Unit 8: Ethical Decision Making

"Even the most rational approach to ethics is defenseless if there isn't the will to do what is right."

Alexander Solzhenitsyn, Russian novelist, (1918-2008)

Unit Outcomes

When you have completed this unit, you should be able to:

define terms related to ethical decision making in nursing;
connect ethical values with ethical decision making;
connect your rights as a nursing student with your responsibilities as a nursing student;
determine how these rights and responsibilities will be the same/different as you transition from a nursing student to a practicing BN.

Learning Activities

Required Readings

Read Chapter 3, Ethical Principles and Chapter 6, Ethical Decision Making in Burkhardt, Nathaniel, and Walton (2014) Ethics and Issues in Contemporary Nursing.

These chapters will help prepare you for the Learning Activities in this unit. As you read, pay particular attention to the content under the subheadings "Ask Yourself", "Case Presentation" and "Think About It". You may find the material in these sections helpful in providing you an opportunity to reflect on how you have approached and made decisions about ethical dilemmas in your nursing practice.

Learning Activity 1: Defining Terms

Burkhardt, Nathaniel and Walton (2014) introduce a number of terms related to Ethical Decision Making Practice. Define each of the following key terms and phrases in your own words as you read this chapter. Check your answers by dragging your mouse between the arrows to highlight the definitions.

ethical principles

--> basic and obvious moral truths guiding thought, discussion, and action. The main ethical principles include: autonomy, beneficence, nonmaleficence, veracity, confidentiality, justice, fidelity. <--

autonomy

--> self-governing; possessing the ability to make independent choices. <--

beneficence

--> do good; acting in a way that benefits another. <--

non maleficence

--> do no harm; acting in a way to avoid causing harm to another. <--

veracity

--> to tell the truth. <--

confidentiality

--> nondisclosure of private information. <--

justice

--> fair, equitable, and appropriate treatment based on what is owed to a person and knowing that giving to some will deny receipt to others. <--

fidelity

--> faithfulness; the act of keeping promises. <--

informed consent

--> a process by which consent is given freely following full disclosure of information such as possible outcomes, alternatives, and risks of treatments. <--

paternalism

--> a gender biased term meaning acting in a fatherly manner; in health care, it refers to one who restricts a patient's autonomy with the misguided intent of protecting the patient from harm. <--

noncompliance

--> a perceived unwillingness of a patient to participate in prescribed or recommended health care activities. <--

distributive justice

--> fair, equitable, and appropriate distribution of the finite supply of health care goods and services. <--

moral uncertainty

--> a situation in which a nurse has a sense that a moral problem exists but is uncertain of the correct action to take. <--

ethical dilemma

--> a situation in which a nurse recognizes that (at least two) conflicting moral claims exist. <--

practical dilemma

--> a situation in which a nurse perceives that moral claims compete with non-moral or practical claims. <--

moral distress

--> a reaction to a situation in which there are moral problems with clear solutions yet the nurse is unable to follow moral beliefs due to restraints (external or institutional). <--

moral outrage

--> the reaction to a situation in which an immoral act has occurred; the nurse did not participate in the act however, the nurse felt powerless to prevent it. <--

Learning Activity 2: Connecting Ethical Values with Ethical Decision Making

College of Nurses of Ontario (CNO)

The College of Nurses of Ontario (CNO), as part of its practice standards, has developed a document titled, "Ethics". In this document are what the CNO believes are the most important ethical values including:

client well-being;
client choice;
privacy and confidentiality;
respect for life;
maintaining commitments;
truthfulness;
fairness (CNO, 2009, p.4)

Each value is described in detail. Scenarios are presented along with behavioral directives to guide nurses' thinking regarding the scenarios. Access the link below and read the document. Pay attention to the particular ethical value being described, consider its connection to the "Scenarios", and reflect on the "Behavioral Directives" presented.

http://www.cno.org/Global/docs/prac/41034_Ethics.pdf

Learning Activity 3: What Were They Thinking?

The John Dossetor Health Ethics Centre at the University of Alberta, produces a newsletter titled, "Health Ethics Today". This newsletter contains several items related to compelling ethical issues. Click on the following link, scroll down to the article titled, "What were they thinking? How appalling acts can spring from good intentions".

http://www.bioethics.ualberta.ca/~/media/dossetor/Health%20Ethics%20Today/HET%20Vol%2018%20No1%202009.pdf

In this article, Austin (2009) outlines five main points for understanding how despite good intentions, unethical acts have taken place in the field of health research/health care. These five points include:

Recognition of a desperate need;
Science need to be conducted objectively;
The lure of technology is strong;
People are tempted by power and certainty;
Othering; some persons are so different from oneself that different moral rules apply (Austin, 2009. p. 6).

Read the article. Consider the examples presented. Even though the examples presented occurred years ago, think about your nursing practice.

Can you think of a recent situation in your nursing practice, when someone said or did something you considered to be unethical or ethically questionable? Did any of the five bulleted points listed above relate to this situation? If so, which one? How?
Look back to Learning Activity 3: Connecting Ethical Values with Ethical Decision Making. When you think again about this situation in your nursing practice, which one ethical value do you believe was being violated? How did you know that particular ethical value in your particular situation was being violated?

Learning Activity 4: Nursing Students: Rights and Responsibilities

Access the following link and read the "Nursing Students' Bill of Rights and Responsibilities". Consider these statements in the context of what you have learned in this unit about ethics and ethical nursing practice.

http://www.cnsa.ca/english/p ublications/nursing-students-bill-of-rights-and-responsibilities

References

Austin, W. (2009). "What were they thinking?" How appalling acts can spring from good intentions. Health Ethics Today, 18(1), 4-6. Retrieved from University of Alberta website: http://www.bioethics.ualberta.ca/~/media/dossetor/Health%20Ethics%20Today/HET%20Vol%2018%20No1%202009.pdf

Burkhardt, M.A., Nathaniel, A.K., & Walton, N. A. (2014). Ethics and issues in contemporary nursing (2nd Canadian ed.). Toronto, ON: Nelson.

Canadian Nursing Students' Association (2005). Nursing students' bill of rights and responsibilities. Retrieved from Canadian Nursing Students' Association website: http://www.aeic.ca/english/publications/nursing-students-bill-of-rights-and-responsibilities

College of Nurses of Ontario (2009). Practice Standard: Ethics (Publication No. 41034. ISBN 1-894557-41-7). College of Nurses of Ontario, Toronto, ON. Retrieved from CNO website: http://www.cno.org/Global/docs/prac/41034_Ethics.pdf

Solzhenitsyn, A. (n.d.). Thinkexist.com. Ethics Quotes. Retrieved from Thinkexist.com website: http://en.thinkexist.com/quotes/with/keyword/ethics/2.html

Additional Readings

Allmark, P. (2005). Can the study of ethics enhance nursing practice? Journal of Advanced Nursing, 51, 618–624. Retrieved from http://0-web.ebscohost.com.aupac.lib.athabascau.ca/

Whitty-Rogers, J., Alex, M., MacDonald, C., Gallant, D.P., & Austin, W. (2009). Working with children in end-of-life decision making. Nursing Ethics, 16, 743-758. doi: 10.1177/0969733009341910.