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WEEK 5 - Ethical Decision Making
WEEK 5 - Ethical Decision Making
Each of us makes decisions every day. These decisions are likely routine and not
that difficult to make.
Studies have shown that “30 - 50% of nurses leave bedside patient care
because of moral distress” (Burkhardt & Nathaniel 2014, p. 136);- the
stress caused by ethical dilemmas.
If nurses are informed about ethics and fully involved in decision making
around moral dilemmas in practice, perhaps more nurses would stay at
the bedside.
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Ethical/Moral Problems
Hand Hygiene
Ethical or moral problems are different from common problems in that they
usually:
“Have no easy solution
Are associated with value laden terms such as, good, bad, harm, benefit, should,
ought to, right, and wrong
Involve uncertainty and conflict
“Are not reversible once a decision is made ” (Burkhardt & Nathaniel 2014, p.118)
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Ethical/Moral Problems
Hand Hygiene
Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z.
© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae
Ethical/Moral Problems Hand Hygiene
examples
Problem: A patient in severe and intolerable pain due to not receiving pain
medication.
Practical/Clinical/Technical: the cause of it is neglecting the patient’s pain, so
by the thorough assessment of the patient and administering the analgesia, we
will solve the patient’s problem.
Ethical/ Moral: If the pain was due to the patient’s refusal of pain relief based
on religious grounds, giving the analgesia is not allowed by the moral demand
to respect the patient’s autonomous wishes, and the nurses’ moral interest in
not suffering.
04/24/2024 SUBTILE 2 : MAIN TITLE 8
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Ethical/Moral Problems
Hand Hygiene
1. Moral unpreparedness
2. Moral blindness
3. Moral indifference
4. Amoralism
5. Immoralism
6. Moral complacency
7. Moral fanaticism
8. Moral disagreements and conflicts
9. Moral dilemmas
10.Moral stress, or distress
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1. Moral unpreparedness Hand Hygiene
expertise to realize what is the situation, and not able to deal with its complexities.
This situation, not only can make the nurse inadequate, but also dangerous, as
“A nurse walks into her new unit appointment, turns out to be ICU, and she receives a
patients on a ventilator, that she has never learnt anything about, or even saw one before!”
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Hand Hygiene
2. Moral blindness :
Moral indifference
Unconcerned or care-free attitude towards moral issues or demands
“Why bother to be moral?”
Usually such persons do not express any wish or opinion towards doing,
or not doing an action.
Example 1: Applying horn in street!
Example 2: A nurse who is not interested in alleviating patient`s pain despite his
complaint, or result of her assessment ! ( or Not interested in any form of violation
of the patients’ rights).
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Hand Hygiene
4. Immoralism
Could be either :
a) Moral turpitude: (social private duty) anything done on purpose against what is
b) Moral delinquency: any act that involves negligence of a moral duty (carelessness or
Those people just cannot accept the fact that they can be mistaken, and so
Example: A nurse with 30 years of experience in elderly home, who insists that it is
right and proper that all elderly patients should be uniformly designated to DNR upon
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7. Moral fanaticism: Hand Hygiene
A morally fanatic person is, someone who is absolutely convinced with certain
In health care setting; a health care professional, might impose his/ her own
Example: a doctor who insists that being honest to the patients about their condition is
the most important thing, disregarding their autonomy.
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8. Moral disagreements and conflicts Hand Hygiene
E.g.: Both RNs agree to prevent the patient’s rights from being violated,
(Nurse A: acts in situations of violation of patient’s rights even if this threatens
her job security, Nurse: B agree to prevent violation patient’s rights from being
violated, but disagree that nurses should do so even if they lost their job). ----
No Resolution --- ( Moral Deadlock )
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8. Moral disagreements and conflicts Hand Hygiene
E.g. : Nurse A: Disagrees on killing a terminally ill patient with a lethal injection
Nurse B: Disagrees on killing a terminally ill patient with a lethal injection, but
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8. Moral disagreements and conflicts Hand Hygiene
Don’t agree on any criteria of relevance, and Don’t share any basic moral
principles.
E.g. : Nurse A: Rejects retrieving organs from patients who are not fully dead for an organ
transplantation as she considers it as a murder, because its violating the sanctity of life.
Nurse B: Doesn’t consider it as a murder as the sanctity of life has no substance with the
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quality of life, (no solution).
9. Moral dilemmas
Hand Hygiene
Moral dilemmas are the most discussed type of moral problems in ethics and
bioethics.
It is a situation, where you have to make a choice between two things, that
both are equally undesirable, or both desirable.
This can be due to: logical incompatibility between 2 different moral
principles (ex. P.109), or due to competing moral duties, or when you have
competing or conflict of interests.
Sometimes the decision is related to people or certain attachments .
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9. Moral dilemmas cont.
Hand Hygiene
E.g. A RN who accepts sanctity of life view and another moral principle as non-
maleficence which demands that persons should be spared intolerable suffering
Accepting sanctity of life -- reject administration of large and potentially lethal doses
of narcotics that might be required to relieve the patient’s pain
Following the principle of non-maleficence-- the RN is required to administer these
lethal narcotics.
----- in this case the RN is confronted with a dilemma that to uphold the sanctity of life
principle could violate the principle of non-maleficence
Informing patient with cancer about his diagnosis against family wishes.
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10. Moral distress, stress, & perplexity Hand Hygiene
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10. Moral distress, stress, & perplexity Hand Hygiene
cont.
Moral distress occurs when one knows the ethically correct action to
take but feels powerless to take that action
This can happen due to institutional constraints, legal barriers, limited
resources, …etc.
Perplexity can also lead to distress, as it is a state of moral confusion.
cont.
Problems
Facing ethical problems leads to difficulty decision making:
2. Context : The world in which the patient lives is critical in defining that person,
and influences the selection of one choice over another.
3. Stakeholders : The number of people that might be involved with the decision
and who have strong or competing differences of opinion in what action to
take (patients, family members, close friends , others) .
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Factors that Confound Hand Hygiene
Ethical Problems
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Steps To Ethical Decision Making
Hand Hygiene
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Steps To Ethical Decision Making
Hand Hygiene
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Steps To Ethical Decision Making
Hand Hygiene
Important questions to ask during steps of ethical decision making might include:
What is the issue here?
Are there any hidden issues?
Where are the conflicts?
What are the ethical theories/principles that apply?
What are reasonable alternatives to resolve the problem?
How do the alternatives rest with my personal/professional values?
Are you treating others as you would want to be treated?
How do the key parties want to resolve the problem?
Would you be comfortable if your decision making were publicized?
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Emotions in Decision Making:
Hand Hygiene
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Emotions in Decision Making: Hand Hygiene
solution to problem and there are conflicts between ethical principles, values,
Moral distress may have significant negatives consequences for patient care.
emotions.
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© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae
Summary Hand Hygiene
Ethical decision making involves defining the problem, identifying a desired goal, gathering
information, comparing options, choosing the best course of action and evaluating the
Identification of one’s own value system as well as the value system of the key
stakeholders involved in the ethical situation are critical to how an ethical dilemma is resolved.
Life experience plays a very major role in dealing with moral issues and moral distress.
Nurses who practice applying the concepts of ethics and the steps of a decision making
model in the realities of day-to-day practice will develop the competence and confidence
References:
Burkhardt, M. & Nathaniel, A. (2014). Ethics and issues in contemporary nursing. 4th
Edition. Canada: Delmar Cengage Learning.
Johnstone, M. (2019). Bioethics: a nursing perspective. 7th Edition. Australia: Elsevier
Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z.
© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae
Hand Hygiene
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