1
Q
what are the 5 main ethical theories in healthcare
A
- goal or consequenced based
- duty-based
- character based (virtue)
- relationships based (ethics of care, feminist)
- principles
2
Q
what is the most prominent ethical theory? what is another name for this?
A
- goal or consequence based
- utilitarian
3
Q
what is another name for duty based ethical theory
A
- deontological
4
Q
describe consequence based theories (3)
A
- rightness or wrongness of actions depends on the goodness or badness of the consequences of actions
- considers the ripple effect –> what could happen as a result of this decision
- goal is to maximize utility –> greatest good for the greatest number
5
Q
by the consequence based theory, what makes a choice good/ethical? (3)
A
- good outcome = ethical choice
- choice is good/ethical if it results in more good/happiness than harm/unhappiness
- even if some unhappiness results, it is still ethical if good > harm
6
Q
what are concerns with consequence-based ethics (2)
A
- majority can overrule individual rules
- may create injustice
7
Q
what is considered w consequenced-based ethics (5)
A
- what could happen if we do this action?
- what could happen if we dont?
- what is the worst case scenario?
- best case scenario?
- what choice would produce the greatest benefit and minimize possible harms?
- consider the ripple effect
8
Q
describe duty-based ethics (3)
A
- involves adherence to duties/rules
- about the duty of obligation “to act according to particular rules or principles”
- little consideration of the consequences of an action –> consequences may be considered but right or wrong is not exclusively related to consequences
9
Q
based on duty-based ethics, what is considered a good/ethical choice
A
- an action is ethical if it is based on ethical rules, regardless of the consequences
10
Q
duties considered w duty-based ethics includes (5)
A
- confidentiality
- veracity (truthfulness)
- preventing harm
- fairness
- duty to care
these are often written down as laws or policies or Codes of Ethics
11
Q
what are concerns w duty-based ethics
A
- duties can & do conflict, some are even mutually exclusive
- may ignore consequences
ex. what if telling the truth would cause harm to someone?
12
Q
what may be considered with duty-based reasoning (5)
A
- what standard laws do we need to follow?
- does the Code of Ethics say anything about the topic?
- is there a facility policy to consider?
- do we have consent?
- right to refuse
13
Q
describe character-based theories
A
- involves thinking about a person you admire, or an exemplary nurse and what they would do
- aka virtue theory
14
Q
what are virtues
A
- character traits that predispose a person w good intentions to act w practical wisdom
15
Q
what virtues may be considered w character-based theories (6)
A
- honesty
- kindness
- loyalty
- fairness (moral virtues)
- intelligence
- prudence (practical virtues)
16
Q
what is considered w character-based ethics (3)
A
- what would a good nurse do?
- is the action consistent w values like honesty and kindness?
- what would someone you consider a moral exemplar choose?
17
Q
describe relationship-based theories (3)
A
- focuses on preserving relationships, improving communication, enhancing cooperation, and minimizing harm to everyone involved while promoting an ideal of caring
- recognizes the web of relationship that health and health care exist within
- ethics of care
18
Q
what does relationship-based ethics acknowledge (4)
A
- power dynamics
- social context
- inequities
- trauma
19
Q
relationship-based reasoning considers.. (4)
A
- is it appropriate to use our power for the action?
- would it cause mistrust?
- how might the action affect the pt’s relationship with other residents? the staff? their family?
- how would the action impact our relationship w the pt
20
Q
what are 6 principles of biomedical ethics?
A
- autonomy
- beneficence
- non-maleficence
- justice
- fidelity
- veracity
21
Q
describe the principle of respect for persons/autonomy
A
- involves the concept of self-determinantion or being in charge of one’s self
- linked to CNA professional values of promoting and respecting informed decision-making & preserving dignity
22
Q
autonomy is a pt’s right of…
A
- they have the ability to make their own decisions on whats best for them AND it will not impede someone else’s rights
23
Q
autonomy requires?
A
- relevant info
- ability to understand
- freedom to act on that info
24
Q
what is done if the pt cannot express their wishes
A
- we need someone who knows them to communicate on their behalf
ex. a substitute decision maker
25
describe the principle of beneficence (4)
- focuses on doing or promoting good in others
- protecting and defending the rights of others
- providing a benefit
- good intentions and good outcomes
26
the principle of beneficence is linked to...
- promoting health and wellbeing
| - providing safe, competent, compassionate, and ethical care
27
describe "the good": what is good, who decides what is good
- pellegrino and thomasma have argued that the biomedical good (what the team or physician recommends) is less important than the pt's perspective on what is good
28
describe the principle of paternalism
- making decisions for pts in the pt's best interests, but without their consent
- making people do what is good for them
- preventing people from doing what is bad for them
29
describe the principle of non-maleficence
- refers to the obligation to do no harm - avoid, prevent, and minimize
- need to balance the risks and benefits of a plan of care
30
harm or injury may refer to..
- physical and emotional harm
31
what is a con regarding the principle of non-maleficence
- it can be impossible to do good without doing some amount of harm or risk
32
describe the principle of justice (5)
- refers to fairness in determining what someone or some group is owed, merits, deserves, or is entitled to
- the basis of treating people equally/equitably
- human rights & public good
- nobody advantaged or disadvantaged
- social justice, fairness, equity
33
describe the principle of fidelity or integrity (4)
- relates to trustworthiness & accountability
- refers to the obligation we have to remain faithful to our commitments
- connected to the concept of loyalty, keeping promises, and being faithful to those who have entrused themselves to us for care
- having integrity, being decent, acting honorably, being true to one's value
34
describe how nursing entails a fiduciary relationship
- the nurse provides services which by their nature cause the pt to trust in their specialized knowledge and integrity of the professional
- nurses have a duty to provide knowledge, competent, and safe care and practice w integrity
- connected to duty to care, non-abandonment, non-judgment, and accountability
35
describe the principle of veracity or truthfulness (3)
- refers to our obligation to tell the truth and not to lie or deceive others
- veracity is central to informed consent
- linked to values of being accountabile & promoting and respecting informed decision-making
36
what do ethical principle ask us to consider (6)
- what does the pt want (autonomy)
- what will do most good? (beneficence)
- what will prevent harm (non-maleficence)
- what is fair to the pt & others (justice)
- is it truthful?
- would it help us to be faithful to our commitments to the pt & others?
37
therapeutic relationships.... (5)
- planned and goal directed towards the client's needs
- always in the best interests of the person
- recognize a power imbalance
- recognize vulnerability
- remain within the Zone of Helpfulness
38
describe the Zone of Helpfulness
- want to avoid being underinvolved and overinvolved
| - be somewhere in the middle
39
non-therapeutic relationships... (3)
- abuse of trust
- exploits client for personal gain
- nurse benefits more than the pt
40
what is a boundary crossing (2)
- brief, intentional, and intended to benefit the client
| - personal disclosures to gain trust and develop therapeutic rapport
41
what is a boundary violation
- when the benefit to client is no longer the focus of the relationship
ex. social or sexual relationships, accepting expensive gifts
42
what are some warning signs of boundary crossings/violations (9)
- giving person contact info
- communicating electronically
- giving gifts to a client
- paying special attention to a current client (spending time w the client outside their shift, on a break)
- discussing personal issues
- changing assignments to care for a certain pt
- dressing differently for a certain pt
- frequently thinking about a pt
- feeling other members of the team do not understand a client
- keeping secrets w a pt
43
what do nurses consider when making ethical decisions (5)
- consequences & outcomes
- duties and obligations
- good character (virtues)
- relationships (caring, power)
- ethical principles
44
the process for making difficult ethical decisions..... (3)
- requires the systematic examination of a problem and its possible solutions
- ensures no important considerations are missed
- provides a way of justifying or explaining a decision
