Ethical principles/concepts

 Autonomy- self determination, respecting to choices

and wishes of persons who have the capacity to
decide and protecting those who lack these capacity.
 It conflicts with the paternalistic attitude of many
health professionals

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 Ethical principles/concepts

FIDELITY
 The individual’s obligation to be faithful to
commitments made to self and to others.
 The professional faithfulnesses or loyalty to
agreements and responsibilities accepted as part of
practice of the profession.
 Is the main support for the concept of accountability

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 Ethical principles/concepts

BENEFICENCE
 Views the primary goal of health care as doing
good for patients under their care in general.
 Here the concern is for norms of value:
 what is good?

 What is bad?

 What is the highest good?

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 ethical principles/concepts…..

NONMALEFICENCE
 Do no harm to your patients intentionally or
unintentionally.
 Might be violated for short run in order to
produce long term well being for the patient.
 Extend also for the protection from harm of
those who can’t protect themselves.

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 ethical principles/concepts…..

VERACITY
 Tell the truth and do not intentionally deceive
patients.
 In application it may interfere with the principle of
nonmaleficence.
 Patient has the right to know the truth

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 ethical principles/concepts…..

JUSTICE
 The obligation to be fair to all people.
 States that individuals have the right to be treated
equally regardless of background.
 Basic goods should be distributed so that the least
advantaged members of society are benefited.

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Informed consent
 Have two values: well-being and self determination
 Possible benefits, risks, costs, other consequences and
alternative treatments includes disclosure of the
health care and decision by the patient
 Disclosure standards include medical standard and
material risk.

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Elements of informed consents

1. Information to be discussed, including the nature of

intervention

2. The patient’s comprehension

3. Patient’s decisional capacity

4. The voluntary nature of decision

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Life sustaining treatment
 Any medical procedure or intervention to a terminally ill
patient or in coma/ persistent vegetative state with no
reasonable expectation of regaining consciousness or
significant cognitive function to prolong the dying
process
 Option of the declarant, needs a “ living will” declaration.

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 Life sustaining treatment include mechanical
ventilation, renal dialysis, chemotherapy, antibiotics
therapy, artificial nutrition or hydration
 Physicians, ethicists and lawyers widely agree that
withdrawing or withholding life sustaining
treatment is legally and ethically permissible under
appropriate circumstances

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 Respect the decision to forego life sustaining
treatment by a patient who has decisional capacity
 Medical futility- rendering unhelpful and possibly
harmful medical intervention.
 CPR is the prevention of sudden death, unexpected
death; not recommended in older persons, terminally
ill or irreversible illness
 Artificial feeding near the end of life

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MODEL FOR CLINICAL ANALYSIS OF CLINICAL CASES
Ethical analysis
Four component model for ethical analysis of clinical
cases
 Medical indication
 Patient preference
 Quality of life consideration
 Contextual/related/features

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Rational for the model
 arise on the facts & values embedded in the case it
self
 Ethical aspects are seen in the medical benefits, the
preference of the patient, the quality of the patient’s
life and the relation between care of the patient,
family, social, economic, and legal circumstance
surrounding the case

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1. Medical indication

 Diagnosis and treatment of the patient pathological condition

 What are the goals of those interventions

 What are the possible benefits of intervention, realistic?

 Moral dimension- Beneficence and non maleficence; risks

should be balanced by benefits

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Medical indication
1. What is the patient’s medical problem? History?
Diagnosis? Prognosis
2. What are the goals of treatment

3. What are the probabilities of success

4. What are the plans in case of therapeutic failure
5. In sum, how can this patient benefited by medical
and nursing care, and how can harm be avoided?

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2. patient preference
• Based on the patient own values and personal assessment of
benefits and burns are ethically relevant;
• What are the patient’s goals
• What does the patient want
• Has the patient get enough information
• Does the patient comprehend? Is the patient consenting
voluntarily?
• Moral dimensions- arising with in this component is
consideration of respect for the principle of autonomy

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The principle of respect for autonomy
1. If competent , what is the patient state about the
preference for treatment
2. Has the patient been informed of the benefits
3. If incapacitated, who is the appropriate surrogate, is the
surrogate using appropriate standard of decision making
4. Is the patient unwilling or unable to cooperate with
medical treatment? If so why?
5. In sum, is the patient’s right to choose being respected to
the extent
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3. quality of life consideration
 Any injury or illness threatens persons with actual
or potential reduced quality of life manifested in the
sign/symptom of their disease
 The objective of medical intervention is to restore,
maintain or improve quality of life
 The topic quality of life must be raised

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The principles of beneficence and non maleficence and
respect for autonomy
1. What are the prospects, with or with out treatment
2. Is the patient’s present or future condition such that
his or her continue life might be judged
undesirable?
3. Are there plans for comfort and patient care

4. Is there any plan and rationale to forge from

treatment
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4. Contextual/related/features surrounding the cases
 Persons, institutions, financial, and social
arrangements have positive or negative influence
on the patient care
 these decisions have psychological, emotional,
legal, financial, scientific, educational, religious
impact on others
 Moral dimension- justice and rights of various
participants
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The principles of loyalty and fairness

1. Are there family issues that influence treatment decision

2. Are there issue in confidentiality
3. Are there religious and cultural factors
4. Are there problems of allocating resources

5. How does the law affects the decision

6. Is there any conflict of interest on the part of the

provider or institutions

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The ethical decision making
Process in ethics/nursing process
 Step one- collect, analyze, and interpret the data;
• Obtain information about the dilemma: pts wish,
families wishes, extent of physical or emotional
problem causes dilemma
• Ex. Whether or not to resuscitate patient with
terminal illness;

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• Understand how mentally competent the patient is
to made a resuscitation decision, what the patient
desires are and what the family thinks about the
situation
• Interpret the total meaning

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 Step two-State the dilemma
 Reduce the dilemma in to a statement of one or two
that resolves around the key ethical issues
 It involves a question of conflicting pts right to
death with dignity and basic ethical principles,
nurses obligation to save life.
 Following the competent Patient wishes, or the
family’s decision is unequivocal.

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 Step three - consider the choices of action
• List all possible courses of action that can resolve the
dilemma with out considering their consequences.
Possible to use inputs from outside colleagues or
supervisors.
 Step four - analyze the advantage and disadvantage
of each course of action /may use code of ethics to
decide/

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 Step five - make decision
• The most difficult part
• Ethical dilemmas produce different opinions;
• Best one is based on sound ethical decision making;
patients wishes always supersede independent
decision
• Collaborative decision making is the idea and tend to
produce fewer complications on the long-term
resolution-patient, physician, nurse and family
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