Foundations in Evidence Based Practice

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Foundations in Evidence Based Practice

• Introduction to Ethics

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Introduction to ethics

• Our care for patients should be based on sound
  judgement
• (or evidence based practice!!)
• ..some of this judgement is about having a strong
  sense of what is right or wrong
• ..having a strong sense of what we should be
  doing and shouldnt be doing as nurses
• ..having a strong sense of what our priorities
  ought to be

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Introduction to ethics

• Nurses frequently have to make difficult
  decisions for which there is not always a quick,
  easy or correct answer
• e.g. Can Mrs X be discharged yet? Can Mr Y manage
  his own medications safely?
• Nevertheless, nurses still have to be able to
  explain and account for these decisions and
  actions
• The NMC Code can act as a guide
• This can be seen as a code of ethics a set
  of important principles to help guide nurses

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Achievement of practice outcomes includes
consideration of ethical issues

• Domain 1 Professional and Ethical Practice
• 1.3 Demonstrate an awareness of, and apply
  ethical principles to, nursing practice.
• Outcomes
• 1.3.1 Demonstrate respect for patient and client
  confidentiality
• THIS OUTCOME IS ONLY ABOUT CONFIDENTIALITY. IT
  IS NOT ABOUT HOW YOU RESPECT PATIENTS GENERALLY
• 1.3.2 Identify ethical issues in day to day
  practice

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What is an ethical issue?

• When you have to judge what is right or wrong
• Choosing between options
• Deciding whether to do something or do nothing
• Should I or shouldnt I?
• Weighing up the potential impact of your
  decisions or actions
• A dilemma making a difficult choice

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Ethical issues in health care

• We usually think of the big issues
• e.g. definition of life, what is a person,
  quality of life, prolonging life, ending life,
  human rights.
• But day to day ethical issues can involve
• Respecting people
• Treating people with dignity
• Treating people fairly
• Supporting patients choices
• These principles are encompassed in the NMC
  code
• The code is a useful source of ethical principles
  in health care

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Another source of ideas in health care ethics

• Principles of Biomedical Ethics (Beauchamp and
  Childress, 2001)
• They discuss
• 4 key principles
• supplemented by 4 rules

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4 Key Ethical Principles

• autonomy
• beneficence
• non-maleficence
• justice

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Autonomy

• Respect a persons right to make their own
  decisions
• Teach people to be able to make their own choices
• Support people in their individual choices
• Do not force or coerce people to do things
• Informed Consent is an important outcome of
  this principle

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Beneficence (to do good)

• Our actions must aim to benefit people
  health, welfare, comfort, well-being, improve a
  persons potential, improve quality of life
• Benefit should be defined by the person
  themselves. Its not what we think that is
  important.
• Act on behalf of vulnerable people to protect
  their rights
• Prevent harm
• Create a safe and supportive environment
• Help people in crises

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Non maleficence (to do no harm)

• do not to inflict harm on people
• do not cause pain or suffering
• do not incapacitate
• do not cause offence
• do not deprive people
• do not kill
• Both Beneficence and Non-maleficence underpin EBP

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Justice

• Treating people fairly
• Not favouring some individuals/groups over others
  
• Acting in a nondiscriminatory / non-prejudicial
  way
• Respect for peoples rights
• Respect for the law

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Justice

• Distributive Justice sharing the scarce
  resources in society in a fair and just manner
  (e.g. health services, professional time)
• How should we share out healthcare resources?
• How do we share out our time with patients?
• Deciding how to do this raises some difficult
  questions
• Patients should get..
• an equal share ?
• just enough to meet their needs ?
• what they deserve ?
• what they can pay for ?

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4 ethical rules

• Veracity truth telling, informed consent,
  respect for autonomy
• Privacy a persons right to remain private, to
  not disclose information
• Confidentiality only sharing private
  information on a need to know basis
• Fidelity loyalty, maintaining the duty to care
  for all no matter who they are or what they may
  have done

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Ethics 2 broad philosophical theories

• 1) consequentialism taking the consequences of
  our actions into consideration
• 2) deontology basing our actions on a set of
  principles or duties

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Consequentialism

• Actions are right or wrong according to the
  balance of their good and bad consequences
• the right act is the one that produces the best
  overall result
• Utilitarianism (what action has the greatest
  utility - use/benefit/positive outcome) is a
  type of consequentialism

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Utilitarianism

• most prominent consequence-based theory
• based on the principle of utility
• actions ought to produce the maximal balance of
  positive value (e.g. happiness) over disvalue
  (e.g. harm)

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Deontology

• Duty or principle based theory
• An act is right if it conforms to an overriding
  moral duty
• For example do not tell lies, do not kill.
• E.g. Christian ethics The Ten Commandments
• But Christian ethics are not important for some
  people in the world so moral duties vary between
  cultures and societies
• A moral duty or principle is one that is
• laid down by god / supremely rational being
• or is in accordance with reason / rationality
• or would be agreed by all rational beings
• The NMC Code of Conduct is a product of
  Deontological ethics it guides action based on
  a set of principles/duties.

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References

• Beauchamp T and Childress J (2001) Principles of
  Biomedical Ethics 5th Edition Oxford University
  Press
• Hunt G (1994) Ethical Issues in Nursing
  Routledge. London
• Seedhouse D (1998) Ethics the heart of Health
  Care Wiley. Winchester.
• Watt H (2000) Life and Death in Health Care
  Ethics Routledge. London
• http//www.iep.utm.edu/e/ethics.htmSH2a
• http//www.nursingethics.ca/articles.html
• http//www.freedomtocare.org/iane.htm
• http//www.lib.flinders.edu.au/resources/sub/healt
  hsci/a-zlist/ethics.html