Ethical Issues in Professional Nursing Practice

Ethical Issues in

Professional

Nursing Practice

Chapter 14

Relationships and

Professional Ethics

• Nurse–physician relationships

• Nurse–patient–family relationships

– Unavoidable trust

– Boundaries

– Dignity

– Patient advocacy

• Nurse–nurse relationships

The National Council of State Boards

of Nursing’s Professional Boundaries

in Nursing Video

https://www.ncsbn.org/464.htm

Moral Rights and Autonomy (1 of 2)

• Moral rights are defined as rights to perform

certain activities

– Because they conform to accepted standards or

ideas of a community

– Because they will not harm, coerce, restrain, or

infringe on the interests of others

– Because there are good rational arguments in

support of the value of such activities

Moral Rights and Autonomy (2 of 2)

• Two types of moral rights

– Welfare rights

– Liberty rights

• Informed consent

• Patient Self-Determination Act

• Advance directives

– Living will

– Durable power of attorney

Social Justice

• Sicilian priest first used term in 1840; in 1848,

popularized by Antonio Rosmini-Serbati

• Center for Economic and Social Justice

definition

• John Rawls’ concept of veil of ignorance

• Robert Nozick’s concepts of entitlement

system

Allocation and Rationing of

Healthcare Resources

• Does every person have a right to health care?

• How should resources be distributed so

everyone receives a fair and equitable share of

health care?

• Should healthcare rationing ever be considered

as an option in the face of scarce healthcare

resources? If so, how?

Organ Transplant Ethical Issues

• Moral acceptability of transplanting an

organ from one person to another

• Procurement of organs

• Allocation of organs

– Justice

– Medical utility

Balanced Caring and Fairness

Approach for Nurses (1 of 2)

• Encourage patients and families to express

their feelings and attitudes about ethical issues

involving end-of-life, organ donation, and

organ transplantation

• Support, listen, and maintain confidentiality

with patients and families

• Assist in monitoring patients for organ needs

Balanced Caring and Fairness

Approach for Nurses (2 of 2)

• Be continually mindful of inequalities and

injustices in the healthcare system and how the

nurse might help balance the care

• Assist in the care of patients undergoing surgery

for organ transplant and donation patients and

their families

• Provide educational programs for particular

target populations at a broader community level

Definitions of Death

• Uniform Determination of Death Act definition of

death: “An individual who has sustained either (1)

irreversible cessation of circulatory and respiratory

functions or (2) irreversible cessation of all functions

of the entire brain, including the brain stem is dead.

A determination of death must be made in

accordance with accepted medical standards.”

• Traditional, whole-brain, higher brain, personhood.

Euthanasia

• Types of euthanasia:

– Active euthanasia

– Passive euthanasia

– Voluntary euthanasia

– Nonvoluntary euthanasia

• Blending of types may occur

• “Is there a moral difference between actively

killing and letting die?”

Rational Suicide

• Self-slaying

• Categorized as voluntary active euthanasia

• Person has made a reasoned choice of rational

suicide, which seems to make sense to others at

the time

– Realistic assessment of life circumstances

– Free from severe emotional distress

– Has motivation that would seem understandable to

most uninvolved people within the community

Palliative Care

• Approach that improves the quality of life of

patients associated with life-threatening illness,

through prevention and relief of suffering

• Do-not-resuscitate order:

– There is no medical benefit that can come from

cardiopulmonary resuscitation (CPR)

– The person has a very poor quality of life before CPR

– The person’s life after CPR is anticipated to be very

poor

Rule of Double Effect

• Use of high doses of pain medication to lessen

the chronic and intractable pain of terminally

ill patients even if doing so hastens death

• Critical aspects of the rule:

– The act must be good or at lease morally neutral

– The agent must intend the good effect not the evil

– The evil effect must not be the means to the good

effect

– There must be a proportionally grave reason to risk

the evil effect

Deciding for Others

• A surrogate, or proxy, is either chosen by

the patient, is court appointed, or has other

authority to make decisions

• Three types of surrogate decision makers:

– Standard of substituted judgment

– Pure autonomy standard

– Best interest standard

Withholding and Withdrawing

Treatment: 3 Cases

• Case 1: Karen Ann Quinlan

• Case 2: Nancy Cruzan

• Case 3: Terri Schiavo

Terminal Sedation

• “When a suffering patient is sedated to

unconsciousness…the patient then dies of

dehydration, starvation, or some other

intervening complication, as all other life-

sustaining interventions are withheld”

• Has been used in situations when patients

need relief of pain to the point of

unconsciousness

Physician-Assisted Suicide

• Act of providing a lethal dose of medication for

the patient to self-administer

• Oregon Nurses Association special guidelines

related to the Death with Dignity Act

– Maintaining support, comfort, and confidentiality

– Discussing end-of-life options with patient and family

– Being present for patient’s self-administration of

medication and death

– Nurses may not administer the medication

– Nurses may not refuse care to the patient or breach

confidentiality

End-of-Life Decisions and Moral

Conflicts with the Nurse

• Communicating truthfully with patients about death due to

fear of destroying all hope

• Managing pain symptoms because of fear of hastening

death

• Feeling forced to collaborate relative to medical treatments

that in the nurses’ opinion are futile or too burdensome

• Feeling insecure and not adequately informed about

reasons for treatment

• Trying to maintain their own moral integrity