Session 3 ethical principals and theories

for generic bsn semester 4

1. ETHICAL PRINCIPALS AND THEORIES UNIT III By Sehrish Naz Lecturer INS-KMU

2. OBJECTIVES At the end of this session learners will be able to: Define ethical principles and theories in health care. Discuss the ethical dilemmas face by nurses and clients. Discuss the strategies to resolve ethical dilemma in daily nursing practice. List steps of ethical decision making.

3. Ethical principles 1. Autonomy: Refers to the right to make one’s own decisions and choices free of harm to others. Synonyms Self-government  Independence  Self-rule Home rule Sovereignty Self-determination Freedom

4. INFORMED CONSENT Definition It is an agreement by a client to accept a course of a treatment, procedure or research after being provided complete information including benefits and risks. Obtaining informed consent is the responsibility of the person performing the procedure or research.

5. TYPES OF CONSENT Types of consent 1 - Expressed Consent 2 - Implied Consent Expressed Consent may either be oral or written. Written consent is preferred if there are greater risks of a procedure. Implied consent Exists when the client’s nonverbal behavior indicates agreement.

6. ELEMENTS OF CONSENT Four Basic Elements The consent must be given voluntarily. The consent must be given by a client/participant with the Capacity and competence to understand. The consent must be specific to the procedure & Person. The client/participant must be given enough information including benefits and possible risks.

7. IMPORTANCE OF CONSENT The requirement of consent reflects the ethical principle of patient’s/participant’s autonomy It also reflects the principles of beneficence and non- maleficence . It saves both health care member/researcher and patient/participant legally in exceptional circumstances, medical treatment must not be administered without obtaining patient’s valid consent. Treatment/investigations/research performed without consent constitutes “battery”

8. PATERNALISM Implies well intended actions of kind decision making, leadership ,protection ,& discipline. Decision making on behalf of the patients without their full consent or knowledge. Professionals restricts others autonomy, to protect that person from perceived & anticipated harm, but also promoting good in a positive way. ( Burkhardt & Nathaniel,2008 )

9. 2. BENEFICENCE This principle means do or promote good, prevent harm, remove evil or harm. Nurses need to assist clients in meeting all their needs Biological Psychological Social ICN says, the nurse takes appropriate action to safe guard individual ,family ,communities when their care is endangered by a coworker or any other person ( Burkhardt & Nathaniel,2008)

10. 3. NON-MALEFICENCE Non- maleficence literally means to “do no harm.” Make sure that the procedure does not harm the patient. Non- maleficence “obligation not to inflict harm on others. (Beauchamp and Childress, 2009)

11. NON – MALEFICENCE Non- maleficence Literally- “Doing no harm”. Make sure that the procedure does not harm the patient. BENEFICENCE Beneficence Literally – “Being charitable or doing good”. Where a Health care provider should act in the “best interests” of the patient, the procedure be provided with the intent of doing good to the patient.

12. 4. JUSTICE According to Salmond , “Justice means provide everyone his share” According to Plato, ‘Justice is a quality. In simple words the meaning of justice is to discharge one’s duties honestly and not to interfere in other actions. So justice is concerned with human welfare.

13. RELATIONSHIP BETWEEN LIBERTY AND JUSTICE Liberty is the first need of justice. Every ruler who attacks the civil liberties is considered unjust ruler. We can not even think of one without the other. Purpose of both is common. Liberty is the first condition of justice But absolute freedom is against justice.

14. ETHICAL THEORIES 14

15. Ethical Theories Ethical theory is means by which we justify a particular ethical decision. 15

16. ETHICAL SCHOOL OF THOUGHTS 1- Absolutism 2- Relativism 16

17. ABSOLUTISM Absolutism refers to the idea that reality, truth, or morality is “absolute”. the same for everybody, everywhere, and every-when, regardless of individual culture or cognition, or different situations or contexts. 17

18. RELATIVISM No universal norms of right and wrong One person can say “X is right,” another can say “X is wrong,” and both can be right Relativism, roughly put, is the view that truth and falsity, right and wrong, standards of reasoning, and procedures of justification are products of differing conventions and frameworks of assessment and that their authority is confined to the context giving rise to them. relativism  is a theory, which claims that there are no universally valid moral principles. relativism theory says that the moral rightness and wrongness of actions varies from society to society and that there are no absolute universal moral standards binding on all men at all times. 18

19. CLASSIFICATION OF ETHICAL THEORIES 1- Virtue based theory 2- Conduct based theory i -Teleological Utilitarianism Hedonism Egoism ii-Deontological 3- Right based theory 19

20. 1- VIRTUE BASED ETHICAL THEORY 20 Your conduct or action is ethical if you focus on values (character) Plato’s Aristotle’s Socrates wisdom Justice Courage Temperance Golden mean approach Middle path approach Knowledge

21. VIRTUE BASED ETHICAL THEORY Types of virtue Intellectual virtue: Associated with reasoning, ability to understand and truth Moral virtue: virtue of character (honesty ) A good person does the right thing at the right time for the right reason 21

22. CONDUCT ETHICAL THEORIES i : Teleological: Focus on the end Focus on consequences Don’t focus on means Maintains that morality of an action is determined solely by its consequences. Basically, it looks on the outcomes, situation and from that one decides what is ethical. Thus, from a consequentialist standpoint, a morally right action is one that produces a good outcome, or consequence. 22

23. i.i . UTILITARIANISM ETHICAL THEORY GHGN (Great happiness for great Number) Democracy Democratic concept What makes something good or bad, right or wrong, is that it produces the greatest amount of pleasure (or lack of pain) for the greatest number of people 23

24. PRINCIPLE OF GREATEST HAPPINESS An action is good in so far as it produces the greatest happiness for greatest number of people, and bad in so far it produces more harm than benefit for the greatest number of individuals. Happiness: is intended pleasure and absence of pain. Pain: unhappiness 24

25. TWO FORM OF UTILITARIAN THEORY A: Act utilitarian B: Rule utilitarian A: Act utilitarianism It asks a person to assess the effects of all actions Rejects the view that actions can be classified as right or wrong in themselves Example: lying is ethical if it produces more good than bad Act Utilitarianism is the belief that an action is good if its overall effect is to produce more happiness than unhappiness 25

26. TWO FORM OF UTILITARIAN THEORY B: Rule utilitarianism: It asks a person to assess actions according to a set of rules designed to yield the greatest net benefit to all affected • Compares act to rules .• Rule Utilitarianism is the belief that we should adopt a moral rule and if followed by everybody, would lead to a greater level of overall happiness • Does not accept an action as right if it maximizes net benefits only once • Example: lying is always wrong ( driving rules, drink ) 26

27. EXAMPLE OF ACT & RULES UTILITARIANISM A judge sending a murderer to prison. The judge knows the convict will not commit any more violent crimes, and wants to be lenient  (maybe the convict is very old or terminally ill). The judge knows that this will make the convict family and friends very happy. Imagine that the victim’s family has forgiven the convict and will not feel pain as a result of this decision. Should the judge let the convict go? Act utilitarianism says yes But rule utilitarianism says no 27

28. EXAMPLE A few doctors decide that a number of experiments on a few people, even if most of them died, would be worth it if they could find a cure for a disease that would relieve the suffering of millions of people. Utilitarianism would give the approval for such because it produces the greatest good for the greatest number of people. 28

29. i.ii . HEDONISM ETHICAL THEORY Hedonism - is an ethical doctrine which claims pleasure as norm of morality. Pleasurable is good Pain is evil is a view that good involves happiness and pleasure, and evil as unhappiness and pain. Pleasure When your conduct/action increases your happiness or pleasure 29

30. HEDONISM ETHICAL THEORY Pleasure in the context means satisfaction of desire; hence the greater the pleasure, the better. 30

31. A: INTELLECTUAL PLEASURE A. Intellectual pleasure- derives from one’s Discovery of truth, Desire for knowledge 31

32. B. AESTHETIC PLEASURE B. Aesthetic pleasure- refers to one’s interested feeling of beholding something beautiful. 32

33. C. PHYSICAL PLEASURE C. Physical pleasure satisfaction of luxurious or sexual desire. What if you attend the office at 11:00am instead of 8am??? 33

34. i.iii. EGOISM ETHICAL THEORY Your conduct or action is ethical if it focus on self-interest • What makes something good or bad, right or wrong, is that it satisfies one’s desires, or meets one’s needs • Basic Principle: Self-interest of person doing, considering, or affected by the action • One should choose the action which most realizes or conduces to one’s own self-interest 34

35. TYPES OF EGOISM Individual Ethical Egoism Judges actions only by their effects on one’s interests Usually rejected by moral philosophers as a defensible basis of ethics Universal Ethical Egoism Can include the interests of others when assessing one’s actions Still self-centered: pursuing pleasure and avoiding pain “Enlightened self-interest.” Considers the interests of others because the person wants others to do the same toward him or her 35

36. OBJECTIONS TO EGOISM Not all human acts are selfish by nature, and some are truly altruistic. Egoism is not a moral theory at all: Egoism misses the whole point of morality, which is to restrain our selfish desires for the sake of peaceful coexistence with others. Does not resolve conflicts in people’s interests One party would always have the pursuit of his or her interests blocked 36

37. ii. DEONTOLOGY ETHICAL THEORY Deontologism - Duty Ethics Greek: deon - duty Deontos : that which is binding, right, proper; Emphasis on universal imperatives such is moral laws , duties , obligations , prohibitions . It is sometimes also called imperativism . Focus on means eg telling truth, Ban on killing, adherence with religious beliefs 37

38. DEONTOLOGY ETHICAL THEORY It looks on one’s duties and obligations in determining what is ethical. It is also known as Duty Ethics . An ethical act is the one that meets obligations , responsibilities and duties . 38

39. KANT’S THEORY Represent deontological ethics For him a right action consists solely in an action that is ruled and justified by a rule or principle. It was the rational and autonomous conformity of one’s will to see right the universal moral law 39

40. RIGHTS BASED THEORY Does not leads to violate the rights of others Right: a person’s just claim or entitlement Focuses on the person’s actions or the actions of others toward the person Types Legal rights: defined by a system of laws Moral rights: based on ethical standards Purpose: let a person freely pursue certain actions without interference from others 40

41. RIGHTS BASED THEORY Features Respect the rights of others Lets people act as equals Moral justification of a person’s action Examples Legal right: right to a fair trial in the Pakistan Moral right: right to due process within an organization 41

42. RIGHTS BASED THEORY Rejects view of assessing the results of actions Expresses moral rights from individual's view, not society's. Does not look to the number of people who benefit from limiting another person's rights Example: right to free speech in the Pakistan stands even if a person expresses a dissenting view 42

43. TYPES OF RIGHTS • Negative rights: do not interfere with another person’s rights • Positive rights: A person has a duty to help others pursue their rights Example Negative: do not stop a person from whistle-blowing Positive: coworker helps another person blow the whistle on unethical actions  43

44. COMPARISON Teleology Deontology Virtue Ethics Morality is about good  outcomes Morality is about good  rules   Morality is about good  people We should make decisions based on what will most likely result in the outcomes we want We should come up with a logical system of moral rules and always follow it no matter what We should strive to become more courageous, honest, generous, and compassionate. “The ends justify the means” The means do not justify the end Such a person will make good moral decisions on their own without the need for abstract moral rules. Focus on desire outcomes/ consequences Focus on the means/act regardless of end/result Moral link with personal characteristics 44

45. DONATION CASE -I The Reluctant Donor Case: Suppose that you are famous transplant surgeon, and that your transplants always work. You have five patients, each of whom needs a transplant. One needs a heart, one a brain, two need one lung each, and one needs a liver. You have a patient named “Mr. Kumar” who has come in today to find out the results from some lab work. You know from the results of the lab work that Mr. Kumar would be a perfect donor for each of your five other patients, and you know that there are no other available donors. So you ask Mr. Kumar if he would be willing to be cut up and have his organs distributed. He declines your kind offer. But you then realize that you could cut Mr. Kumar up without his permission during some minor surgery he has already consented to. Is it permissible for you do so? 45

46. State will create a new stretch of highway New highway segment will circumvent towns allowing trucks an alternate route. Some wildlife habitat would be destroyed Taxes will be raised Highway Scenario case-II

47. Shazia earning an “A” on all work so far Carla doesn’t have time to write final report Shazia purchases report; submits it as her own work PLAGIARISM SCENARIO CASE -III Shazia Single mother Works full time Takes two evening courses/semester History class Requires more work than normal

48. WHAT TO DO ??? CASE-IV 48

49. ETHICAL DILEMMA, ETHICAL DECISION MAKING & CODES OF ETHICS FOR NURSES

50. ETHICAL DILEMMAS Ethical dilemmas, also known as a moral dilemmas, are situations in which there is a choice to be made between two options, neither of which resolves the situation in an ethically acceptable fashion. An ethical dilemma or ethical paradox is a decision-making problem between two possible moral imperatives , neither of which is unambiguously acceptable or preferable. The complexity arises out of the situational conflict in which obeying would result in transgressing another.

51. ETHICAL DILEMMAS

52. Continue A decision that morally requires two or more courses of action, which are in practice incompatible with each other. A decision that should "taken in one’s self interest, but which appears to violate a moral principle that you support. It is the imperative to act, combined with the uncertainty of which action to take, that causes a dilemma. Doing morally right Bad outcome Doing morally wrong Good outcome In such a dilemma, choosing one moral will result in violating another; or, doing one thing could bring positive results but is morally wrong. A common example is “stealing from the rich to feed the poor.”

53. ETHICAL DILEMMAS

54. ETHICAL DILEMMAS IN SOCIAL WORK Ethical dilemma occurs when social workers must choose between two contradictory ethical principles or directives. Conflict may arise between patients, families, agency staffs, and government regulations. Tensions may arise in homecare National Association of Social Workers

55. SOCIAL WORKERS DILEMMA Social workers reported that the most common issues were patient competence and confusion because of the lack of advance directives Some examples of ethical dilemmas are: A social worker's personal or professional values conflict with serving their client A social worker's values or conduct deviate from the professional code of ethics that governs social work. A social worker must decide whether to break confidentiality for the good of their client An organization or colleague violates a standard of ethical conduct

56. SOCIAL WORKERS DILEMMA AND DECISION MAKING The National Association of Social Workers (NASW) provides the Code of Ethics as a decision-making model that all social workers use. Function of the code is to ensure the conditions under which social workers practice: Maintaining appropriate boundaries Following privacy rules Obtaining proper legal consent from clients Protecting confidentiality the code reminds social workers of their professional values and mission. These standards benefit both social worker and client, and, ideally, create an environment that is conducive to progress.

57. ETHICAL DILEMMAS PHYSICIANS FACED Three possible areas of decision making have been Identified Using all possible means to keep the patients alive (ordinary & extraordinary means). Surgeons experience ethical dilemmas in deciding the right treatment in different situations. Taking some “positive” steps to hasten individual’s death.

58. ETHICAL DILEMMAS IN NURSING The challenge of decision making . The sanctity of life vs the quality of life. Truth-telling A code of ethics in nursing basically states that nurses are responsible for respecting human rights and treating all patients with respect while promoting health , minimizing suffering , and preventing sickness .

59. 4 COMMON NURSING ETHICS DILEMMAS 1. Informed consent Concerns that patients and their families have not been fully informed about their treatments or clinical prognosis is a common ethical concern of nurses, Ulrich reported. 2. Disclosing medical conditions Another example of an ethical dilemma is telling the truth to a patient vs. being deceptive, “Sometimes families request that patients not be told about their medical condition or diagnosis. “The nurse must consider the patient's right to know. How does the nurse know what the family is saying is true?” (Altman) The nurse has an obligation to the patient and the ethical principles of nonmaleficence and fidelity —the obligation to prevent harm and to be faithful to your colleagues, “The nurse’s own value of truth telling must also be considered.”

60. 4 COMMON NURSING ETHICS DILEMMAS 3. Incompetence among peers Another dilemma when a nurse notes incompetence in a fellow health care team member and struggles with speaking up or staying silent, They may feel the behavior should be reported because of the threat to patient safety but hesitate to do so because it would worsen inadequate staffing, “Some dilemmas can be framed as competing obligations, such as protecting the patient on one hand and protecting the staff on the other. The principles to consider are nonmaleficence and fidelity.

61. 4 COMMON NURSING ETHICS DILEMMAS 4. Broader ethical issues According to Felicia “Liz” Stokes, JD, RN, senior policy advisor at the ANA’s Center for Ethics and Human Rights, ANA considers the top three nursing ethics issues as: Creating and maintaining an ethical work environment Nursing’s role in social justice, such as opposing capital punishment Moral distress and moral resilience. “The Code of Ethics for Nurses with Interpretive Statements is clear that nurses are bound in their duty to protect human health,” (Ruth McBain on behalf of ANA).

62. ETHICAL DILEMMA VIDEO https://www.youtube.com/watch?v=-GxuvKRL7ks https://www.youtube.com/watch?v=oQl6b-fN1BI

63. ETHICAL DECISION MAKING In the context of decision making, your ethics are your personal standards of right and wrong. They are your basis for making ethically sensitive decisions. Ethical decision making is a cognitive process that considers various ethical principles, rules, and virtues or the maintenance of relationships to guide or judge individual or group decisions orinted actions

64. ETHICAL DECISION-MAKING MODEL Ethical decision-making models provide a suggested mechanism for critical thinking and planning for the resolution of ethical dilemmas. An ethical decision-making model is a tool that can be used by health care providers to help develop the ability to think through an ethical dilemma and arrive at an ethical decision. The goal of each model is to provide a framework for making the best decision in a particular situation with which the health care provider is confronted.

65. References Aroskar ; M.A., Davis, A., Drought, T., Liaschenko , J.(1997). Ethical dilemmas and nursing practice https://www.noodle.com/articles/ethical-dilemmas-in-social-work-what-to-know-about-nasw-code-of-ethics Retrieved on 6 April 2020

66. References 1 Wake E. Commentary on Twycross A, Finley GA (2013) Children’s and parents’ perceptions of postoperative pain management: A mixed methods study. Journal of Clinical Nursing 22, 3095-3108. Vol. 23, Journal of Clinical Nursing. 2014. p. 3290–1. 2 American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health, Task Force on Pain in Infants C and A. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001;108(3):793–7. 3 Tein AJ, Roosa MW, Michaels M. Agreement Between Parent and Child Reports on Parental Behaviors. J Marriage Fam. 2012;56(2):341–55. 4 Cordell WH, Keene KK, Giles BK, Jones JB, Jones JH, Brizendine EJ. The high prevalence of pain in emergency medical care. Am J Emerg Med. 2002 May;20(3):165–9. Stevens BJ, Abbott LK, Yamada J, Harrison D, Stinson J, Taddio A, et al. Epidemiology and management of painful procedures in children in Canadian hospitals. CMAJ. 2011 Apr 19;183(7):E403-10. Online guide to Ethics and Moral Philosophy . (1996). Kant's Ethics . Recuperado el 22 de Febrero de 2013, de Onlie guide to Ethics and Moral Philosophy : http://caae.phil.cmu.edu/Cavalier/80130/part1/sect4/Kant.html 68

67. References Immanuel Kant Biography – life, family, childhood, children, death, history, school, information, born, tall, t ime . ( n.d .). Encyclopedia of World Biography . Retrieved February 25, 2013, from http://www.notablebiographies.com/Jo-Ki/Kant- Immanuel.html#b Immanuel Kant Biography - Facts, Birthday, Life Story - Biography.com . ( n.d .). Famous Biographies & TV Shows - Biography.com . Retrieved February 25, 2013, from http://www.biography.com/people/immanuel-kant- 9360144 (2011). Kant's ethical theory. Retrieved February 24th. 2013, de RSRevision from: http://www.rsrevision.com/Alevel/ethics/kant/index.htm Fledderman , Ch. (2014). Engineering Ethics. International Edition, Pearson Prentice Hall. Encyclopedia Britannica, Inc. 2003. www.search.eb.com Online Ethics Center for Engineering and Science. 2004. http://onlineethics.org Fledderman , Ch. (2014). Engineering Ethics. International Edition, Pearson Prentice Hall. Encyclopedia Britannica, Inc. 2003. www.search.eb.com Online Ethics Center for Engineering and Science. 2004. http://onlineethics.org

68. Ethical dilemmas A decision that morally requires two or more courses of action, which are in practice incompatible with each other. A decision that should "taken in one’s self interest, but which appears to violate a moral principle that you support. It is the imperative to act, combined with the uncertainty of which action to take, that causes a dilemma. Doing morally right Bad outcome Doing morally wrong Good outcome In such a dilemma, choosing one moral will result in violating another; or, doing one thing could bring positive results but is morally wrong. A common example is “stealing from the rich to feed the poor.”

69. Ethical dilemmas

70. Ethical Dilemmas in Social Work Ethical dilemma occurs when social workers must choose between two contradictory ethical principles or directives. Conflict may arise between patients, families, agency staffs, and government regulations. Tensions may arise in homecare National Association of Social Workers

71. Social Workers dilemma Social workers reported that the most common issues were patient competence and confusion because of the lack of advance directives Some examples of ethical dilemmas are: A social worker's personal or professional values conflict with serving their client A social worker's values or conduct deviate from the professional code of ethics that governs social work. A social worker must decide whether to break confidentiality for the good of their client An organization or colleague violates a standard of ethical conduct

72. Social Workers dilemma and Decision making The National Association of Social Workers (NASW) provides the Code of Ethics as a decision-making model that all social workers use. Function of the code is to ensure the conditions under which social workers practice: Maintaining appropriate boundaries Following privacy rules Obtaining proper legal consent from clients Protecting confidentiality the code reminds social workers of their professional values and mission. These standards benefit both social worker and client, and, ideally, create an environment that is conducive to progress.

73. Ethical Dilemmas Physicians Faced Three possible areas of decision making have been Identified Using all possible means to keep the patients alive (ordinary & extraordinary means). Surgeons experience ethical dilemmas in deciding the right treatment in different situations. Taking some “positive” steps to hasten individual’s death.

74. Ethical Dilemmas in Nursing The challenge of decision making . The sanctity of life vs the quality of life. Truth-telling A code of ethics in nursing basically states that nurses are responsible for respecting human rights and treating all patients with respect while promoting health , minimizing suffering , and preventing sickness .

75. 4 Common Nursing Ethics Dilemmas 1. Informed consent Concerns that patients and their families have not been fully informed about their treatments or clinical prognosis is a common ethical concern of nurses, Ulrich reported. 2. Disclosing medical conditions Another example of an ethical dilemma is telling the truth to a patient vs. being deceptive, “Sometimes families request that patients not be told about their medical condition or diagnosis. “The nurse must consider the patient's right to know. How does the nurse know what the family is saying is true?” (Altman) The nurse has an obligation to the patient and the ethical principles of nonmaleficence and fidelity —the obligation to prevent harm and to be faithful to your colleagues, “The nurse’s own value of truth telling must also be considered.”

76. 4 Common Nursing Ethics Dilemmas 3. Incompetence among peers Another dilemma when a nurse notes incompetence in a fellow health care team member and struggles with speaking up or staying silent, They may feel the behavior should be reported because of the threat to patient safety but hesitate to do so because it would worsen inadequate staffing, “Some dilemmas can be framed as competing obligations, such as protecting the patient on one hand and protecting the staff on the other. The principles to consider are nonmaleficence and fidelity.

77. 4 Common Nursing Ethics Dilemmas 4. Broader ethical issues According to Felicia “Liz” Stokes, JD, RN, senior policy advisor at the ANA’s Center for Ethics and Human Rights, ANA considers the top three nursing ethics issues as: Creating and maintaining an ethical work environment Nursing’s role in social justice, such as opposing capital punishment Moral distress and moral resilience. “The Code of Ethics for Nurses with Interpretive Statements is clear that nurses are bound in their duty to protect human health,” (Ruth McBain on behalf of ANA).

78. Ethical Dilemma Video https://www.youtube.com/watch?v=-GxuvKRL7ks https://www.youtube.com/watch?v=oQl6b-fN1BI

79. Ethical decision making In the context of decision making, your ethics are your personal standards of right and wrong. They are your basis for making ethically sensitive decisions. Ethical decision making is a cognitive process that considers various ethical principles, rules, and virtues or the maintenance of relationships to guide or judge individual or group decisions orinted actions

80. Ethical Decision-making Model Ethical decision-making models provide a suggested mechanism for critical thinking and planning for the resolution of ethical dilemmas. An ethical decision-making model is a tool that can be used by health care providers to help develop the ability to think through an ethical dilemma and arrive at an ethical decision. The goal of each model is to provide a framework for making the best decision in a particular situation with which the health care provider is confronted.

81. ETHICAL DECISION-MAKING PROCESS Article Activity Please read the article carefully, and fill the questions table with your own nursing practice issues, how you identified the problem and what was your decision for resolving that problems Note: please answer all the question. This is a graded activity

82. References Aroskar ; M.A., Davis, A., Drought, T., Liaschenko , J.(1997). Ethical dilemmas and nursing practice https://www.noodle.com/articles/ethical-dilemmas-in-social-work-what-to-know-about-nasw-code-of-ethics Retrieved on 6 April 2020

83. Case A 32-year-old pregnant woman, who came for vaginal delivery. She had two previous babies with emergency cesarean section. The second baby was born just a year back. Due to this doctors wanted Mrs. X to avoid any risk and to get her baby delivered through c- section . The staff members tried to convince Mrs. X and her husband, but to no avail. Finally, the patient was sent home for trail of normal labor. Two weeks later she came up with strong pains, but during delivery her uterus got rupture. The baby was delivered normally, whereas, mother was transferred to the intensive care unit for close observation. Unfortunately a few weeks later she died. Sayani , A.H (2015) 29 April 2021 87

84. Question “ Could medical paternalism have saved patient life?” and if so, how could the principle of autonomy be justified ?” 29 April 2021 88

85. In this emblematic ethical dilemma, if couple autonomy was respected, women were exposed to complications. While if a health care professional’s decision was taken into account, then patients autonomy, was violated. According to Beuchamp and Childress there is a disparity between the principle of paternalism and autonomy . Sayani , A.H (2015) 29 April 2021 89

86. Medical Paternalism 69 years male diagnosed with metastatic likely terminal cancer. Based on a long relationship, the man's physician knows that the patient has a history of psychiatric illness and is emotionally fragile. When the patient blurts out, "Am I OK? I don't have cancer, do I?" the physician answers, "You're as good as you were ten years ago," knowing that the response is a paternalistic lie, but also believing it justified in protecting the health and well-being of the patient. 29 April 2021 90

87. Futility Medical futility is described as proposed therapy that should not be performed because available data have shown that it will not improve the patient's medical condition .   James L. Bernat , 2005 29 April 2021 91

88. Cont: Futility in medicine is an ancient concept; Hippocrates clearly stated that physicians should “refuse to treat those who are overmastered by their disease, realizing that in such cases medicine is powerless Deborah L. Kasman , October 2004 29 April 2021 92

89. What can physicians do when their professional judgment differs from preferred patient or family choices? First, it is important to determine who has the moral and legal right to make medical decisions. The patient has the right to make decisions regarding his own care as long as he is mentally competent. If a patient is deemed mentally incompetent to make decisions, a surrogate must be identified. (Deborah L. Kasman , 2004) 29 April 2021 93

90. Cont: This surrogate can be legally assigned by the patient prior to incapacity (a durable power of attorney), or his next of kin. If there is not an identifiable surrogate by either means, the courts must assign a morally valid proxy who can act in the patient’s best interest. (Deborah L. Kasman , 2004) 29 April 2021 94

91. Process to consider a treatment futile Patient’s Right ( e.g. spirituality) Surrogate Involvement (incapable patient) Physicians Decision Nurse play an important role (as a bridge) Court Effective communication is mandatory (Nathaniel A.K Burkhadt M.A 2008) 29 April 2021 95

92. Futility Differs for Different Age and Case A futile care / Procedure for one is not futile for all; it may be a useful for another… Child Young Old Acute Chronic (Nathaniel A.K Burkhadt M.A 2008) 29 April 2021 96