[BIOETHICS] ‘To provide guidelines in knowing ‘What & GOOD or what is BAD? What is RIGHT and what is WRONG? Ethics enables us to make correct judgement of diffs of situations In order to eoose the ight cours of ation ‘newly ws towards the ttainment four goals wiih sto attains happy and frat ie. ‘los ~ refers to yell bused standard of ight oF wrong that preverbes what human ought todo, usually terms of rights, ‘obligations, bene ts to sity ames, o specie virtues Eg clhis refers to those standards that impose the reasonable obligations to refain from rape, stealing, Imureer assault slander, and fraud. cial standards abo include those that enjoin vitues of honesty, compassion and ovat. ad, eical standards include standards relating to vghts, Sc the right to If, the right to fedom from injury, and the right fo privacy Rees to the study and development of one! ethical ffandards, Came from the Greck word “ethos which means “moral duty” The branch of philosophy that examines the diferences between ight and wrong ie about making chien that are bet forthe individual oe socey at certain times andin particular situations and then evaluating such choles and batcomes When singular: 1s also known as “moral philosophy’ A field of philosophy that deals with the study of the Thora) value of human conduet and the rules. and 5 nature and funetion. Purpose of theory: to enhanee clarity, systematic order and precision of argument in our thinking, about mor 4. Consequence-based (teleological) theories = look to the outtomes. (consequences) of an action in judging whether that action is right or wrong, Utilitarianism, one form of consequentialist theory, views a good act as one that ste most useful that is, one that brings the most good and the least harm to the greatest number af people called the principle of utility. oten used in making decisions about. the funding and delivery of health care, focus on iesues of justice Principles-based (deontological) theories - involve logical and formal processes: and. emphasize individual rights, duties, and obligations. The morality of an aetion is determined not by its consequences but by whether itis done according to an impartial, objective principle focus on formal reasoning stress individual right 3 Relationships-based (caring) theories stress courage, generosity, commitment, and the need to nurture and maintain relationships. Judge actions according to a perspective of caring and responsibility ‘promote the common good or the welfare ofthe group When plural: Pertain to sorial, religions or eivil eode of behavior that is considered correct, for that of a particular group, profession, or individual. It also refers to the moral fitness of a decision or course of action. The expected standards of moral behavior of a particular ‘group as described in the group’ s formal code of rofessional ethics. Per ‘Are specific ways of behavior or accomplishing ethical practices. ~~ Fundamental standards of right and wrong, learned and. Interalized in early chilthood, offen based on religious ifs. ‘Moral Virtues: Justice, Temperance, Fortitude & Prudence Derived from the Greck word “moralis which refers to social consensus about moral conduet for human beings and society. Refers to social conventions about right and wrong, Jhuman conduct thet are so widely shared that they form a stable, commtinal consensus, in a certain population or ina certain specific society. Refers to behavior in accordance with eustom or tradition and usually reflects personal or religious beliefs = Addresses the questions of what is RIGHT and WHAT is WRONG. - Human tendency, right or wrong, good oF evil, proper or improper, eruel or benevolent acts are explained in terms ‘of morality Elements determining Morality 4. Object: the act itself ‘Ex: to end the life ofthe fetus is object of abortion; to end the life ofa terminally ill patient is the object of euthanasia 2, End: Purpose, intension, motive, or reason - without end, the act will not be eatried out at all 3 Circumstances - accidental aspects surrounding the act - include time, place, means to the act ‘Morals Ethies Principles and rules of vight | Formal reasoning process conduct used to determine right conduct Private and personal Professionally and publicly stated ‘Commitment to principles | Inquiry oF study of principles and values are usually | Process of questioning and defended in daily life pethaps changing one morals » Biology ~ branch of science that deals with living ‘organisms and their vital processes. Encompasses diverse fields, including botany, conservation, ecology, ‘evolution, genetics, marine biology, medicine, microbiology, molecular biology, physiology, and zoology. » Bioethies - Ethical implications and applications of health-related life sciences. Ethies as applied to human lite or jhealth. eg, decisions about abortion “or euthanasia, » Health Care Ethies ~ is a set of moral principles, beliefs and values that guide us in making choices about ‘modical care Nursing Ethics - refers to ethical issues that occur in nursing practice. ayrso7 enennss:! ER[BIOETHICS] “walere” = to be strong, ‘Strongly held beliefs or convictions about what one holds to be important and worthy in life. Freely chosei i beliefs, oF attitudes about the worth of a person, object, idea, ot ‘ection. Person’ s real values is shown by consistent patterns of Ddehavior. + Value system - the organization of a person’ s values along a continuum of relative importance © Purposive behaviour - setions that are performed “ ‘on purpese with the intention to reach some goal Purposive behavior -> based on decisions or choices ~ >based onvalues + Value Transmission ‘The origin ofa person’ s values can be traced to © Culture © Society’ © Institutions © Personality Greatly influenced by sociocultural environment ~>learned, ‘through observation and experience. ‘Types of Values © Religious - obtains strength from religious beliefs ‘Theoretical - holds truth, rationality, and empiricism in high esteem Politieal - values power ‘Eeonomie - values usefulness and practic “Aesthetic - values beauty, harmony and form Social - values human interactions, is kind, sympathetic, and unselfish + Intrinsic value - Relates to maintenance of ife + Extrinsic value - Originates outside the individual. Not necessary for the maintenance of life + Positive value - A view of what is desirable, How something should be + Negative value — Undesirable, How something not should be + Personal values - Personal values + Societal values - Used to feel accepted + Professional values - Reflection and expansion of personal values. Acquired during socialization into pursing: © Codes of ethies © Nursing experiences © Teachers Peers Nursing values: Competence and Comparison Important Values in Nursing (Watson) ‘Strong commitment to service. Belief in the dignity and worth of each person. ¥ Commitment to education ¥ Autonomy ‘Nurses should be value-neutral Values Clarification - a process by which people identify, examine, and develop their own individual values. Promotes personal growth by fostering awareness, empathy and insight. Prineiple: .no ane set of values is right for everyone. Values Clarification Process (Raths, Harmon and ‘Simon 1966) 4. Choosing (Cognitive) ‘9 Beliefs are chosen © Freely, without outside pressure © From among alternatives (© After reflecting and considering consequences 2. Prizing (Affective) Y Chosen belief are prized and cherished 3 Acting (Behavioral) Chosen belief are: Affirmed to “others, Incorporated into one’ sbehavior & Repeated. consistently in one’s life > Professional Ethies - A brinch of moral selence concerned with the obligations thet a member of the profession owes to the public, to his profession, to his brethren, and to his clients. Norms of behavior oF Code of hies of professionals to help members ofthe discipline to coowdinate their actions ot activities and to establish the publics trast on the discipline > Health Care Ethies - Deals with the conduct and moral issues that arise in. the practice of health eare professionals. It strives to resolve ethieal Issues that offen ‘confront health eare professionals > Bioethies~ Is a living study of the conduct of human life, Ikisa systematie study of human behavior in the field of Iilescienee and health eare in the light or moral vakies and principles Isa specific domain of eties that focuses on tora issues in the field of health cae. It evolved into a discipline all on His own as a result of life and death dilemmas faced by health eare practitioners. Caring for people’ s lives entails a continuous process of decision- raking because we want to save lives and enhance quality coffe ata times ‘Nursing Ethies- In limited sense, is known as, nursing liquette In general sense, itis concerned with moral principles governing the right conduet of murses in her relationship with patients, physicians, eolleagues, the nursing. profession and the public. Examination of all ethical and bio-ethial issues from the perspective of nursing theory and nursing ethics (lohnston). > Ethical Dilemma - Occurs when the decisions available in making an ethical decision are equally justifiable alternatives. When there is only one course of action, oF when conflict does not exist there is uo ethical dle Sometimes, it requires. an individual to make a choice between two equally unfavorable alternatives. Tt occurs Iheeause people have different ethical philosophy, follows different: philosophy in life and see’ life situations at different perspectives. In many instances, decisions must tbe made quickly beeause patient’ s medical condition is deteriora v . cused problems - cificuly lies in deciding, swhat to do, “ What should Ida? ‘Moral Dilemma = Being between a rock and a hard place + Difffeuty is internal and personal + Addressed by: learning to make better decisions ~ Reviewing personal value system ~ Attending staff development offerings and ethios rounds, © Action-focused problems - difficulty lies not in making the decision but in implementing it, " What ean I do?" * What rskam willing to take tod what sit?” Moral distress ~ Nase knows the right course of aetion but eannot carry it ‘out because of institutional polieies or other constraints. gyrso7 enennss:! ERCe Composed of interdiseiplinary group of health care providers (Goctors and nurses), community representatives (government officials, NGOs, clergy), and non medical representatives (social workers, ethieist) They discuss sensitiv sues such a: ‘when to withdraw or withhold treatment for an adult ‘and the treatment of a severely handicapped newborn some may include topies such as ~ the right to die ~ informal consent Fight to choose or refuse treatment right to know who is trating the patient Serves as a forum in which nusses and other health care professionals ean challenge a treatment decision. Increase communication between health eare providers, patients, and their families in order to clarify issues, ‘conflicts, and ‘expectations, With increased understanding between them, lawsuits can be avoided, Formulate organizational cade of ethics Why be Moral? ¥ The Answer of Divine Command: We strive to become moral because God is good and Hee commands it to us to be also good. ¥ The Answer that Morality pays: This means that we should act from self interest. This emphasizes that good deeds are rewarded. Whenever a person does the right thing, his action is always to his advantage Y The Fair Play or Common Interest Argument: This answer proposes that life is a game with rules and it is our ‘mutual advantage or common interest to play by the rules. ¥ “Reeause It is Right” Argument: This view holds that a person should aet morally simply beeause of his ethies or because it is right, not whether the aet will pay or be rewarded, PERT Are systema guides for developing ethical behavior. They answer the normative question of what beliefs and values should be morally accepted. Reflects the professions values and established stance at condht or a veriten list of acceptable behavior that every member is expected to observe Functions of Ethical Codes (Kozier etal) “To inform the public about the minimum standard ofthe profession and. to help them understand. professional hursing conduet, To provide a sign of the profesion’s commitment to the pbleit serve ¥ To outline the major ethical considerations of the profession, ‘To provide general guideline for professional behavior. ‘To guide the profession in self-regulation. ‘To remind nurses of the speeal responsibility they assume when caring forthe sick Functions of Professional Code of Ethies (Caffery and Sugarman) ¥-'Set forth basic principles and regulations to serve as guidelines Serve as resource for the orientation of new practitioners for their duties, rights and privileges Y Serves. as guide 10 identify and evaluate qualities symonymous with professional conduct nas ¥ Provide guideline for the establishment and operation of ‘education programs to prepare future members for service in the profession Identify common practices to be followed and those to be shunned Y Provide a guide for considering the relationships of individuals tothe employers, co-workers, society” in ‘general and to their own profession ¥ Serve as a basis for identifying standards of quality practice ¥ Provide, by implication, for legal actions against incompetents and violators ofthe code and for liability for the consequences of their actions ¥ Provide for due process under the law for practitioners "unjustly accused of misconduct in the performance of their tics Promulgated by. the ‘adopted by Professional Regulatory boards Set of professional and ethical principles ‘which all Filipino Professionals should be followed in the conduct of daily lives Adopted to cover an environment of good governance in which shall perform their duties, General Principles of the Code of Governance 4, Service to Others - This implies a commitment to. Iife of saeriice and genuine selflessness in carrying fut their duties even at the expense of personal gain, 2 Integrity and Objectivity - Professional should perform their responsibilities with the highest sense of integrity and imbued with netionaliam and spiritual Values, maintain objectivity, be free of conflicts, refrain fom engaging in any activity that would prejudice their abilities to ethically carry out their abilities nor make any representatives that would likely cause a reasonable person to misunderstand and be deceived. Professional Competence - It is their express ip with the new knowledge and ‘techniques in their field and upgrade their level of competence, taking part in lifelong continuing cacation prograun, ‘ty and Teamwork - Each professional shall) maintain and support one professional organization for all ls members promoting a deep spirit of solidarity and teamwork. 5 Social and Civic Responsibility ~ Professionals shall always earry out their professional duties with due consideration of the broader interest ofthe public, serve them with professional concern consistent with their responsibilities to aocily and as Filipinos, contribute to the allainment of the country’s national objectives: 6. Global Competitiveness - Professional shall remain open (0 challenges of a more dynamic and interconnected world, rise up to global standards and ‘maintain levels of professional practices fully aligned ‘with global practices. E. Code of Ethies + +a formal statement ofa group! s ideals and values. ‘set of ethical principles that: | is shared by members of the sg10up, | reflects their moral judgments over time, and | serves asa standard fr their professional actions. - usually hve higher requirements than legal standards, and they are never lower than the legal standards of the profession DIEZID' EMER S ![BIOETHICS] arses are reponstl for being fiiar with the code that the profession and help them understand professional ‘nursing conduct. Provide a sign of the profession’ s commitment to the ® Outline the major ethical considerations of the profession. Provide ethical standards for professional behavior. Guide the profession in self-regulation. Remind nurses of the special responsibility they aassuue when cating for the sick International Council of Nurses Code of Ethies Preamble ‘Nurses have four fundamental responsibilities: to promote heslth, to prevent illness, to restore health and to alleviate suflering. The need for nursing is universal. Inherent in nursing is respect for human rights, indluding 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, ereed, culture, disability or ilness, gender, sexual orientation, nationality, polities, race or social Siatus.’Nurses render health services to the individual, the family and the community and coordinate their serviees with, those of related gro one & ae ceerienres ‘The nurse’ s primary professional responsibility is to people requiring mursing care. + Tn 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 accurate, sufficient and timely information in a culturally Appropriate manner on whieh to base consent for eare 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 necds of the public, in particular those of vulnerable populations. The nurse advocates for equity and social justice in resource allocation, aceess to health cave, and oiher social and economic services ‘The nurse demonstrates professional values such as respectfulness, responsiveness, compassion, ‘uustworthiness, and integrity. 2 Nursesand Practice ‘The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual earning. The nurse maintains a standard of personal health such that the ability to provide eare is not compromised. ‘The nurse uses judgement regarding individual competence when accépting and delegating responsibility ‘Tho murse at all times maintains standards of personal conduct which reflect well on the profession and enhaneo public confidence. ‘The nurse, in providing care, ensures that use of technology and scientific advanees are compatible with the safety, dignity and rights of people. ‘The nurse strives to foster and maintain a practice culture promoting ethical behavior and open dialogue 3. Nurses and the Profession “The nurse assumes the major role in determining and implementing acceptable standards of linieal nursing practice, management, research and education. ‘The nurse is active in developing a core of research-based professional knowledge. ‘The nurse is active in developing and sus professional values. ‘The nurse, acting through the professional organization, participates in creating and maintaining sale, equitable social and economie working conditions in mursing. ‘The nurse practices to sustain and protect the natural environment and is aware of its consequences on health ‘The nurse contributes to an ethical organizational ‘environment and challenges uncthical practices and settings. 4. Nurses and Co-workers “The nurse sustains co-operative relationship with coworkers 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. ‘The nurse takes appropriate action to support and guide ‘coworkers to advance et Cs 41982 - the PNA Special Committee under chairmanship of Dean Emeritus Julita V. Sotejo developed the Code of Bthies of Filipino nurses, was approved but not implemented 4984 - BON adopted the Code of Ethics of the International Council of Nurses (ICN) and added the filth commitment which is "promotion of spiritual ‘environment” through Board Resolution No. 633 and was ‘enforced in 1989 4989 - Code of Ethics promulgated by the PNA was approved by the PRC through Board Resolution No. 1955 2004 - A new amended Code of Ethies for RNs has been promulgated by the BON in coordination and consultation ‘with the PNA. ‘The Code of Good Governance was principal basis and was adopted and integrated as they apply to the Nursing Profession. Adopted under RA 9173 and promulgated by the BON tunder Resolution No. 320 Series of 2004 last July 14, 2004 Preamble Health is « fundamental right of every individual. The Pilipino registered nurse believing in the worth and dignity of each human being recognizes the primary responsibility to preserve health at all cost. Emphasizes the responsibility of ining a core of the nurse to: People they serve Practice Co-workers Y Society and environment Profession Emenee ens gyrso7 enennss:! ERPromotion of health Prevention of illness Prolonging of life Restoration of health Spiritual upliftment ofthe 8888 tients ‘are statements about broad, general, philosophical concepts that direct or govern actions ‘They provide the foundation for moral rules, which are specific preseriptions for actions ‘They are widely accepted and generally are based on the humane aspeets of society. = By applying ethical principles, nurses become more systematic in solving ethical eoniliets. Prineiples are useful in ethical discussions because even if people disagree about which action is right in a situation, ‘they may be able to agree on the principles that apply. Such an agreement can serve as the basis for a solution ‘thats acceptable to all parties Son 4. Autonomy = refers to the right to make one’s own decisions Comes from the Greek words “autos” meaning self and “nomos” meaning governanee,rule aw Personal liberty to determine one’s action Self governance Individual choice Freedom of will It involves self-determination and freedom to choose and implement one’ s decision, free from deceit, duress, constraint and coercion, ‘To govern onc’ s self, one must have the eapacity to: 'Y Understand the issue and what the situation is all about Reason out and give one’ s own opinion Y Deliberate by weighing the pros and cons of the ‘Y__ Make an independent choice Informed consent is based on clients’ right to decide for themselves. Upholding autonomy means that the nurse accepts the client’ s choices, even when those choices are not in the client's best interests. Examples of clients’ autonomous behavior that ean impair recovery or treatment: © Smoking after a diagnosis of emphysema or lung, © Refusing to take medication © Continuing to drink alcohol when one has cirrhosis © Refusing to receive a blood transfusion because of religious beliefs Restrictions on autonomy may occur when there is potential hhann to others such as communicable diseases or acts of violence. Example: A person in the acute stage of contagious disease ius be isolated, even against his will, in order to prevent the spread of disease and proteet the greater public. = Legal exception of the rule of informed consent is therapeutic privilege = allows the caregiver to proceed with care in case of emergency, incompetence, waiver, or implied consent Example: % 4 © The nurse capacity to restrain a violent patient without need of asking for the patient’ s consent) who ‘may harm himself or other persons around him © An unconscious patient brought to the emergency room who receives: medical treatment without him. ‘being made to sign consent for medical treatment first Liberty-limiting Principle (Justification for overriding autonomy) + Harm principle - A person’ s liberty is justifiably restricted to prevent that person from Iiarming others * Offense principle ~ A person’ s liberty is justifiably redrced to prevent that person ffom offending, others + Principle of patemalism - A person’ s liberty is justifiably restricted to. prevent that person from harming himself or herself Nonmaleficence ‘Latin word: “Primum non nocere" ~ first, da no harm = isthe duty to™ do no harm” Harm can mean: intentionally causing harm In nursing, international harm is never acceptable = Considered 2 fundamental duty of health care providers Both the Nightingale Pledge and the Hippocratic Oath state that providers are to cause no harm to clients, ‘When upholding the principle of nonmaleficence, the nurse practices according to professional and legal standards of care. © The question most frequently asked in court of a nurse is "Did you eause any harm?” ‘The principle may justi be violated in some medical situations ‘When a pregnant women with advanced cardiac disease must have abortion = When you intubate a patient * When painful and disfiguring surgery is performed like radical neck dissection for the purpose of prolonging life in ‘patient with advaneed laryngeal cancer ~ When a gangrenous limb of a diabetic patient must be amputated in order to prevent the spread of infection to the other parts of the body Violated in short term to produce greater good for the patient in the long term Beneficenee - means“ doing good.” Latin words: “bene”- good ands “fiche”- to sct or do v The duty to do acts of kindness and mercy that directly benefit the client = Nurses are obligated to do good, that Is, to implement actions that benefit clients and their support persons. Example: 2 nurse may advise a client about a strenuous exercise program to improve general health, but should not do. soif the client is at risk of a heart attack. Five Rules of Beneficence from Principles of Biomedical Ethies Y- Protect and defend the rights of others. Prevent harm from occurring to others. Y Remove conditions that will eause harm to others. ¥ Help persons with disabilities Y Rescue persons in danger Justice - Based on the concept of fairness Requires that all people be treated fairly and equally © The major health-related issues of justice involve fair treatment of individuals and allocation of resource distribution, Example: a nurse making home visits finds one client tearful and depressed, and knows she could help by staying for 30. ayrso7 enennss! ERmore minutes to tak, However, that would take time from her next client, who has diabetes and needs a great deal of teaching and observation. The nurse wil need to weigh the facts caeflly in order t divide her time justly among her clients. The material prineiple of justice is the rationale for determining, when there can be unequal allocation of This concept specifies that resources should be allocated: Equally According to need effort ual’ merit ability) Y According to the individual's contribution to society Underlies the nurse commitment to provide services With respect for human dignity and render nursing care 10 the best of her ability to every patient regardless of religion, ses, ace, and eeonomi Tan individual need care, he/she has the right to be care for because care is his/her duc. No one therefore as the right to refuse healthcare to Emergency: regaedless of the individual’ s capacity to pay, health eare must be given othe person needing care because as health ere professionals out st duly i to save lives. ‘Three types of actions considered to be unjust: © Discrimination or abitrarily unequal treatment in enforcing policies/rules + Exploiting (taking unfair advantage of) another * Making unfair (false or derogatory) remarks about others ‘Veracity - The obligation to tll the trath ~~ means truthfulness, neither lying nor deceiving others Deception ea ake many forms: intentional ling 7 Ranlceoure ef information ¥ partial disclosure of information no culture, the two traits that affect truth telling are: + Family orientation to illness - Means members are often informed of serious diagnosis before the patients told + Non-confrontational attitude - Prevents us from disclosing unpleasant views Most pisicias stil Subseribe to death denial cultaro( fear of hurting others) Benevolent deception - Physician intentionally withholds information according to his sound judgement when such revelation would do more harm to an emotionally unstable or depressed person. 6. Fidelity ~ obligation of a person to be faithful to agreements, responsibilities and commitments that he has rade to himself and to others Sth main principle that supports the concept of accountability of nurses and other professionals ~ means faithfulness and keeping promises «ethical foundation of nurse-client relationships (tients have an ethical right to expect nurses to act in Uhr best interests, = Nurses function in the role of lient advocate (a person who speaks up for or acts on behalf of the client) Fidelity is demonstrated when nurses: ~~ Represent the client's viewpoint to other members of the health eare team Avoid letting their own personal values influence their advocacy for clients Support the client’ s decision even when it conflicts with the nurse’ s preferences or choices Abandonment - is a breach of fidelity and infidelity ‘amounting to disloyalty ‘Confidentiality ~ Respect for individual privacy Privilege communication Confidential communication or professional secrecy because it is given based on trust. Both legal and moral obligation of health care providers: ‘The client and his/her family are entitled to known information or facts within the limits determined by the physician. "Nurse may only repeat what the doctor wishes to disclose ‘Any information gathered by the nurse during the course fof earing for the cient should always be treated confidential until the client’ death ‘Nurses reassures the client that information gained in the interview will be treated confidential Persons required to observe confidentiality Physicians who deal with the elient even for a briefest times at varius phases of the client’ s illness or treatment Y Pharmacist who prepares and dispenses the ‘medication preseribed to the client all other health eare professionals involved in the care of the client such as nurses , medical technologist, hospital chaplain, student nurses and social workers: All other personnel who attend to the care of the patient ‘such as janitors, hospital receptionists, secretaries, accountani, treasurer, ee. ‘Confidential information may be revealed when: ¥--Thepatient himself/herself permits ¥ ‘Theease is medicolegal Y ‘The patient is ill of communicable or highly contagious disease and public safety may be jeopardized ¥ Given to the mombers of the health team if information is relevant to his care Y Upon order of the court or when public safety and or iro otherwise ‘A moral dilemma is a problem in the decision-making between two possible options, neither of which is absolutely acceptable from an ethical perspective. 1 is also referred to a fan ethical dilemma, The Oxiord Dictionary defines ethical dilemma as a “decision-making problem veen two possible ‘moral imperatives, neither of which is unambiguously acceptable or preferable. paradox in moral philosoph is sometimes called an ethieal (Oxford Dictionary) Based on these definitions, moral dilemmas have the following in commor 1. ‘The agent is required to do each of two (or more) 2 Theagent can do each ofthe act 3+ But the agent cannot do both (or all) ofthe actions, actions which are morally unacceptable ayrso7 enennss: ER[BIOETHICS] ‘The agent thus seems condemned to moral failure; no matter what she does, she will do something wrong (or fail to do something that she ought to do) “This means that moral dilemmas are situations where two ‘or more moral values or duties make demands on the deeision- maker, who ean only honor one of them, and thus will violate at Teast one important moral eoncern, no'matter what he or she decides to do, Moral dilemmas present situations where there is tension between moral values and duties that are more or less on equal footing. The decision-maker has to choose between a wrong and another wrong. The decision-maker is a deadlock. > False Dilemma - is a situation where the decision- ‘maker has a moral duty to do one thing, but is tempted or under pressure to do something else. A false dilemma isa choice between a right and a wrong, For example, a lawyer or an accountant can face an ‘opportunity to prioritize self-interest over the client's interest. ‘What to do when faced with a moral dilemma? ‘Uhimately, dilemmas are conflicts in the application of moral standards. The question is which moral standards rmuist be followed? In a state of emergency, necessity demands rho moral lw. You have to decide based on your best judgment or choose based on the principle of lesser evil or greater good Lh Tsetse! Plena refers to personal dilemmas. Itis an individual's damm. if-you-do-and-damn-if-you-don't situation “The ease of Heinz as given in the Activ fone of the best known individual os) Koblberg’s dilemma questions were as follows: “Should Heinz have stolen the drug” (Mackinnon, B, et, al 2015). If he ‘didnot steal the drug that would mean his wife's death, He was tom between stealing the drug and saving his wife, The dilemma is faced by an individual who is tom between 2 ‘obligations ~ Lo save the wife o obey the lave. So this is an ‘xaunple of aa individual dilemma. 2. Organizational = An organizational dilemma is a puzzle posed by the dual necessities of a. sock ‘Organization and members’ sel-interest. It may exist between personal interests and organizational welfare or between group interests and organizational well- being (Wagner, J. 2019) ‘The example ofthe Catholic school in the Activity phase of the lesson shows the dilemma between the geal of the school to five quality education for the poor and so must charge the Towest tuition fee possible and yet to keep quality faculty the school must raise their salary and consequently, must raise tuition % Structural - The case ofthe principal whether to be participatory or non-partieipatory in school affairs but uo to her not 50 favorable experience of attempting tobe partipatry ended up to one-woman rls a ty phase of the lesson is lemma’s of Kohlberg’s Different divisions have their own different culture ‘and so coordination between divisions or bringing them together becomes more difficult With decentralization; local governments have become more empowered to direet their affairs just as schools hhave become empowered to address their problems or are given opportunities to localize the given enevieulum. In effect, local governments and schools have likewise become more differentiated and so it becomes more difficult to integrate them for a unified structure, Local governance and school curricula have become more complex. There is need for ‘more costly coordination strategies gyrso7 enennss:! ER