Principles of Ethics

Objectives: At the end of the end of the lecture the student should be able to: Define ethics Discuss the ethical reasoning

Definitions
Ethical principles Autonomy Non maleficence Justice Beneficence

Descriptions
Patients rights Nurses rights

At the end of the lecture you should be able to :

Understand and relate ethical principals to your nursing practices.

REFERENCES
Thomson, Ian, E., Melia,Kath, M., Boyd, Kenneth,M (2003) Nursing Ethics,4th edition, Elsevier, Science Limited,Philadelphia , USA. Crisp &Taylor (2005) Potter & Perrys Fundamentals of Nursing 2nd ed., Elsevier, Australia.

Presenter: Sr., Uma Lal 22/03/11

ETHICS
Ethics is concerned with the studies and practice of what is good and right for human beings. In ethics we seek to determine what conditions will promote what is good or bad for the betterment of individuals,communities,businesses and organizations.

ETHICS TO NURSES
Values and means to ensure the wellbeing ,health ,prosperity and happiness of people with identifying the kind of things that are likely to prevent this happening. This was recognized in the ICN code for nurses: Ethical concepts applied to nursing (ICN 1973).

FOUR FUNDAMENTAL RESPONSIBILITY OF A NURSE

A) To promote health B)To prevent illness C) To restore health D) To alleviate suffering The need for nursing is universal

CORE COMPONENT OF NURSING CARE

A) Respect for life B) Dignity and rights of human being C) Unrestricted by considerations of Nationality,race,creed,color, age,sex,politics or social status.

Core component of nursing care

Nurses render health services to the individual, the family,and the community. They coordinate their services with those of related groups.

ETHICS IS CONCERNED WITH

Formation of rules defining what is right or wrong, eg to state what regulations are necessary to monitor (oversee) individual and community wellbeing and what is required to protect the safety /integrity of individuals ,communities and organizations.

Ethics is concerned with

Fundamental responsibility of nurses is to hold in confidence personal information and use judgment in sharing this information. To maintain the highest standards of nursing care possible within the reality of a specific situation. Maintain personal and professional conduct at all times to uphold nursing profession (ICN 1973).

Nurses role in safeguarding Human Rights (ICN 1983) asserts that:

Health care is a right of all individuals. Everyone should have access to health care regardless of financial ,political, geographic, racial or religious backgrounds. Nurses must make sure that they deliver impartial and adequate treatment within available resources.

SUMMARY-what ethic is?

Commitment to positive values to ensure the wellbeing and flourishing of individuals and society. Communal activity of applying rational principles and universal standards to social life. Our active participation in a moral community and ownership of the policies it develops.

Summary of what ethic is

Problem solving activity based on knowledge of ethical principles and their skilled application to life. Educational process in which by experience we learn what it means to be responsible moral agents.

Autonomy
Principles of self rule, of clients making decisions about their own lives. An individual who is able to exercise some degree of self determination in terms of understanding the requirement of membership of the moral community to he/she belongs. A person who is free and able to act ,to exercise his or her rights and to recognize his or her duties to others. Respect for persons also requires that we also respect his independence for self determination.

NON MALEFICIENCE
Not to do harm-the duty to do good and to avoid harm to others. The duty of care ,to protect the weak and the vulnerable. The duty of advocacy, depending on the rights of those incompetent or temporarily unable to defend their own. The golden rule says: DO UNTO OTHERS AS YOU WOULD HAVE THEM DO UNTO YOU.

BENEFICENCE
To do good, it is the protective duty of care the strong owe to the weak. Patient advocacy, defending the rights of the vulnerable patient or acting on behalf of those unable to assert their rights.

Beneficence
Principle of beneficence is indispensible in cases of dependent ,severely disabled or helpless people in need of support or urgent care and attention.

Beneficence
This duty of care towards one another should make us realize that we all need others to speak for us ,to do things for us, or to defend our rights when we are too weak to do so for ourselves.

Beneficence
But if knowledge is power ,the power of the true carer is aimed at sharing knowledge and skills with vulnerable individuals so as to empower them to reassert control over their own lives, if this is humanly possible (May, 1983,Campbell,1984,&1985).

JUSTICE
The demand for universal fairness in terms of respect for the rights of individual persons ,the exercise of individual rights such as freedom of movement, or association. Equal opportunity to benefit from ,or have access to, preventative medicine and treatment health services and the outcome of research. Equality of outcomes for different ethnic groups in terms of fair distribution and access to health resources by sound research and policy development.

The right to know

The normal expectation of clients is that carers will discuss their problem with them and give an opinion as to its nature ; that they will discuss the proposed course of treatment or management of the problem ;and they will discuss the possible options and outcomes.

The right to privacy

The right to respect for the dignity of the person in terms of physical privacy Respect for the persons secret in terms of maintaining strict confidentiality of the information disclosed. The right to privacy does not mean the right to have a private ward or the right to private medicine although in some case it may include that eg an elderly lady who has never shared a room with another person may be emotionally distressed at having to be nursed in a public ward . She might prefer to pay extra health insurance to ensure that she can get privacy that is very important to her. Most people might expect some general loss of privacy which often comes as a shock to realize how little privacy they have.

Right to privacy
Hospital staff often show very little consideration for peoples sensitivities or need for privacy, the needs of those who are dying. Generally people are prepared to expose their secrets ,expose their bodies and reveal their vulnerabilities when they need help and when they feel that they can TRUST the person from whom they are seeking help.

Right to privacy
Sensitive carers will respect the patients confidences and privacy. The carers will also recognize that the information is to be used ONLY for the benefit of the patient, and that they acquire duties of advocacy, to protect the rights and interests of their patients in the light of what they have learnt about them .

The right to care and treatment

Every person who has been taken on by a doctor or nurse as a patient has a right to expect proper care and treatment. The doctor or nurse is employed to provide a service, or offers a service on a fee- for service basis ,and patients are entitled to treatment in fulfillment of the deal made with the carer to whom they have entrusted themselves.

Right to care and treatment

Malpractice and negligence are not confined to being incompetent but also for failure to provide due in fulfillment of the contract to-care.

Nurses Rights
Nurses have the right to practice in accordance with the Nursing legislation of the country in which they work. They adopt the ICN code for nurses or their own national ethical code Nurses &Midwives Board Fiji Code of ethics &Code of conduct for Fiji Nurses 1999.

Nurses rights
Right to practice in an environment that provides personal safety ,freedom from abuse and violence, threats or intimidation. National nurses associations need to ensure an effective mechanism through which nurses can seek confidential advice , counsel, support and assistance in dealing with difficult human rights situations.`

Relating Ethical Principle To Nursing Practices

Nurses have an obligation to safeguard peoples health rights at all times and in all places. This includes assuring that adequate care is provided within the resources available and in accordance with nursing ethics.

Relating ethical principle to nursing practices

The nurse is obliged to ensure that patients receive appropriate information prior to consenting to treatment or procedures, including participation in research if you do one in future.

Relating ethical principle to nursing practices

As professionals, nurses are accountable for their own action in safeguarding their patients rights in every sense of their care.

Limitations
In all aspects of their professional role nurses deal with human rights issues everyday .Nurses may be pressured to apply their knowledge and skills in ways that are detriment to patients and others.

Limitations
There is a need for increased vigilance , and a requirement to well informed ,about how new technology and experimentation can violate these human rights.

Limitations
Furthermore nurses are increasingly facing complex human rights issues, arising from conflict situations within jurisdictions, political upheaval and wars. The application of human rights protection should emphasize vulnerable groups such as women,children,elderly people, refugees and stigmatized groups.

Limitations
ICN has developed a Health and Human rights fact sheet ,addressing the major areas where human rights impact on the health of populations, including public health, health care reform, access to care and gender perspectives

Home work
Read ICN publications on their website: http://www.icn.org> (ICN endorsed the Universal Declaration of Human Rights ,adopted by the United Nations General assembly in 1984).

Discussion activity
Get into groups of five and discuss how you are going to relate the above ethical principles to your daily nursing practices. What are some of the limitations that you are going to come across in applying these ethical principles ?

Bill of rights (American Hospital Association 1973,revised 1992)

1.The patient has the right to considerate and respectful care. 2. The patient has the right to obtain understandable information concerning diagnosis,treatment and prognosis.

Bill of Rights
3.The patient has the right to make decisions about the plan of care prior to and during the course of treatment. 4.The patient has the right to have an advance directive such as a living will, health care proxy ,or durable power of attorney for health care. 5.The patient has the right to every consideration of privacy.

Bill of rights
6.The patient has the right to confidentiality. 7.The patient has the right to review his /her records pertaining to his health care.

Bill of rights
8.The patient has the right to expect that ,within its capacity and policies a hospital will make reasonable response to his /her request. 9.The patient has the right to ask and be informed of the people and other health care agencies which influences his health care.

Bill of rights
10.The patient has the right to consent or refuse in any kind of research studies or human experimentation affecting his care and treatment.

Bill of rights
11.The patient has the right to expect reasonable continuity of care when appropriate and to be informed by the physicians and other care givers of available and realistic patient care options when hospital care is no longer appropriate.

Bill of rights
12.The patient has the right to be informed of hospital policies and practices that relate to his /her care ,treatment and responsibilities.

IMPORTANT NOTE:
Remember your primary role as a nurse is to provide competent nursing care promoting an environment in which the values ,customs,and spiritual beliefs of the individuals are respected. Maintain confidentiality in holding personal information and use your judgment in sharing this information .

Important Note

DO UNTO OTHERS WHAT YOU WANT OTHERS TO DO TO YOU.