The context within which the conflict arose◦ Interpretation of the conflicts and values involved

3. Identify the moral values involved and where they conflict with other values.

Ethical Analysis4. What is the significance of the values involved?

◦ Explore the meaning of values held, examine their values and values of others so negotiations can begin.

◦ Identify the potential cultural, religious, personal, professional, and political origins of values◦ Respect each other values◦ Prioritize & preserve values

The FC/PN should ask:◦ What does it mean to care for this patient?◦ What are my nursing responsibilities to this patient?◦ What are my FCN responsibilities to this patient?◦ Are there any legal questions that might need to be explored by a legal

representative?◦ How do I, as a FCN maintain my ethical integrity in this situation?

Ethical Analysis

5. What is the significance of this conflict to the parties involved?◦ Identify how the parties involved relate their values to the present situation.

◦ Values are never static; they are dynamic in that they change over time◦ Value conflicts do not occur in a vacuum

◦ Consider that the conflict of values might lead to a decision that affects several of the parties involved:◦ The quality of the patients life◦ How long the patient may live◦ The amount of guilt that others might experience◦ Emotional and psychological stress might experience.

◦ Consider that the conflict of values might lead to the formulation of policy:◦ May prevent similar value conflicts◦ Significance to health professionals

Ethical Analysis6. What should be done?

◦ Explore all the ways in which the conflict might be resolved – consensus “the right thing”

◦ Recognize that there is seldom an “ethically correct” solution

Ethical decisions are usually made based on:◦ Relevant info available◦ Moral weight of values◦ Best judgment of decision maker◦ Ethical stance of group

Explore all options in light of:◦Values held◦Potential outcomes◦Perceived moral rightness/wrongness

Ethical Analysis◦ Choose a course of action based on:

◦ Decision maker’s best judgment◦ Consideration of context of values conflict◦ Consideration of values◦ Consideration of ethical relevance

◦ Assess the outcome of the situation & process that led to decision◦ Ethical analysis improved◦ Implication of ethical action implemented

Analysis◦ Recognize same/similar value conflicts may recur

◦ Result of similar value conflicts or cultural backgrounds ◦ Result of personal or professional values of RN◦ Require policy recommendations◦ Require information of professional standards & position statements

◦ Other considerations include:◦ Others may have different value system◦ Be mindful of your influence with another person or a family◦ Family members may have conflicting motives/feelings/religious beliefs◦ Some situation may require interventions by faith leaders, ethics committee,

or ethicist◦ Complexity of value conflicts may increase when dealing with issues at the

community or congregational level

Evaluation of Learning:

Case Study Work/Discussion: Engage in small group discussions in projects forum with your teammate of the simulated situations involving conflicts of value. Use ethical analysis method you learned this week to understand the value conflicts. Propose ethical actions that the faith community nurse would implement in the case using a knowledge of ethical principles, ethical concepts of nursing, and ethical standards for nursing practice.