Principles, Concepts, and

Application of Bioethics in Care of

the Client
 Bioethics

 Bioethics is a rather young academic inter-

disciplinary field that has emerged rapidly as a
particular moral enterprise against the background
of the revival of applied ethics in the second half of
the twentieth century.
 General goals of bioethics:
 Discipline: Bioethics provides a disciplinary framework
for the whole array of moral questions and issues
surrounding the life sciences concerning human beings,
animals, and nature.
 Inter-disciplinary Approach: Bioethics is a particular
way of ethical reasoning and decision making that: (i)
integrates empirical data from relevant natural sciences,
most notably medicine in the case of medical ethics, and
(ii) considers other disciplines of applied ethics such as
research ethics, information ethics, social ethics, feminist
ethics, religious ethics, political ethics, and ethics of law
in order to solve the case in question.
 Ethical Guidance: Bioethics offers ethical guidance
in a particular field of human conduct.
 Clarification: Bioethics points to many novel
complex cases, for example, gene technology,
cloning, and human-animal chimeras and facilitates
the awareness of the particular problem in public
discourse.
 Structure: Bioethics elaborates important arguments
from a critical examination of judgements and
considerations in discussions and debates.
 Internal Auditing: The combination of bioethics and
new data that stem from the natural sciences may
influence−in some cases −the key concepts and
approaches of basic ethics by providing convincing
evidence for important specifications, for example,
the generally accepted concept of personhood might
be incomplete, too narrow, or ethically problematic
in the context of people with disability and, hence,
need to be modified accordingly.
. A Brief History of
Bioethics
 The Origin of the Notion of Bioethics

 It is commonly said that the origin of the notion of

bioethics is twofold: (i) the publishing of two
influential articles; Potter’s “Bioethics, the Science of
Survival” (1970), which suggests viewing bioethics as
a global movement in order to foster concern for the
environment and ethics, and Callahan’s “Bioethics as
a Discipline” (1973)
 The Origin of the Academic
Discipline and Institutionalization
of Bioethics
The Origin of Bioethics as a Phenomenon

 The notion of bioethics and the origin of the

discipline of bioethics and its institutionalization in
academia is a modern development. The
phenomenon itself, however, can be traced back, at
least with any certainty, to the Hippocratic Oath in
Antiquity (500 B.C.E.) in the case of medical ethics
(Jonsen 2008) and possibly beyond if one considers
the Code of Hammurabi (1750 B.C.E.), which
contains some written provisions related to medical
practice .
Sub-disciplines in
Bioethics
 Medical Ethics

 The oldest sub-discipline of bioethics is medical

ethics which can be traced back to the introduction
of the Hippocratic Oath (500 B.C.E.). Of course,
medical ethics is not limited to the Hippocratic Oath;
rather that marks the beginning of Western ethical
reasoning and decision making in medicine. The
Hippocratic Oath is a compilation of ancient texts
concerning the proper behaviour of physicians and
the relationship between physician and patient.
Theories In Bioethics
 Deontological Approaches

 Deontological approaches such as provided by Kant

(1785) and Ross (1930) are commonly characterized
by applying usually strict moral rules or norms to
concrete cases.
 Utilitarianism

 One of the most prominent and influential ways of

ethical reasoning and decision making in the field of
bioethics is based on utilitarianism. In the late
twentieth century, utilitarian approaches were so
influential that many people outside academia
believed that all bioethicists were utilitarians.
 The Four-Principle Approach

 One of the most important approaches in bioethics

or medical ethics is the four-principle approach
developed by Tom Beauchamp and James Childress
(1978, latest edition 2009). consists of four
universal prima facie mid-level ethical principles:
(1) autonomy, (2) non-maleficence, (3) beneficence,
and (4) justice. Together with some general rules and
ethical virtues, they can be seen as the starting point
and constraining framework of ethical reasoning and
decision making (“common morality”)
 Feminist Bioethics

 Feminist bioethics can only be fully appreciated if

one understands the context in which this
increasingly important approach evolved during the
late twentieth century (Tong 1993, Wolf 1996,
Donchin and Purdy 1999, Rawlinson 2001). The
social and political background of feminist bioethics
is feminism and feminist theory with its major social
and political goal to end the oppression of women
and to empower them to become an equal gender.
Principles of Bioethics
 Autonomy
 Justice
 Beneficence
 Non-maleficence
Application of Bioethics in
the Care of Clients
 The Role of Ethics in Nursing
 Nurses work alone and with other healthcare
professionals. This collaboration between nurses,
colleagues and physicians is important to the safety
and quality of patient care. Nurses perform duties
based on physicians’ instructions and use their own
judgment as necessary. Ethics in nursing includes fair
and equable treatment of all patients regardless of the
following:
 Economic status.
 Age.
 Ethnicity.
 Citizenship.
 Disability.
 Sexual orientation.
The Ethical Responsibilities of Nurses

 Nurses must maintain professional

competency by continuing their
education and participating in
professional development. The ethical
responsibilities of nurses include
promoting health, preventing disease
and alleviating suffering.
 Morality and Ethics in Nursing

 Nurses have a responsibility to report any immoral

professional behavior. They should notify staff
leaders about healthcare professionals who engage in
illegal activities, demonstrate incompetence or work
while impaired.
 Balancing Nursing Ethics with Job
Performance

 Ethical nursing constitutes a framework for optimal

patient care. With ethics at the forefront, nurses must
balance the needs of their patients and the requirements
of the healthcare systems that employ them. The
American Nurses Association (ANA) recommends that
nurses see to the following:
 Support and honor the rights of patients.
 Advocate for ethical nursing.
 Serve on ethics committees.
 Refuse to compromise ethics.
 Educate students about ethics.
 Patient Rights

 A nurse’s priority is to focus on the care and rights of

their patients and put aside any prejudices
concerning a patient’s situation or demeanor.
 Patients have the right to make decisions about their
healthcare. They can decide to accept or refuse
treatment. Patients should expect to receive accurate
and complete information about their conditions.
 Ethics in Nursing Education

 Nurses can never infringe on a patient’s human

rights. Nurses must also set boundaries with patients
to remain professional. They must be sensitive to a
patient’s cultural and religious beliefs, values,
language, lifestyle and literacy level while caring for
them. Patients trust nurses to resolve conflicts, keep
them safe and concentrate on their needs, all while
telling the truth and upholding ethics in nursing.
 Outcome Criteria For:
Inflammatory and Immunologic
Reaction
 Risk Factors

A patient becomes at risk for infection if he is vulnerable to pathogenic

organisms. It can be related to any of the following:
 Invasive procedures
 Pharmaceutical agents, like immunosuppressants
 Increased exposure to pathogens
 Compromised circulation
 Break in the integrity of the skin
 Chronic disease
 Rupture of amniotic membrane
 Lack of immunization
 Inadequate primary defense, like tissue damage and broken skin
 Inadequate secondary defenses, like decreased hemoglobin and suppressed
 inflammatory response
 Trauma
 Insufficient knowledge regarding avoidance of pathogens
 Desired Outcomes

 Remain free from signs of any infection

 Demonstrate ability to perform hygienic measures,
like proper oral care and handwashing
 Demonstrate ability to care for infection-prone site
 Verbalize which symptoms of infection to watch out
for
 Show capability to recognize symptoms of infection
Cellular Aberration
 Risk Factors:
Presence of adverse personal habits
Evidence of impaired perception
Low income
Lack of knowledge
Poor housing conditions
Risk-taking behaviors
Inability to communicate needs adequately (e.g.,
deafness, speech impediment)
Dramatic change in health status
Lack of support systems
Denial of need to change current habits
 Expected Outcomes:

 Patient describes positive health maintenance behaviors such as

keeping scheduled appointments, participating in smoking and
substance abuse programs, making diet and exercise changes,
improving home environment, and following treatment regimen.
Patient identifies available resources.
Patient uses available resources.
Assess for physical defining characteristics
Assess patient's knowledge of health maintenance behaviors
Assess health history over past 5 years
Assess to what degree environmental, social, intrafamilial
disruptions or changes have correlated with poor health behaviors
Determine patient's specific questions related to health
maintenance
Multi-Organ Failure
 Outcome Criteria

 Treatment of patients with septic shock has the

following three major goals:
 To resuscitate the patient from septic shock, using
supportive measures to correct hypoxia,
hypotension, and impaired tissue oxygenation
 To identify the source of infection and treat it with
antimicrobial therapy, surgery, or both
 To maintain adequate organ system function, guided
by cardiovascular monitoring, and to interrupt the
pathogenesis of multiple organ dysfunction
syndrome (MODS)
Emergency and Disaster
Preparedness
 Emergency and disaster planning involves a
coordinated, co-operative process of preparing to
match urgent needs with available resources. The
phases are research, writing, dissemination,
testing, and updating. Hence, an emergency plan
needs to be a living document that is periodically
adapted to changing circumstances and that
provides a guide to the protocols, procedures, and
division of responsibilities in emergency response.
 Emergency planning is an exploratory process that
provides generic procedures for managing
unforeseen impacts and should use carefully
constructed scenarios to anticipate the needs that
will be generated by foreseeable hazards when they
strike. Plans need to be developed for specific
sectors, such as education, health, industry, and
commerce.
 Risk identification
 Risk reduction
 Preparedness
 Financial protection
 Resilient reconstruction
Thank You for Listening!