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Clinical Ethical Issues

Many of our ethical issues arise when dealing with the: -Beginning of human life -End of human life -Use of technology but there are other ethical. Often they are viewed as clinical problems but not ethical problems.

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بالین اخالقی مسائل

با پرستاری که وتالش ” 8وقتی وقت کند می کار بدحال بیمار “ کند؟ می تقسیم راچگونه خود کاری

داده انجام غیراخالقی کار یک دربخش همکارتان بینید می که وقتیبکنید؟ باید چه

. اونگویند به قراراست وخانواده است العالج درگیربیماری بیماریجوابی چه پرسید خودازشما سالمتی اگربیمارازوضعیت

خواهیدداد؟

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بالین اخالقی مسائل

- یک دارونما آیا هست؟ اخالقی کار بیمار به گفتن دروغ اصالاست؟ دروغ

نداردوواقعا, - رادوست بیماری که پرستاری ازنظراخالقیبکند؟ باید چه دهد ارائه اوخدماتی به تواند نمی

خوددرگیربشود؟ - درمانی گیری تصمیم بیماربایددر آیاذهنی اگرناتوان باشد؟ مسن اگر باشد؟ نوجوان اگربیمار

باشد؟دستور - این داند می که بیماری آیاپرستاربایددستورپزشکی

اجراکند؟ بیماردارد برای ای بالقوه خطر

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Two ethical principles are Do No Harm and Do Good. What do we mean by Harm and Good? Health professionals have 2 basic ethical obligations: -To extend life -To lessen pain and suffering (do no harm). Can they do both in this situation when morphine may shorten patient’s life?

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In the beginning…

There were no antibioticsThere were no ICUsThere were no CT scanners and MRIsThere were just physicians and nurses who cared for people in sickness and in health

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1960s

Technological advances allowed for the development of intensive care unitsNew biomedical developmentsAdvances in surgical techniques, such as open heart surgery

The advances created new questions for health-care professionals

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EthicsEthics deals with the “rightness” or “wrongness” of human behaviorConcerned with the motivation behind the behaviorBioethics is the application of these principles to life-and-death issues

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Morals

An individual’s own code for acceptable behaviorThey arise from an individual’s conscienceThey act as a guide for individual behaviorLearned

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Ethical Principles

AutonomyNonmaleficence BeneficenceJustice

FidelityConfidentialityVeracityAccountability

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Autonomy

The freedom to make decisions about oneselfNurses need to respect clients’ rights to make choices about health care.

Best medical interests Best interests

More to well-being than medical well being

مخالف

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Who is autonomous ?

Understand + Form Values + Make Decisions

You80 year old

80 year oldwith dementia

2 year old Drunk

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Respecting autonomy

Respecting autonomy means enabling patients to make autonomous choices:oReasonable choicesoAdequate informationoClear explanationoTime to consider optionsoNot unduly pressurising oBeing non-judgemental

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Nonmaleficence

Requires that no harm be caused to an individual, either unintentionally or deliberately.

This principle requires nurses to protect individuals who are unable to protect themselves.

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Beneficence

This principle means “doing good” for others.Nurses need to assist clients in meeting all their needs:

BiologicalPsychologicalSocial

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Justice

Every individual must be treated equallyThis requires nurses to be nonjudgmental

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1- Equal share 2-Individual need

3-Individual effort

4-Societal contribution 5-Merit

6-Free market exchanges

Principles of distributive justice(Beauchamp and Childress 2001)

To each person to:

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Continually increasing health care costs

می افزایش بطورمدام ودرمان سالمت های هزینهودرمان بهداشت عدالت اجرای درنحوه باید یابدکه

شود لحاظ پرسنل :وپرداخت

population increaseageing populationincrease demand for healthcarenew technologies, new procedurespersonnel and other resources

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Issues of Justice

1- , ( تخت حیات ادامه وامکانات خدمات که وقتی )... , چه, است محدود و تجهیزات عمل اتاق دارو

کند؟ رادریافت امکانات این باید کسیقریب -2 مرگ که بیماری برای کردن خرج پول آیا

اوکرد؟ خرج حدباید تاچه است؟ صحیح دارد الوقوعاست؟ -3 کدام وعمومی شخصی نفع حالت بهترین

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Fidelity

LoyaltyThe promise to fulfill all commitments The basis of accountability

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Dignity: a Human Right?

The right to life Freedom from

degrading treatment

The right to liberty

The right to respect for

private and family life

Freedom of thought, conscience and religion

Freedom of expression

The right to peaceful enjoyment

of your property

The right not to be discriminatedagainst in any of these

rights or freedoms

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Confidentiality

Anything stated to nurses or health-care providers by clients must remain confidential

The only times this principle may be violated are:

- If clients may indicate harm to themselves or others

- If the client gives permission for the information to be shared

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Veracity

This principle implies “truthfulness”Nurses need to be truthful to their clientsVeracity is an important component of building trusting relationships

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Accountability

Individuals need to be responsible for their own actions.Nurses are accountable to themselves and to their colleagues.

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Ethical CodesThese are formal statements of the rules of behavior for a particular group of individuals.Ethical codes are dynamic. Most professions have a “code of ethics” to guide professional behavior. The Code of Ethics for Nurses. Why have a code? What does it say? What purpose does it serve?

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• ICN code for nurses was formed in 1933. • While the international code of nursing ethics

accepted in 1953.• In 1973 the new ICN code of ethics was approved. It

identifies four major responsibilities of the nurse:• Promote health.• Prevent illness.• Restore health.• Alleviate suffering.

Ethical Dilemmas

Occur when a problem exists between ethical principles.Deciding in favor of one principle usually violates another.Both sides have “goodness” and “badness” associated with them.

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Ethical Dilemmas

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Dilemma Resolution•Nursing

Process•MORAL

Model• Ethics

Committees

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برائت نامه ورضايت نامه

يعني امضاء مدركي كه بيمار قبل از تن دادن به هرگونه درماني از كليه خطرات عمل ، راههاي درماني و جايگزين و خطرات آن توسط پزشك

.)تلویحی, اظهاری,رضایت آگاهي يابد.درمواردخاص(

يعني چنانچه بيمار در طي درمان دچار برائت عوارض يا نقص عضوي گرديد ، پزشك در

صورتيكه بر اساس موازين فني و علمي اقدام كرده باشد مقصر نيست

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تفاوت رضایت و برائت؟

رضایت گرفته باشد، در صورت بروز فقطاگر پزشک مرگ، نقص عضو یا خسارت مالی، ضامن است ولی اکر

نیز تحصیل کرده باشد، عهده دار خسارت پدید برائت.آمده نیست

اصل برائت است که موجب سقوط ضمان می فقط

شود. البته در صورت قصور پزشکی، برائتی که قبل از .درمان گرفته شده، باعث سقوط ضمان نیست

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Healthcare and Ethics

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IT’S NOT ROCKET SCIENCE?

• OR IS IT?

What do you do to ensure dignity in care?

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Barriers to Patient Satisfaction

• Wait Times• Overcrowding• Interruptions of caring• Consultants • Radiology &Laboratory… • Patient expects something from you

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Common Patient Complaints• Too little time for patient interaction• Does not listen• Does not explain well• Shows no sympathy• Does not understand • Incompetent

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Demographics affecting satisfaction

• Age—older pts more satisfied• Ethnicity—minorities less satisfied• Gender—females less satisfied • Socioecominc—lower socioecomic less

satisfied• Heath status—Chronic illness less satisfied

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Increasing Patient Satisfaction

• Greet the patient with a hand shake & a smile

• TALK to your patient, not at them• Listen to what they have to say• Give them the opportunity to ask

questions• Don’t be afraid to apologize & tell patient

why they had to wait for x, y, z.• Listen to your support staff

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How can you affect satisfaction?

• COMMUNICATE• Utilize as well as listen to Patient

Advocates • Put yourself in the patient’s shoes• positive patient interaction

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The Communication Circle

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The communication cycle involves an exchange of messages through verbal and nonverbal means.

MESSAGE

FEEDBACK

NOISESourceSource ReceiverReceiver

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