Foundations in Evidence Based Practice

Introduction to Ethics

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

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

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

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

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

Another source of ideas in health care ethicsPrinciples of Biomedical Ethics (Beauchamp and Childress, 2001)

They discuss:4 key principlessupplemented by 4 rules

4 Key Ethical Principlesautonomybeneficencenon-maleficencejustice

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

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

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

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

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 ?

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

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

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

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)

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.

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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