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What is Utilitarianism and Deontology and how do these theories affect children and families?

The Deontological Theory

The word 'deontological' comes from the Greek word deon which translates to "binding duty" (Moreland, 2009).

The theory is manifested in the idea of what a healthcare professional owes to a patient – the duty of care and the duty not to harm (Slowther et al, 2004).

This theory accords with absolute rules that are grounded on pure reason - it is therefore an obligation-based moral theory (Tuckett, 2002).

Rules rather than consequences determine an individuals actions (Slowther et al, 2004).

Deontological Theory continued ...

Deon - greek

NMC Code of Conduct (2015)

- Deontological approach

- Guides nursing staff to take action based on a set of principles

Friends - Why is it relevant?

NICE Guidelines

Ross + Rachel's happiness

- Utilitarian approach

- Produces a better outcome for a wider range of people

Case Study:

Emma's happiness

  • Nurses are obligated to act accordingly to a certain set of principles - in the UK this is the Code of Conduct, set out by the Nursing and Midwifery Council (Goldsmith, 2011).
  • Nurses are expected to adhere to the rules and regulations in order to meet the best standard of care for their patients and families.
  • Nurses operating from this theory understand what is wrong (therefore not permissible) in order to determine what is right. This can only be determined by reason (Tuckett, 2002).

- Ross and Rachel sing to Emma 'Baby Got Back' (morally wrong)

- However, the result was making Emma laugh (morally right)

= the action resulted in the greatest number of people achieving the greatest happiness

(it had a effective outcome)

Utilitarianism

This approach promotes the greatest good that is possible in situations (Rich et al, 2014). It encourages the maximization of happiness and positive outcomes for the majority (Tuckett, 2002)

What's the difference?

- The right action is that which has the greatest usefulness (increasing utility)

- Concerns the bigger picture

- It focuses on the consequences of an action, rather than the action itself

- Being a community-based theory, each person is counted as an equal (Aroskar, 1980).

Where did the theories originate from?

Deontology Founder

Utilitarianism Founders

John Stuart Mill (1863)

Immanuel Kant (1785)

However...

Jeremy Bentham (1789)

Learning Outcomes

Kant: Grounding for the Metaphysics of Morals, 1785.

Ethical Theories Continued...

1. To gain an understanding of the ethical theories; Deontology and Utilitarianism

2. Being able to recognise and link theory to practice within a healthcare setting

3. Academically recognise the importance of both theories when working with children and young people considering holistic and family-centered approaches

4. To briefly explore the legality, ethical and professional principles of these theories.

Beauchamp and Childress (2001) developed a biomedical ethical framework that consists of 4 principles:

- Autonomy (respect for other's decisions)

- Beneficence (actions which benefit the patient)

- Non-maleficence (avoiding harm to the patient)

- Justice (treating patients fairly)

Deontology Vs. Utilitarianism

Ethical Theories: Application to Nursing

Parent Vs. Child

A parent can make a decision regarding their child's care because a parent is seen as the best judge for their child's interests.

- Nurses are the primary agents (Furne et al, 2006) in a scenario, and ethical issues are viewed from a nursing rather than a medical perspective (Rich et al, 2014).

- Theory provides a nurse with guidance in moral thinking, reasoning and justification of their actions.

- Nurses use their critical thinking skills to respond to many everyday decisions e.g. Triage - use theoretical knowledge on how to navigate ethical dilemmas (Rich et al, 2014).

Nurse Vs. Parent

A nurse may be able to override the decision of a parent if it is considered to be in the best interests of the child - The code clearly directs nurses to act without delay if they believe someone is being put at risk. (Goldsmith, 2011).

Definition: Ethics

Deontology Vs. Utilitarianism

Health care ethics ("medical" ethics or "bioethics"), at its simplest, is a set of moral principles, beliefs and values that guide us in making choices about medical care (Vermont Ethics Network, 2011).

Parent Vs. Nurse

A child is nil by mouth as they are due for surgery. They are unhappy, crying and complaining as they are thirsty. Their mother wants to give their child a drink to calm them down - their happiest outcome.

Safety Vs. Comfort

In relation to health;

- Nurses have a duty of care (morality)

- Beauchamp & Childress 2001 - Biomedical Framework

- We have a duty to display fairness, truthfulness and justice (Department of Health, 2012)

- Nurses are trusted to safeguard and act as advocates for the service users under their care

- Nurses are expected to follow holistic (PIES + Cultural + Spiritual - dimensions of care) and family-centered care approaches

The nurse has to follow regulations concerning pre-operation assessments for the child's safety regardless of their comfort. However the nurse can find ways to meet the clinical needs without interfering with safe practice.

How do the theories impact children and families?

It means:

  • Nurses should follow rules to ensure they meet the duty of care which is owed to children and their families.
  • Nurses should judge the situation and act appropriately by applying the theory best suited.
  • Nurses should act in the best interests of the child and the family.
  • Nurses should acknowledge ethics within their practice whilst adhering to the legalities.

Conclusion

Reference List

The best outcome is a combination of both ethical approaches:

- Both ethical theories play an equal part in the nursing world and it is suggested that both theories have an important role when working with children and families (Simons et al, 2011).

Any Questions?

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