Question

- Identify a right to decide ethical dilemma you had to face in your professional nursing career. Discuss how you dealt with your values clarification, the outcome and how the common terms (autonomy, beneficence, justice, etc,) were applied in resolving this dilemma.
- Also, briefly discuss the importance of values clarification and bioethics to the professional nurse.

Answer 1

Ans) Ethics, simply defined, is a principle that describes what is expected in terms of right and correct and wrong or incorrect in terms of behavior. For example, nurses are held to ethical principles contained within the American Nurses Association Code of Ethics. Ethics and ethical practice are integrated into all aspects of nursing care.

- The two major classifications of ethical principles and ethical thought are utilitarianism and deontology. Deontology is the ethical school of thought that requires that both the means and the end goal must be moral and ethical; and the utilitarian school of ethical thought states that the end goal justifies the means even when the means are not moral.

- The ethical principles that nurses must adhere to are the principles of justice, beneficence, nonmaleficence, accountability, fidelity, autonomy, and veracity.

- Justice is fairness. Nurses must be fair when they distribute care, for example, among the patients in the group of patients that they are taking care of. Care must be fairly, justly, and equitably distributed among a group of patients.
Beneficence is doing good and the right thing for the patient.
Nonmaleficence is doing no harm, as stated in the historical Hippocratic Oath. Harm can be intentional or unintentional.
Accountability is accepting responsibility for one's own actions. Nurses are accountable for their nursing care and other actions. They must accept all of the professional and personal consequences that can occur as the result of their actions.
Fidelity is keeping one's promises. The nurse must be faithful and true to their professional promises and responsibilities by providing high quality, safe care in a competent manner.
Autonomy and patient self-determination are upheld when the nurse accepts the client as a unique person who has the innate right to have their own opinions, perspectives, values and beliefs. Nurses encourage patients to make their own decision without any judgments or coercion from the nurse. The patient has the right to reject or accept all treatments.
Veracity is being completely truthful with patients; nurses must not withhold the whole truth from clients even when it may lead to patient distress.
- The most commonly occurring ethical issues and concerns in healthcare include the allocation of scarce resources and end of life issues.

- Bioethics is a subcategory of ethics. Bioethics addresses ethical concerns like those that occur as the result of advancing science and technological advances. Some of the most common, current bioethical issues revolve around stem cells, cloning, and genetic engineering.

- Nurses have the responsibility to recognize and identify ethical issues that affect staff and patients. For example, providing nursing care for clients undergoing an abortion may raise ethical and moral concerns and issues for some nurses; and some patients may be affected with a liver transplant rejection because donor livers are not abundant enough to meet the needs of all patients who request it.

- Many hospitals, medical centers and other healthcare facilities have multidisciplinary ethics committees that meet as a group and resolve ethical dilemmas and conflicts. Nurses should avail themselves to ethicists and ethical committees within their facility when such ethical resources and mechanisms are present in order to resolve ethical concerns and ethical dilemmas.

- In addition to utilizing these resources, the nurse can take appropriate actions when faced with an ethical dilemma by understanding and applying the ethical guidelines provided in the American Nurses Association's Code of Ethics, the American Medical Association's Code of Ethics, the World Medical Association's Code of Ethics, the American Nurses Association's Standards of Care and Standards of Practice, American Nurses Association's position papers such as that which describes the ethical use of narcotic analgesics at the end of life even if this medication hastens death, state board of nursing declaratory statements, and the International Nurses Association's Code of Ethics.

- The steps of the ethical decision making process, like the problem solving process, are:

• Problem Definition- Problem definition is the clear description of the ethical dilemma and the circumstances revolving around it.
Data Collection. During this phase of the ethical decision making process includes a review of ethical codes, published evidence based practices, declaratory statements, professional position papers and the professional literature.
Data Analysis. The collected data is then organized and analyzed.
The Identification, Exploration and Generation of Possible Solutions to the Problem and the Implications of Each. All possible solutions and alternatives to resolve the ethical dilemma are explored and evaluated.
Selecting the Best Possible Solution- All potential solutions and alternatives are considered and then the best and most ethical action is taken.
Performing the Selected Desired Course of Action to Resolve the Ethical Dilemma
Evaluating the Results of the Action- Like the evaluation phase of the Nursing Process, actions to resolve ethical issues are evaluated and measured in terms of their effectiveness to resolve the ethical dilemma.