NURSING ETHICS NSG 700

Jay Osurman Malanyaon

To err is human, to forgive is divine (Pope, 1709)

Definition of Nursing Practice

Dilemmas for Health Professional  Dilemma created by Technology  American Nurses Association Code of Ethics  International Council of Nurses Code of Ethics


study of standards of conduct and moral judgment

Ethics

Serve the purpose of governing conduct to ensure the protection of individuals rights.

Bioethics - synonymous term with

healthcare ethics and encompass not only questions of quality of life, life-sustaining and a life-altering techniques and bioscience in general (Catalano)

Human acts voluntary, full knowledge,

will to do it

Acts of man - involuntary actions of

man

Nursing ethics - formal study of

ethical issues that arise in the practice of nursing and of the analysis used in the judgment of the practice.

Morality - behavior in accordance

with the gen. ethical principles of health care

Dilemmas for Health Professionals

    

Life and death Quality of life Right to decide Informed consent Alternative treatment issues

Dilemmas Created by Technology

Illnesses once leading to mortality are now classified as chronic illnesses Cost is a consequence of prolonging life with technology

American Nurses Association: Code of Ethics for Nurses

Provision 1


The nurse in all professional relationships, practices with compassion and respect for the inherent dignity, work and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes or the nature of health problems.

    

1.1 Respect for human dignity 1.2 Relationships to patients 1.3 The nature of health problems 1.4 The right to self determination 1.5 Relationship with colleagues and others

Provision 2


The nurses primary commitment is to the patient, whether an individual, family, group or community

   

2.1 Primacy of the patients interests 2.2 Conflict of interest for nurses 2.3 Collaboration 2.4 Professional boundaries

Provision 3


The nurse promotes, advocates for, and strives to protect the health, safety and rights of the patient.

     

3.1 Privacy 3.2 Confidentiality 3.3 Protection of participants in research 3.4 Standards and review mechanisms 3.5 Acting on questionable practice 3.6 Addressing impaired practice

Provision 4


. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurses obligation to provide optimum patient care.

4.1 Acceptance of accountability and responsibility 4.2 Accountability for nursing judgment and action 4.3 Responsibility for nursing judgment and action 4.4 Delegation of nursing activities

Provision 5


The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth

 

 

5.1 Moral self respect 5.2 Professional growth and maintenance of competence 5.3 Wholeness of character 5.4 Preservation of integrity

Provision 6


The nurse participates in establishing, maintaining, and improving healthcare environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.

6.1 Influence of the environment on moral virtues and values 6.2 Influence of the environment on ethical obligations 6.3 Responsibility for the health care environment

Provision 7


The nurse participates in the advancement of the profession through contributions to practice, education, administration and knowledge development.

7.1 Advancing the profession through active involvement in nursing and in health care policy 7.2 Advancing the profession by developing, maintaining, and implementing professional standards in clinical administrative, and educational practice 7.3 Advancing the profession through knowledge development, dissemination, and application to practice

Provision 8


. The nurse collaborates with other health professionals and the public in promotion community, national and international efforts to meet health needs.

 

8.1 Health needs and concerns 8.2 Responsibilities to the public

Provision 9


The profession of nursing, as represented by associations and their members, is responsible of articulating nursing values, for maintaining the integrity of the profession and its practice and for shaping social policy.

 

 

9.1 Assertion of values 9.2 The profession carries out its collective responsibility through professional associations 9.3 Intraprofessional integrity 9.4 Social reform

The ICN Code of Ethics for Nurses

An international code of ethics for nurses was first adopted by the International Council of Nurses (ICN) in 1953. It has been revised and reaffirmed at various times since, most recently with this review and revision completed in 2005.

PREAMBLE


Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering. The need for nursing is universal.

Inherent in nursing is respect for human rights, including cultural rights, the right to life and choice, to dignity and to be treated with respect. Nursing care is respectful of and unrestricted by considerations of age, color, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status.

Nurses render health services to the individual, the family and the community and co-ordinate their services with those of related groups.

1. NURSES AND PEOPLE



The nurses primary professional responsibility is to people requiring nursing care. In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected.

The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment. The nurse holds in confidence personal information and uses judgement in sharing this information.

The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations. The nurse also shares responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction.

2. NURSES AND PRACTICE



The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning The nurse maintains a standard of personal health such that the ability to provide care is not compromised.

The nurse uses judgment regarding individual competence when accepting and delegating responsibility. The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance public confidence

The nurse, in providing care, ensures that use of technology and scientific advances are compatible with the safety, dignity and rights of people.

NURSES AND THE PROFESSION



The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education. The nurse is active in developing a core of research-based professional knowledge.

The nurse, acting through the professional organization, participates in creating and maintaining safe, equitable social and economic working conditions in nursing.

4. NURSES AND CO-WORKERS



The nurse sustains a co-operative relationship with co-workers in nursing and other fields. The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a coworker or any other person.

ETHICAL DILEMMAS
Situation with unsatisfactory alternatives or options

1. ARTIFICIAL INSEMINATIONis a procedure or process whereby the fertilization of an egg is the result of the sperm being introduced into the female reproductive system other than the natural, that is, other than the sexual act or intercourse.

Types: 1. Artificial Insemination by the Husband (AIH) or Homologous Type 2. Artificial Insemination by a Donor(AID) or Heterologous Type

Argument that support A.I  strengthens and enhances family relationship. Ethical Objections:  Ethically wrong by reason of the manner of procuring semen.  Contrary to the signification of the Human Sexual act.

2) IN VITRO FERTILIZATION
Laboratory procedure whereby one or a few eggs are surgically taken from a womans ovary, fertilized with sperm in a petri dish, and transferred to and implanted in the womans uterus, hoping for a normal pregnancy to happen.

Argument that support IVF  Technological Imperative  opens infertile couples to joy of having children  Guarantee society with healthier children

Ethical Objections:  manner of procuring semen  product factor  surrogate mother factor  disadvantage of pregnancy in later years

3) HUMAN CLONINGRefers to the production of one or more living human beings that are genetically identical to an original human being.

Types:
1. Embryo Cloning- Artificial Twinning

POSSIBLE EXAMPLE OF DEFECTIVE CLONING

2. Adult DNA Cloning 3. Therapeutic Cloning ( Somatic Cell Nuclear Transfer)

Argument that support Cloning:  improvement to humanity  production of human tissues or organs  a fundamental human right- Reproductive freedom

Ethical Objections:  Violates the autonomy of the individual  Diminishes the value of human life  Disadvantageous to child  Humans subjected to exploitation for commercial purposes

4) CONTRACEPTION
is any act done before, during, or after the act of intercourse that purposely frustrates begetting of new life.

Types: 1. Direct- deliberately intended A. Artificial  Mechanical 1. condom

   

2.diaphragm 3.cervical cup 4.IUD Chemical = cervical sponge, vaginal suppository, vaginal jelly Surgical = tubal ligation, vasectomy

B. Natural 2. Indirect


  

Argument that support contraception:

Womans autonomy or right Situationalism ( Love Theory) Utilitarianism (Sexual pleasure or happiness) Population Time Bomb

Ethical objections:  Meaning of human Sexual Act  Population Time Bomb Scare

5) ABORTION
Termination of pregnancy.

Q: When will termination of pregnancy be called abortion punishable by law? If terminated a. First trimester b. 20 weeks age of gestation c. Moment of conception d. 7 months pregnancy

Types:
1. Spontaneous Abortionmiscarriage, kind that occurs without medical or some other kind of intervention.  Complete- all content in uterus expelled  Incomplete- part or entire placenta is retained  Missed abortion- fetus is retained in the uterus for a period of time after its death.

2. Direct, induced or procured Abortion- elective or therapeutic abortion  Early Uterine Evacuation or Vacuum aspiration- suctioning  Dilatation and Evacuation, Dilatation and Curettage (D & C)  Prostaglandin and Saline injectionthrough amniotic sac  Hysterectomy

3. Indirect Abortion- necessary result of another medical procedure.

Right of the mother versus Right of the unborn/ fetus

Principle of Double Effect refers to an act that causes two immediate effects: one good,the other bad.

Conditions:
1. The act must either be good or at least indifferent. 2. The intention is to achieve the good effect. 3. The expected good effect must be equal to or greater than the harmful effect that is expected. 4. The good effect must follow from the action,or at least,must happen as immediately as the bad effect.

6) EUTHANASIA MERCY KILLING, is the intentional taking of the life of an ailing person. reasons:  Incurability of illness  Unbearable intensity of physical or emotional pain  Unbearable financial burden arising from the illness.

Types:
1. By Reason of the manner of attaining death  a. Active or Direct Euthanasia- the active taking of steps by the physician or the caregiver to end the life of the patient.

b. Passive or Indirect Euthanasia- the intentional omission or non-administration of medical treatment to cause or hasten the death of the patient.

2. By reason of patients consent a. Voluntary Euthanasia- the patient consciously and directly requests the health care provider to take the steps to put an end to the patients life. b. Involuntary Euthanasia- the act of seeking the death of the patient is without the patients consent or knowledge.

Q: If a nurse stops giving medications with the consent of the family, what type of euthanasia?
a. b. c. d.

Active voluntary Inactive involuntary Active involuntary Inactive voluntary

 DO NOT RESCUCITATE ORDER

Q : A patient has been in the ICU for two weeks. The relatives consented to a DNR order. What should the nurse do? a. Only medications will be given b. All ordinary measures will be stopped c. Basic and advance life support will not be given d. Mechanical ventilation and NGT stopped

Types of treatment:
1. Ordinary treatment 2. Extraordinary treatment a. not easily available b. risky c. expensive d. gravely inconvenient or burdensome

7. PHYSICIAN ASSISTED SUICIDEthe patient requests from the physician to provide the means to end his life.

8. HUMAN TRANSPLANTATIONsurgical procedure whereby an organ or tissue is transferred from one part of the body to another or from one organism to another organism.

TYPES:
1. Autotransplantation- donor and recipient are one and the same Ex: skin and bones

2. Heterologousdonor and recipient are two different individuals. a. animal to human b. human to human  cadaver donor  living donor

Types of organs used: 1. Those that regenerate - bone marrow, skin 2. Those that come in pair - kidneys, eyes

 

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