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Bullets in BIOETHICS

ETHICS - Rules and principles that guide decisions or conduct in terms of rightness/wrongness of that decision or action. Publicly announced. MORALITY - Personally held beliefs, opinions, and attitudes that guide our actions. Subjective, Personal Lawrence Kohlbergs Stages of Moral Develo !ent Level 1 (Pre-Conventional) 1. bedience and punishment orientation !"-# y.o.$ ". Self-interest orientation !Reward Orientation) !#-% y.o.$ !S" erego #evelo !ent$ Level 2 (Conventional) #. &nterpersonal accord and conformity !The good boy/good girl attitude$ !%-1' y.o.$ (. )uthority and social-order maintaining orientation !Law and order morality$ !1'-1" y.o.$ Level 3 (Post-Conventional) *. Social contract orientation !1"-1+ y.o.$ %. ,niversal ethical principles !Principled conscience$ !1+ and above$ $TILITARIA%ISM - -he broader good deems to be the better good. The end justifies the means. DEO%TOLO&ICAL . )rgues that /good conse0uences may have to be set aside to respect inalienable human rights.1 Do no harm. A$TO%OMY - /&ndependence,1 / ne2s ability to decide for himself1 %OTE' nly a 3 ,R- R45R can overrule the client2s right to )utonomy. %O%MALE(ICE%CE - /4o no 6arm1 )E%E(ICE%CE - /4o good for the client2s benefit1 hat is the undesira!le out"ome of !enefi"en"e# Paternalism the health care provider decides what is best for the client and attempts to encourage the client to act against his own choices. *$STICE - /7airness and 50uality1 (IDELITY - /8eing 7aithful1 +ERACITY - /-ruthful1 CO%(IDE%TIALITY - respect for privileged information. Reasons to disclose 3onfidentiality9 a. 3ourt rder !criminal cases, abuse$ b. 3onsent from client c. 3ommunicable diseases d. 3ompromised safety +ol"ntar, co!!-t!ent . the client willfully admitted himself to the hospital. a. 3lient must be released when he no longer chooses to be hospitali:ed. b. 3lient has the right to refuse treatment. Invol"ntar, co!!-t!ent . client was brought and admitted to the hospital by his fol;s against his will. a. Reasons9 3lient is mentally ill, Poses a danger to self and others, and ,nable to care for self b. 3lient may not refuse treatment. -Report it to the <urse =anager in a confidential manner

If a nurse suspects that a co-worker is abusing chemicals, what must she do? The goal of reporting the co-worker is?
--reatment of the impaired colleague and safety of the patient

When does a nurses responsibility to the patient begin?


-,pon admission I%(ORMED CO%SE%T - >iving the client factual information about the benefits, ris;s, and alternatives prior to the procedure he will undergo. Obta-ne# b, the /h,s-c-an or S"rgeon 0Role of the %"rse' a. ?itnessing the 3onsent. b. =a;ing sure that the client understood the given information. c. ?itnessing the client2s signature. Co! onents of Infor!e# Consent' +IC a. +oluntary . free of coercion or the client was not forced. 1

b. Informed . client was informed by the physician and understands the procedure. c. Competent . of legal age !1+ y.o. and above$, mentally stable, not under the influence of drugs =inors can sign the consent only if they are EMA%CI/ATED MI%ORS9 a. =arried b. in =ilitary Service c. Self-sufficient and &ndependent T, es of Infor!e# Consent

12 E3 resse# Consent - @erbal or written 42 I! l-e# . signed during hospital admission and needs no separate consentA for simple B routine procedures. ,sed also during emergency cases.

A client has signed the consent but he no longer wish to undergo the procedure, what can the client do? - 3lient may withdraw consent anytimeC Informed consent is waived in EMERGENCY CASES. Sterilization: husband B wife must give consent !eDcept in9 abruptio placenta, ectopic pregnancy, ruptured
uterus$

Informed Consent is Valid only for: 24 hrs


AD+A%CED DIRECTI+ES . any advance declaration by a person regarding his care and medical treatment if he becomes unable to communicate his wishes. T, es of A#vance# D-rect-ves9 o LI+I%& 5ILL !it2s a LIST of treatments to be avoided$ - LISTS the medical treatment that a client chooses to omit or refuse if the client becomes unable to ma;e decisions and is terminally ill. o D$RA)LE /O5ER O( ATTOR%EY !with HEALTH CARE /RO6Y$ - is a legal document that A//OI%TS A /ERSO% 7HEALTH CARE /RO6Y8 chosen by the client to carry out the client2s wishes or to ma;e decisions on the client2s behalf when the client can no longer ma;e decisions. @alid for how longE <5 F5)R <GF =ust be reviewed with whom after 1 yearE P6FS&3&)< 3an a nurse witness in the ma;ing of )dvanced 4irectivesE %o. )ny employee of the hospital where the client is admitted can2t stand as a witness nor the client2s family members. D%R ORDER - &s an order written by a physician when a client has indicated a desire to be allowed to die if the client stops breathing or the client2s heart stops beating. - -he client or his or her legal representative must provide informed consent for the 4<R status. OR&A% DO%ATIO% - )ny person 1+ years of age or older may become an organ donor by written consent, in a living will, or indicated in his driver2s license. - &n the absence of appropriate documentation, a family member or legal guardian may authori:e donation of the decedent2s organ. (alse I! r-son!ent -unlawfully restraining personal liberty. -unlawful detention T, es' a2 Act"al' -,se of physical force to prevent departure of client. b2 I! l-e#' -,se of words, threats, or gestures to restrain client. Incl"s-ons -n I! l-e# Consent' a. Refusing to allow client to leave the hospital until bill is paid. b. Refusing to release newborn until bill is paid. c. Refusing to allow client to leave without signing against medical advice. Inc-#ent Re orts a. nly person directly involved in the incident should document the facts. b. 4o not complete an incident report for someone else. "

c. 4ocument the facts. 4o not9 -Draw conclusions who was to blame. - tate opinions. - peculate on who caused or who was responsible !or incident. d. 4on2t document any reference to the &R in the chartA the same factual information filed on the incident report should be included on the chart. e. 7ailure to complete an &R could be considered a cover-up. f. 7ollow the line of authority within the institution for reporting an incident.