Download - ethics.ppt
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Foundations in Evidence Based Practice
Introduction to Ethics
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Introduction to ethicsOur care for patients should be based on sound judgement
(or evidence based practice!!)
..some of this judgement is about having a strong sense of what is right or wrong
..having a strong sense of what we should be doing and shouldnt be doing as nurses
..having a strong sense of what our priorities ought to be
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Introduction to ethicsNurses frequently have to make difficult decisions for which there is not always a quick, easy or correct answere.g. Can Mrs X be discharged yet? Can Mr Y manage his own medications safely?
Nevertheless, nurses still have to be able to explain and account for these decisions and actions
The NMC Code can act as a guideThis can be seen as a code of ethics a set of important principles to help guide nurses
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Achievement of practice outcomes includes consideration of ethical issuesDomain 1 Professional and Ethical Practice
1.3 Demonstrate an awareness of, and apply ethical principles to, nursing practice.
Outcomes:
1.3.1 Demonstrate respect for patient and client confidentiality
THIS OUTCOME IS ONLY ABOUT CONFIDENTIALITY. IT IS NOT ABOUT HOW YOU RESPECT PATIENTS GENERALLY
1.3.2 Identify ethical issues in day to day practice
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What is an ethical issue?When you have to judge what is right or wrong
Choosing between options
Deciding whether to do something or do nothing
Should I or shouldnt I?
Weighing up the potential impact of your decisions or actions
A dilemma making a difficult choice
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Ethical issues in health careWe usually think of the big issuese.g. definition of life, what is a person, quality of life, prolonging life, ending life, human rights.
But day to day ethical issues can involve:Respecting peopleTreating people with dignityTreating people fairlySupporting patients choices
These principles are encompassed in the NMC code
The code is a useful source of ethical principles in health care
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Another source of ideas in health care ethicsPrinciples of Biomedical Ethics (Beauchamp and Childress, 2001)
They discuss:4 key principlessupplemented by 4 rules
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4 Key Ethical Principlesautonomybeneficencenon-maleficencejustice
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AutonomyRespect a persons right to make their own decisions
Teach people to be able to make their own choices
Support people in their individual choices
Do not force or coerce people to do things
Informed Consent is an important outcome of this principle
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Beneficence (to do good)Our actions must aim to benefit people health, welfare, comfort, well-being, improve a persons potential, improve quality of life
Benefit should be defined by the person themselves. Its not what we think that is important.
Act on behalf of vulnerable people to protect their rights
Prevent harm
Create a safe and supportive environment
Help people in crises
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Non maleficence (to do no harm)do not to inflict harm on peopledo not cause pain or sufferingdo not incapacitatedo not cause offencedo not deprive people do not kill
Both Beneficence and Non-maleficence underpin EBP
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JusticeTreating people fairly
Not favouring some individuals/groups over others
Acting in a nondiscriminatory / non-prejudicial way
Respect for peoples rights
Respect for the law
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JusticeDistributive Justice sharing the scarce resources in society in a fair and just manner (e.g. health services, professional time)
How should we share out healthcare resources?
How do we share out our time with patients?
Deciding how to do this raises some difficult questions
Patients should get..
an equal share ? just enough to meet their needs ?what they deserve ?what they can pay for ?
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4 ethical rulesVeracity truth telling, informed consent, respect for autonomy
Privacy a persons right to remain private, to not disclose information
Confidentiality only sharing private information on a need to know basis
Fidelity loyalty, maintaining the duty to care for all no matter who they are or what they may have done
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Ethics 2 broad philosophical theories1) consequentialism taking the consequences of our actions into consideration
2) deontology basing our actions on a set of principles or duties
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ConsequentialismActions are right or wrong according to the balance of their good and bad consequences
the right act is the one that produces the best overall result
Utilitarianism (what action has the greatest utility - use/benefit/positive outcome) is a type of consequentialism
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Utilitarianismmost prominent consequence-based theory
based on the principle of utility
actions ought to produce the maximal balance of positive value (e.g. happiness) over disvalue (e.g. harm)
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DeontologyDuty or principle based theoryAn act is right if it conforms to an overriding moral dutyFor example do not tell lies, do not kill.
E.g. Christian ethics The Ten CommandmentsBut Christian ethics are not important for some people in the world so moral duties vary between cultures and societies
A moral duty or principle is one that is:laid down by god / supremely rational beingor is in accordance with reason / rationalityor would be agreed by all rational beings
The NMC Code of Conduct is a product of Deontological ethics it guides action based on a set of principles/duties.
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ReferencesBeauchamp T and Childress J (2001) Principles of Biomedical Ethics 5th Edition Oxford University PressHunt G (1994) Ethical Issues in Nursing Routledge. LondonSeedhouse D (1998) Ethics the heart of Health Care Wiley. Winchester.Watt H (2000) Life and Death in Health Care Ethics Routledge. London
http://www.iep.utm.edu/e/ethics.htm#SH2ahttp://www.nursingethics.ca/articles.html http://www.freedomtocare.org/iane.htmhttp://www.lib.flinders.edu.au/resources/sub/healthsci/a-zlist/ethics.html
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