Michael D. Czechowskyj

Ferris State University

ETHICS IN HEALTH CARE

Objectives

• Discuss different ethical definitions• Why do we need ethical education• Discuss the main ethical principles• Go over the decision tree to support the staff• Go over the ethics SBAR form

Lets talk about ethics

• What are ethics?• What is the code for ethics for nursing and

how is it different?• Why are we talking about ethics?

Ethics Education

• What the literature says about current state of ethics and what can be done about it.

• Why are we here?

6 Ethical Principles

• Autonomy• Beneficence• Nonmaleficence• Fidelity• Justice• Paternalism

Autonomy

• Agreement to respect another's right to self-determine a course of action; support of independent decision making.

• Ms. A. – 34 years old with Hodgkin’s lymphome– She is refusing chemotherapy

• Mr. J.– 50 year old in failing health following an accident– Wants to be removed from the ventilator knowing it

will end his life

Beneficence

• Compassion; taking positive action to help or benefit others; desire to do good; core principle of our patient advocacy.

• Mrs. B.– Patient declining and needing an intervention– PA doesn’t address the situation– Going up the chain of command to get what the

patient needs

Nonmaleficence

• Avoidance of harm or hurt; core of medical oath and nursing ethics.

• The tricky part about this principle relates to doing no harm unless the benefit is greater than the harm being done.

• Ms. Q.– 63 year-old stage 4 non-small cell lung cancer– No more treatment options– Care team feels CPR would be harmful for the patient

but son refuses to make her a DNR.

Fidelity

• This principle requires loyalty, fairness, truthfulness, advocacy, and dedication to our patients. It involves an agreement to keep our promises.

• Mr. J.– Wife has stage 4 brain cancer– Husband doesn’t want the physician to tell his

wife her prognosis• Facebook situation

Justice

• This principle refers to an equal and fair distribution of resources, based on analysis of benefits and burdens of decision.

• Home care resources– Multiple patients– The company is dictating what supplies you use

and how much time you spend based on reimbursement

Paternalism

• The attitude that the physician or caregiver knows better than the patient what is in the patient’s own best interest, typically expressed in the caregiver withholding information from patients or aggressively directing patient care without giving the patient herself the opportunity to consider her values and what treatment options they do or do not support. This principle is heavily laden as an application of power over the patient.

• Mr. Q.– Jehovah’s witness with large blood loss– Family insist on no blood products even if it results in death

Decision Tree

• To help with the decision making process please use the decision tree as a guide.

• Also use the SBAR form so the team will have all the information needed when discussing the ethical concern.

Ethical Decision TreeAn ethical concern is

identified by staff

Discuss with upline

Is this something the Upline can solve?

YesNoContinue discussion

with upline and develop a plan with all

stakeholders

Is this a concern that needs to be addressed today

Fill out Ethics SBAR form and consult the Medical Director and

Administrator

No Yes

Fill out Ethics SBAR form and consult the Medical Director and

Administrator Call the system clinical ethicist hotline# 616-391-1131

At any time during this process you can make a

phone call using the ethics hotline# if you

feel you are not getting what you need for your

patient.

Ethics SBAR FormPatients Name: Attending Physician:

DOB: Can patient make own decisions: Yes No Unknown

Diagnosis: DPOA:

Care managers name: Advanced Directives: Yes No Unknown

Nurses name: Social Worker:

Situation: What is the current ethical problem identified

Any pending medical decisions:

Psychosocial support/challenges:

Background: What is the patients medical history Code Status:

Assessment: What is the patients current condition?

Recomendatoin: What are your sugestions for this patients care

Conclusion

• The main ethical principles are?• What tool can you use to help guide you to an

ethical consult?• What form can you use when getting an ethics

consult?• Thank you for your time.• Any Questions?

ReferencesAmerican Nurses Association. (2015). Code of Ethics for Nursing. Silver Spring, MD: Nursebooks.org.Dierckx de Casterle, B., Izumi, S., Godfrey, N. S., & Denhaerynck, K. (2008). Nurses’ responses to ethical

dilemmas in nursing practice: meta-analysis. Journal of Advanced Nursing 63(6), 540-549. dio: 10.1111/j.1365-2648.2008.04702.x.

Leuter, C., Petrucci, C., Mattei, A., Tabassi, G., & Lancia, L. (2012). Ethical difficulties in nursing, education needs and attitudes about using ethical resources. Nursing Ethics, 20(3), 348-358.

Merriam- Websters. (2014). Ethics. Retrieved from http://www.merriam-webster.com/dictionary/ethicsTschudin, V. (2013). Two decades on nursing ethics: Some thoughts on the changes. Nursing Ethics, 20(2), 125-

127. dio: 10.1177/0969733012473013.Vynckier, T., Gastmans, C., Cannaerts, N., & Dierckx de Casterle, B. (2014). Effectiveness of ethics education as

perceived by nursing students: Development and testing of a novel assessment instrument. Nursing Ethics. dio: 10.1177/0969733014538888.