Ethical Decision Making

We constantly make decisons

Where to go to college
Which job to accept
Whether to marry or not (ehehehehe)
What to have for lunch
What to wear

Decisions may be routine,

others call for more
deliberation, and others are not
as clear-cut as others.

Moral / Ethical Problems

Moral Uncertainty
We sense that there is a moral problem, but are not
sure of the morally correct action.
We are unsure what the moral principles or values
apply
We are unable to define the moral problems

Moral/ Ethical Dilemma

When a difficult problem seems to have no satisfactory
solution or when all solutions to a problem appear to
have to be equally favorable
Conflicting moral claims
Must be careful to differentiate from practical dilemmas

Practical Dilemmas
Moral claims compete with nonmoral claims.
Nonmoral claims can be often be identified as claims of
self-interest
Moral claims have greater weight than nonmoral claims

Moral Distress
Situations that present moral problems which seems to
have clear solutions, yet they are unable to follow their
moral beliefs because of institutional or other
restraints.
Violation of personal moral value and fails to fulfill
perceived responsibility
Will undermine integrity
Results to most burnout
Can erode ones values and affect confidence and selfesteem

Moral Outrage
Shares feelings of powerlessness with moral distress
One do not participate in the act that is considered to
be immoral, do not believe they are responsible for
wrong, but perceive that they are powerless to prevent
it.
Results to whistleblowing

Making decisions

Nursing Process
Problem identification based on assessment of data
Development of a plan of care, guided by desired
outcomes
Implementation of interventions
Evaluation of outcomes
Revision of the plan over time

Scientific Process and Ethical Decision

Making

Observation
Hypothesis
Law
Theory

Assessed ethical dilemma

Rule
Principle
Theory

Emotions and Ethical Decisions

A Guide to Ethical Decision Making

The guideline presented

provides a framework that
requires an ongoing evaluation
and assimilation of information

A couple is pregnant with their

second child after numerous
unsuccessful attempts with
artificial insemination. During a
routine ultrasound at 28 weeks
gestation, the physician
discovers that the fetus is
anencephalic. The life
expectancy of an anencephalic
baby is only a few days to
weeks after birth.

Gather Data and Identify Conflicting Moral

Claims
What makes this situation an ethical problem? Are
there conflicting obligations, duties, principles, rights,
loyalties, values or beliefs?
What are issues?
What facts seem most important?
What emotions have an impact?
What are the gaps in information at this time?

Identify Key Participants

Who is legitimately empowered to make this decision?
Who is affected and how?
What is the level of competence of the person most
affected in relation to the decision to be made?
What are the rights, duties, authority, context and
capabilities of participants?

Determine Moral Perspective and Phase of

Moral Development of Key Participants
Do participants think in terms of duties or rights?
Do the parties involved exhibit similar or different moral
perspectives?
Where is the common ground? The differences
What principles are important to each person involved?
What emotions are evident within the interaction and
with each person involved?
What is the level of moral development of the
participants

Determine Desired Outcomes

How does each party describe the circumstances of the
outcome?
What are the consequences of the desired outcomes?
What outcomes are unacceptable to one or all
involved?

Identify Options
What options emerge through the assessment process?
How do the alternatives fit the lifestyle and values of
the person(s) involved?
What are legal considerations of the various options?
What are alternatives are unacceptable to one or all
involved?
How are alternatives weighed, ranked and prioritized?

Act on the Choice

Be empowered to make a difficult decision.
Give yourself permission to set aside less acceptable
alternatives.
Be attentive to the emotions involved in the process

Evaluate Outcomes of Action

Has the ethical dilemma been resolved?
Have other dilemmas emerged related to the action?
How has the process affected those involved?
Are further actions required?