What does it mean to be a good person according to CSUN?

* Ethics & Law * Ethical Decision-making

M.Highfield Spring 2011 NURS 426

Values of Nursing Program?

BSN handbook p. 13, 36, 47 -

Of CSUN?
Values Ethical code Center for ethics & values Business Dept

Student Conduct Code

Standards of Ethical Behavior

The personal behavior and ethical conduct of each student at California State University, Northridge impacts, positively or negatively, on the climate and reputation of the entire institution. Thus, it is imperative that each student act at all times with integrity and with respect toward all members of the campus community. The University assumes that all students will conduct themselves as mature, responsible, and law abiding citizens who will comply with University policies and regulations.

Factors Influencing Our Ethics & Morality

Morality Ethics
Morality & ethics are colored by many factors including Gender, Religion, Culture, Tradition, Family, & Stage of development Values

What is Ethics ?
The explicit, philosophical reflection on moral beliefs and practices. The difference between ethics and morality is similar to the difference between musicology and music. Ethics is a conscious stepping back and reflecting on morality, just as musicology is a conscious reflection on music.
http://ethics.sandiego.edu/LMH/E2/Glossary.asp

Ethics is NOT
Feelings Religion Following the law Following cultural norms Science (is is not an ought)

What is Morality?
Morality is behaviors & beliefs about human decency, right/wrong, good/evil, proper/improper
(Butts & Rich; http://ethics.sandiego.edu/LMH/E2/Glossary.asp)

What is Moral Orientation?

The underlying basis on which we make moral decisions. The point of referencethe moral compassthat helps us decide what we should believe and how we should act (morality).

Practices and beliefs about good and evil by means of which we guide our behavior.
Hinman,

http://ethics.sandiego.edu/Glossary.html

What is The Moral Point of View ? [see handout from webpage]

Lawrence M. Hinman

What is law?
Minimum ethic Rules made by human beings to guide society & regulate human interactions. (Aiken, p. 98). They written down and enforced by the state to promote peaceful & productive interactions (Aiken; Hall).

Law & ethics

What does Hall say about the relationship between ethics & law

What does Hinman (n.d.) say?

Types of Law
1.

Classification of Law
Criminal law wronged the public Civil law wronged another individual

Statute Regulation Case law

2.

3.

Ethics & Law: 4 quadrants

Actions can be: Ethical & legal Yes Unethical & illegal ETHICAL Ethical & illegal No Unethical and legal ( p. 5, Davis & Aroskar,
1991).

RIGHTS: Law & Ethics

Your right is someone elses obligation or duty
1. 2.

LEGAL Yes

No

Yes Yes Yes No

Yes No No No

Legal rights are defined by law Ethical rights are grounded in ethical principles, rules, values (not law)

How do Professional Codes Fit?

Law = minimum ethical standard Ethics defines what law should say. Ethics guides and extends beyond law. It may or may not be what the law does say. Professional codes of conduct help define the ethical rights, duties, & obligations of the nurse. Codes outline a standard against which nurses can measure their own and their peers decisions and actions. They are not law, but may be used in a court of law as a standard to judge nursing actions.

Nursing Codes
Nightingale pledge 1853 International Council of Nurses Code 1953/2005 ANA Code (1950/2005) Think about what each has to do with Relationships in nursing Who we should be and how we should

act

Nightingale Pledge
1893 - Lystra Gretter, an instructor of nursing at the old Harper Hospital in Detroit, Michigan I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician, in his work, and devote myself to the welfare of those committed to my care.

Professional codes reflect professional values. They do not necessarily reflect all the values of the individual professional.

Case #1
ANA Guide to Code of Ethics for

What is an Ethical Dilemma?

Wouldnt it be nice if we could always do the right action and get the good outcome? Right action good outcome.

Nurses*

*you bought this in HSCi303

Ethical Dilemma
However, sometimes instead of Right action good outcome. We end up with a choice between: Right action bad outcome.

All dilemmas arent ethical ones

Problematic choices: nothing to wear! Legal choices: What does the state [the government] require you to do?

OR
Wrong action outcome. good (or less bad)

Ethical DecisionMaking (Aiken)

1. 2.

Decision making: 1. Identify your values

Your own values Hall (pp. 48-50)

3.

4. 5. 6.

Similar to Nursing Process Your own values (Hall, pp. 48-50) Collect information (Jonsen 4 quadrant model) State dilemma (in ethical terms, not clinical ones) List choices (include do nothing) Analyze pros & cons of each choice Decide!

2. Get the data: 4 topics

(Jonsen et al,)

Get the data: 4 topics

(Jonsen et al,)
Medical Indications - all clinical
encounters include a review of diagnosis and treatment options

(cont.)

Medical indications (beneficence & nonmalfeasance)

Patient preferences (respect for autonomy)

Patient Preferences - all

clinical encounters occur because a patient presents before the physician with a compliant. The patient's values are integral to the encounter. clinical encounters occur in a wider context beyond physician and patient, to include family, the law, hospital policy, insurance companies, and so forth.

Quality of life Context (loyalty & (beneficence, fairness) Nonmaleficence & respect for autonomy)

Quality of Life - the objective of Contextual Features - all

all clinical encounters is to improve, or at least address, quality of life for the patient

3. State the ethical dilemma

Dilemma created when persons encounter conflicting moral imperatives

If not a clinical ethical dilemma, you should still seek to list all the facts of the case. e.g., p. 107, Box 3.6 from Butts & Rich for nonclinical case.

Maurice Bernstein, M.D (quoted)

1. Ones PERSONAL and PROFESSIONAL values 2. Two values/ethical PRINCIPLES 3. Two possible actions: each with reasons strongly FAVORABLE and UNFAVORABLE 4. Two UNSATISFACTORY alternatives: Ones VALUES/PRINCIPLES and ones PERCEIVED ROLE State in ETHICAL terms (state in clinical terms; then ID competing moral imperatives)

4. List choices
Do nothing _________ _________

5. Analyze pros & cons

Option 1
Pros Cons

Option 2
Pros Cons

5. Decide!
Not to decide, is to decide. You dont get a choice This will be affected by law, values, your moral orientation, professional duties, and so on. Along with these ethical decisionmaking steps we use ethical reasoning to make decision

How do we choose?
In the WEST perhaps more Autonomy (self-determination) Individualism Self-understanding e.g.," You deserve a break today In the EAST perhaps more Relationships/ community Connections with others & cosmos e.g., do this for your family/ community
(Butts & Rich, 2008; Hall 2002)

Ethical reasoning
Deontologists Duty & reason. If I act this way, is it an action that could be a universal law for everyone to act in the same way? (categorical imperative. Consequentialists the greatest happiness or pleasure and least pain/suffering to the most people (utilitarianism) Virtue ethicists An excellent person will make excellent decisions (Aristotle) Natural law based in the rational order of nature & persons
(Butts & Rich, 2008; Hall 2002)

Causistry individual cases decided based on similar, model cases. Narrative context bound stories tell us how we should be; people are moral agents who make choices Critical theory ethics as liberation from dominant groups (e.g., feminist/care ethic) Principlism ethics is done based on ethical principles (e.g., Belmost report: respect, beneficence & justice)
(Butts & Rich, 2008; Hall 2002

How do we reason?
In the WEST perhaps more Autonomy (self-determination) Individualism Self-understanding You deserve a break today

In the EAST perhaps more Relationships/ community Connections with others & cosmos
(Butts & Rich, 2008; Hall 2002)

Ethical reasoning
Hinduism: ethic of unity with the cosmos Buddhism: ethic of suffering
Avoid attachment

Ethical DecisionMaking (Aiken)

1. 2.

Taoism (& native American traditions): ethic of harmony Confucianism: ethic of what is good for society
(Butts & Rich, 2008)

3.

4. 5. 6.

Similar to Nursing Process Your own values (Hall, pp. 48-50) Collect information (Jonsen 4 quadrant model) State dilemma (in ethical terms, not clinical ones) List choices (include do nothing) Analyze pros & cons of each choice Decide!

Nursing Law & Ethics

*

Summary
Relationships! Law reflects a minimum standard of ethics, but it is not ethics One persons right is another persons duty. Ethical decision-making in nursing includes
Law Values Moral orientation Professional codes Ethical reasoning

BRN? http://www.rn.ca.gov/regulations/bpc. shtml#2725 ANA Code or ICN code?

Models can provide us with direction