Values, Morals and Ethics
More controversy surrounds health care decisions made by and for critical care patients than in any other health care area. Review the slide show to learn more about the ethical reasoning and the examination of moral principles in critical care environments.
Values
Beliefs of a person or social group in which they have an emotional investment (either for or against something)
- Strong personal beliefs
- Ideal or standard that a person or group believes has merit
- Reflect cultural and social influences, relationships and personal needs
- Vary among people
- Set of rules by which
- Develop over time and are affected by: Family and individual experience, Moral development, Cultural, ethnic and religious community involvement
Values in the CNA Code of Ethics
- Providing safe, compassionate, competent and ethical care
- Promoting health and well-being
- Promoting and respecting informed decision-making
- Honouring dignity
- Maintaining privacy and confidentiality
- Promoting justice
- Being accountable
Morals
Motivation based on the ideas of right and wrong.
- The ”shoulds” and “should nots”
- Closely related to cultural and religious values and beliefs that govern social interactions
- More about good and bad
- What people are judged on
Ethics
a theory or system of moral values; the rules or standards governing the conduct of a person or the members of a profession.
- A formal system or set of rules explicitly adopted by a group of people
- Internally defined and adopted
- Philosophical ideals of right and wrong
- A reflection of what matters to most people or professions
Ethical Principles Inherent to Nursing:
Autonomy Respect for Persons
- Respect the patient’s inherent dignity and capacity for rational choice
- Right to determine what is done to or for them without coercion or undue interference from others
- Crucial and sometimes difficult responsibility of the critical care nurse
- Patient’s capacity may fluctuate during their time of care
- What happens when a patient’s wishes do not match that which are being expressed by their family members when their capacity is diminished/
Beneficence Doing or Promoting Good Vs. Nonmaleficence Minimizing harm
- Maximize good and minimize harm is often a difficult balance.
- Consider the example of a patient with a large family. They want to visit frequently and the patient is getting minimal rest when they are present. The patient is attempting to communicate when they are not able to do so effectively and they are becoming increasingly agitated.
- The nurse’s role is to correct harmful situations and this may mean intervening and communicating with the family member the importance of the patient’s rest. This may upset the family members and may also contradict agency policy….this is an ethical dilemma.
Justice Equitable distribution of limited resources
- Blood and blood products in a mass casualty situation
- Medications that may be on back order
- Human resources: Decreasing the number of times a patient is repositioned because there is not enough staff to do so safely OR, repositioning the patient without enough staff to safely do so and risking the health of the staff members
- Allocation of organs for transplantation
- Cancelling of surgeries due to lack of available beds in a hospital
- Hallway medicine
Ethical Problems in Critical Care Occur When
- There is a conflict between the right action and the ability to take it
- There is uncertainty about the right action
- There is conflict about which of several right actions is most ethical
Examples of Ethical Dilemmas in Critical Care
- Pain management and addiction
- End of Life
- Advanced directives
- Medically futile treatment
- Withdrawal of life sustaining treatments
- Allocation of scarce resources
- Use of restraints
- Inadequate staffing levels
Ethical Decision Making in Critical Care
Critical care nurses should be aware of early indicators of ethical dilemmas
- Signs of patient suffering
- Signs of unrealistic expectations
- Signs of nurses’ moral distress
- Signs of conflict
- Signs of poor communication
- Signs of ethics violations
Assessment
Identify the key facts and values that are applicable
- What are the crucial facts of the case?
- What moral principles are at issue here?
- What decision-making procedure is appropriate?
Planning
Explore available and best means to achieve the goal
- What is the primary aim or good for which you are acting?
- What objectives, benefits, and moral goals are achievable?
- What previous cases or contingencies should we take into account?
Implementation
Take decisive and effective action to implement plan
- How do we begin, continue and finish the process of intervention?
- How do we assess costs/benefits of the intervention?
- How do we monitor success/failure in the overall process?
Evaluation
Evaluate progress and outcomes with planned objectives
- What means have we set up for debriefing and feedback?
- Have we used the “right” means to a “good” end?
- How do we review the pros/cons for the action taken?
Final Steps
In Retrospect, apply the following tests:
- Could I/we provide a reasonable ethical justification for the course of action taken?
- Can I/we identify what we have learned from applying this model to decision-making?
- How do we integrate this learning into the next decision-making cycle?