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An Introduction to Ethical Concepts

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Kaye Greenough

on 10 April 2017

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Transcript of An Introduction to Ethical Concepts

Aims and Objectives
Aim

To have a fundamental understanding of the ethical and moral issues in healthcare and how to begin to unravel.

Ethics
"Generic term for various ways of understanding and examining the moral life."


Beauchamp and Childress (2001:1)

Ethical Challenges in 21st Century Healthcare
An Introduction to Ethical Concepts
In Healthcare
Objectives
What do we mean by 'ethics'?
What are the issues?
How can I act ethically in practice?

"Ethics is an unavoidable and necessary part of nursing practice. It involves doing the
right thing
."

Chadwick and Gallagher 2016:1

What is The Right Thing?
How can I make the right 'ethical' decision?
Whose perspective should I consider?
Does everyone have the same thoughts on what is and what is not ethical?

Three Types of Ethics
Normative or Prescriptive Ethics
Norms
Rules
Principles
Theories
Metaethics
Explores the meaning of ethical concepts e.g care, compassion.
Empirical or Descriptive Ethics
Describing and researching the moral life e.g. what do patients expect of a caring nurse?
Why is important to consider ethical behaviour?
Andrews report 2014
Francis inquiry 2013
Winterbourne care home 2012
Baby P 2007

Public Expectations
Aging population
Technology
Abortion
Right to die
Trust
Values change across time
Francis Report
Andrews Report
Local issues
Global issues
Ethical Approaches
Theories
Duty Based/Deontology
Duty bound
What is right or wrong about an action?
Underpin Codes of Practice
The consequence is irrelevant
Kant
To treat others as an end in themselves and not merely as a means.
Respect individuals and guards against exploitation.
Chadwick and Gallagher 2016:9
Rights based Ethics
Human Rights Act (1998)
Patients Rights
Health care professionals rights
Obligation versus Rights
http://thirdforcenews.org.uk/tfn-news/campaigners-produce-video-on-assisted-suicide
Frank a 90 year old gentleman who was terminally ill with Pancreatic Cancer was being cared for on a medical ward. John was a staff nurse caring for Frank and was aware of deterioration in Frank’s condition since the start of his shift. He decided to alert Frank’s relatives of this deterioration.
http://www.shutterstock.com/video/clip-4760009-stock-footage-male-medical-proessional-discussing-treatment-plan-with-elderly-female-patient-while-using-a.html
Frank’s 89 year old wife, Mary had suffered a heart attack 3 days previously and was an in patient on the cardiac medical ward in the same hospital. Therefore, John contacted Frank’s siblings and they asked if he would contact the ward Mary was on so that she could be with Frank. John called the ward and alerted the staff to Frank’s continued deterioration.
Mary’s condition required continuous cardiac monitoring. Therefore, the staff on the ward contacted her consultant before informing her of Frank’s deterioration. The consultant said that Mary should be informed; but she would not be able to visit Frank unless she could be accompanied by a member of the ward staff and that she would be monitored during her visit. Mary wanted to visit Frank as soon as she found out his condition was deteriorating. However, the ward was busy and it took 30 minutes before a suitably qualified member of staff and portering staff were arranged.
https://www.google.co.uk/search?q=elderly+male+patient&espv=2&biw=1280&bih=918&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiFwOSbsL7PAhXC4iYKHbL8BNYQ_AUIBigB#tbm=isch&q=clock&imgrc=3zqj4hMfcXsfvM%3A
Since, John first alerted the ward it had taken nearly 2 hours before Mary was allowed to go to visit Frank
Frank’s siblings were already with him and John could see that Frank had died. He informed the siblings that Frank had died. They were upset and voiced their concern as Mary had not been there when he died.
https://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjEosSntL7PAhWROsAKHXRdAywQjRwIBw&url=http%3A%2F%2Fblindskateboards.com%2F&bvm=bv.134495766,d.ZGg&psig=AFQjCNHLqxgSl5fSYNBbexfKXTswFfTiLw&ust=1475576266155349
John knew Mary was on her way and remembered Mary was registered blind and suggested to the family that he would not inform her of Frank’s death until she had sat with him a while.
http://e-ageing.wacha.org.au/index.php?id=1416
The family agreed and when Mary arrived she sat and held Frank’s hand, which was still warm. She kissed him and chatted to him. After a few minutes John knelt by Mary and explained Frank had ‘passed away’.
Rule or Value?
Cardiff is East of Swansea
Rule or Value
Chocolate Ice cream is better than Strawberry Ice cream
Rule or Value?
Adults should care for children
Rule or Value?
Nurses should protect the confidentiality of their patients
Virtue Ethics
Places an emphasis on the type of person you should be or the life you should lead.

Key Principles of Virtue Ethics
An action is right if it what a person with a virtuous character would do in those circumstances.

Goodness is prior to rightness.

Virtues are irreducibly pleural intrinsic goods
Virtues are objectively good.

Acting rightly does not require that we maximise good
Virtuous
Good
Righteous
Worthy
Honourable
Moral
Upright
Honest
https://www.england.nhs.uk/nursingvision/compassion/

6 C’s of Nursing or Nursing Virtues?
How does virtue ethics affect decision made?
Unraveling Ethical Dilemmas – Principle Based Approach
Judgements
Rules
Principles
Ethical Theory
Moral Principles
Autonomy
Deliberate self rule
Decisions based on deliberation
Not at the expense of another's wishes
Capacity
Knowledge
Understanding
Lack of coercion

To have autonomy you have to have
Not all individuals will have autonomy
Beneficence and Non maleficence
http://www.jarofquotes.com/view.php?id=make-a-habit-of-two-things-to-help-or-at-least-to-do-no-harm
Beneficence - to provide benefit

Non-maleficence – to do least harm

Often considered together as healthcare often is a balance of harms versus benefits.

NB the net benefit assumed may be a harm dependent on the patient’s autonomous choices.

Justice
Equal treatment of equal cases.

Fair distribution of resources.

Respecting individual rights.

Legal justice.
http://www.iop.org/resources/topic/archive/society/page_66049.html
http://www.gponline.com/reaction-francis-report/article/1169913
http://www.muitsun.com/building-trust-through-your-website-design/
Ethics is not only about the big dilemmas.

It is also about every day decisions you make.

Using tool kit can help to decide on moral decisions.

Use reflection to think things through after an event and take forward into practice.

ABM University Health Board 2014 The Andrews Report - “Trusted to Care” – An independent Review of the Princess of Wales Hospital and Neath Port Talbot
Hospital at ABMU Health Board

http://www.wales.nhs.uk/sitesplus/documents/863/1%20(vii)%20'Trusted%20to%20Care'%20Report.pdf

Beauchamp, TL; Childress, JF (2011) Principles of Biomedical Ethics 7th ed USA: Oxford University Press

DOH 2007 Transforming care: A national response to Winterbourne View Hospital:
Department of Health Review Final Report https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213215/final-report.pdf

Edwards, S (2009) Nursing ethics, a principle-based approach 2nd ed UK: Palgrave

Hendrick, J (2004) Law and Ethics Cheltenham: Nelson Thornes

Kushe, H; Singer, P 2009 A companion to bioethics (3rd Ed) Blackwell, USA

LSCB Harigley 2009
Serious case review baby Peter.
http://www.haringeylscb.org/sites/haringeylscb/files/executive_summary_peter_final.pdf

NMC guidance for students http://www.nmc.org.uk/education/becoming-a-nurse-or-midwife/when-studying-to-be-a-nurse-or-midwife/guidance-for-students/

NMC (2015) The Code:Professional standards of practice and behaviour for nurses and midwives. London: NMC http://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/revised-new-nmc-code.pdf (accessed 10.10.15)

The Mid Staffordshire NHS Foundation Trust 2012 Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry http://webarchive.nationalarchives.gov.uk/20150407084003/http://www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20summary.pdf

Seedhouse, D (2008) Ethics: The Heart of Health Care (3rd Ed) Chichester: Wiley https://www.dawsonera.com/abstract/9780470773161 (accessed 10.10.15)

Shafer-Landau, R (ed), Ethical theory an anthology 2nd ed 2013 Wiley: USA http://www.upscsuccess.com/sites/default/files/documents/Ethical_Theory_An_Anthology_@nadal.pdf#page=663 (accessed 11.04.16)
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