ethical decision making & a caring response

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Ethical Decision Making & A Caring Response

E. Ayn Welleford, PhD & Alexa Van Aartrijk, MS, LAFLA

June 2021

Original curriculum developed by E. Ayn Welleford, PhD, Jenny Inker, PhD, Gigi Amateau, PhD, Jay White, EdD

Learning Objectives

Compare and contrast

Compare and contrast morality and ethics.

Recognize

Recognize a caring response in the context of person centered care.

Identify

Identify ethical principles that are important in guiding our everyday practice and individuals and as professionals.

Recognize

Recognize types of ethical problems.

Apply

Apply the PAUSE model of ethical decision making.

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Culture

be courteous and attentive

be reflective

respect silences

slow down!

make space for all voices participate

What else?

Today let’s agree to…

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Morality: Identifying Core ValuesWhat’s your BIG WHY? What gives your work meaning and purpose?

List three words describing your aspirational self or who you most want to be (e.g., kind, honest, strong)

Think of three people you admire most, name the qualities you admire in them (e.g., trustworthy, calm, self possessed)

These are three questions that will help you identify your own values and principles.

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Compassion Fatigue

Why does it matter?“The most insidious aspect of compassion fatigue is that it attacks the very core of what brings helpers into this work: their empathy and compassion for others.” (Figley, 1995)

Compassion Satisfaction & YOUR BIG WHY

BURNOUT occurs when an individual cannot

achieve their goals and this results in frustration, a sense of loss of control, and diminishing morale”

(Stamm, 2010, Valent, 2002). Burnout is often thought of as a

“resource shortage.”

SECONDARY TRAUMATIC STRESS

arises from a rescue-caretaking often appears as rumination or preoccupation with one patient,

client, or incident. Results from a “full container” or carrying another’s stress or trauma.

RESILIENCEis an individual’s strengths and resources, both internal and

external protective factors that help a person to recover from, or

succeed despite adverse circumstances (Gentry et al., 2010)

COMPASSION FATIGUE

A state of exhaustion and dysfunction biologically, psychologically, and socially as

a result of prolonged exposure to compassion stress and all it invokes

(Figley, 1995)

COMPASSION SATISFACTION

Your BIG WHYThe joy, purpose, and meaning derived

from one’s work (Flarity, 2016)

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To whom do we owe a caring response?

Ourselves

Individuals we serve

Family Members

Staff/Coworkers

Maintaining professional boundaries

(navigating skillfully between friendly &

professional conduct)

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Technical competence

(keeping skills up, knowing the limits of

your role)

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Professional responsibility

(accountability + responsiveness )

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Recognize a caring response in the context of person-centered care

Person-Centered Care

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Fosters optimal aging for the whole person (a BPSS approach)Recognizes the

individuality of each person

Upholds autonomy (and avoids paternalism)

Care is driven by the care recipient

(and supported by the care professional)

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Our personal Moralityconsists of our personal principles of what we perceive as right/wrong, good/bad. These are acquired over a lifetime.

Our morality may only take us only so far – when our personal “alert” sounds, we need an ethical decision-making process to help us go further. Ethics gives us that process to decide what to do next.

Our Ethics are our systematic reflection on morals

REVIEW

A caring responseThe GOAL

Maintaining professional boundaries

Being competent

Acting responsibly (being accountable & responsive)

MoralityInternalPersonal beliefs about right & wrongUnlikely to change unless beliefs change

EthicsExternalRules of conduct for acceptable behavior in professionsProvides a process to follow in making decisions

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ETHICAL PRINCIPLES

• Do good (beneficence)• Do no harm (non-maleficence• Uphold justice• Keep promises (fidelity)• Tell the truth (veracity)• Support autonomy

ETHICAL PRINCIPLES


Beneficence (doing good)

• Traditionally understood as the first principle of morality• Bring about good outcomes• Action done to benefit another• Notion of benefits over burdens

But how do we know what “doing good” means in any given situation?

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ETHICAL PRINCIPLES


Non-maleficence (doing no harm)

• Inflict no harm on self or others• Prevent harm• Remove an existing harm

Is it always possible to avoid harm? Could minimizing harm sometimes be the best outcome we can get?

ETHICAL PRINCIPLES


Justice

Equitable and appropriate treatment through:

• Fair allocation of benefits and burdens• Compensation for wrongdoing• Procedures that require ordering in a fair manner

How do we create justice in an unjust system?

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ETHICAL PRINCIPLES


Fidelity

• Being faithful• Adhering to professional codes of ethics• Honoring what is agreed upon, whether verbal or written• Promise keeping

Is it always possible to make – or keep – promises?

ETHICAL PRINCIPLES


Veracity

• Honesty• Truth-telling

Could telling the truth actually cause harm? Is honesty always the best policy?

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ETHICAL PRINCIPLES


Autonomy

• Thinking, deciding and acting freely and independently • Self-determination• Choosing for oneself

How do we support autonomy for those who rely on others for survival?

Recognize types of ethical problems

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Ethical dilemma

Path A is morally correct, but if you take path A you cannot also take path B.

Path B is morally correct, but if you take path B you cannot also take path A.

You have at least 2 morally correct, mutually exclusive choices of action (meaning you can only take 1 path).

By following 1 path, you are not following the other(s) which are also correct.

Hence, a dilemma.

Moral Distress

2. The situation is new or very complex and you know something is wrong BUT

you don’t know what to do.

3. Locus of Authority - it may not be your place to act.

Are you the Moral Agent?

1. You know the ethical action to take but you are blocked from doing so for some reason, e.g.,

• Supervisor or Co-worker action

• Organizational policies

• Your own fears

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REVIEW

Ethical principles

• Do good

• Do no harm (x3)

• Uphold justice

• Keep promises

• Tell the truth

• Support autonomy

Ethical problems

• Moral distress (something is wrong but you are blocked from action)

• Ethical dilemma (you have at least 2 morally correct options but cannot do both, so you will be both wrong & right)

Knowing when you need an ethics practice

• Tune into your “alert system” or emotional discomfort

• Respond by stopping and reflecting on what is & what ought to be

Apply the PAUSE model of ethical decision making

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Pause & clear your mind.Assess the facts.Understand your options.Seek the best solution.Evaluate the outcome & the process.The 5 step PAUSE model of ethical decision making

What enables you to be your best Moral Agent?

Stay connected with your Big WhyBuilding Blocks of the Caring Response

BoundariesBalance friendly and professionalBeware of Burnout and STS

CompetenceKeep your skills sharpKnow your limits

Professional ResponsibilityAccountabilityResponsiveness

PAUSE & Practice your process of Ethical Decision Making

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ethical decision making & a caring response

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