Ethico-Moral Responsibility
of Nurses: Euthanasia
Ethico-Moral Responsibility of Nurses: Euthanasia
⮚ Hallmarks of end-of-life care include respect for patient self-
determination, nonjudgmental support for patients’ end-of-life.
Preferences and values and prevention and alleviation
of. suffering
Ethico-Moral Responsibility of Nurses:
Euthanasia
2 options of end-of-life
1. Medical aid in dying – patient with terminal illness, self- determination,
voluntary choice and informed request to self-administer medication to
hasten death
2. Euthanasia- occurs when someone other than the patient administers
medication in any form with the intention of hastening the patient’s death
Ethico-Moral Responsibility of Nurses:
Euthanasia
⮚ Euthanasia is inconsistent with the core commitments of the
nursing profession and profoundly violates public trust
⮚ Nurses are ethically prohibited from administering medical
aid in dying medication. Yet they must be comfortable
supporting patients with end-of-life conversations, assessing
the context of a medical aid in dying request
⮚ Nurses should reflect on personal values related to medical
aid in dying and be aware of how those values inform one’s
ability to provide objective information in response to a
patient’s request.
Recommendations
⮚ It is the shared responsibility of professional nursing organizations to speak for nurses
collectively in shaping health care hence the American Nurses Association supports
recommendations that nurses:
1. Remain objective when discussing end-of-life options with patients who are
exploring medical aid in dying.
2. Have an ethical duty to be knowledgeable about this evolving issue.
3. Be aware of their personal values regarding medical aid in dying and how these
values might affect the patient-nurse relationship.
4. Have the right to conscientiously object to being involved in the aid in dying process.
Recommendations
5. Never “abandon or refuse to provide comfort and safety measures to the
patient” who has chosen medical aid in dying
6. Protect the confidentiality of the patient who chooses medical aid in dying.
7. Remain objective and protect the confidentiality of health care
professionals who are present during the aid in dying process, as well as
the confidentiality of those who choose not to be present.
8. Be involved in end-of-life policy discussions and development
Ethico-Moral Responsibility of Nurses:
Euthanasia
⮚ important that nurses are clear about the ethical foundations of their own
views on medical aid in dying.
⮚ Clarity about personal and professional values related to end-of-life
options and care can also help nurses recognize the conditions to which
they may wish to conscientiously object
Ethico-Moral
Responsibility of Nurses:
ADVANCE DIRECTIVES
Advance directives
- Is a legal document in which a person specifies what actions should be
taken for their health if they are no longer able to make decisions for
themselves because of illness or incapacity.
Advance directives are written, legally-recognized documents that state your
choices about health- care treatment or name someone to make such choices
for you if you are not able to do so (Reyes, 2010).
Purposes:
• Appointment of health care proxy
• Make decision and guide doctors about life sustaining procedures in the
event of terminal condition, persistent vegetative state and end stage
condition i.e DNR, Pain management, Organ Donation, Euthanasia.
Forms:
1. 2. 3.
Advance directives
• ADVANCE DIRECTIVES: ADVANTAGE
unnecessarily prolonged painful hospitalization
Prevents unnecessary prolonged comatose or vegetative state
Prevents burden of rising Medical costs
Releases responsibility of love ones of difficult decisions
Advance directives
• ADVANCE DIRECTIVES : DISADVANTAGE
Family or loved ones may disagree with your medical decisions.
Difficulty in predicting what treatments will be available and preferred in a “future”
crisis.
Uncertainty over who can/should be a health care agent, especially for individuals
without available (or willing) family.
Advance directives
• nurses have a key role and responsibility in ensuring that patients have an
opportunity to complete advance directives, and in interpreting and
following through with patient’s wishes as expressed through these
directives.
• As nurses, we need to know our state’s statutes that guide and govern
advance directives
• be aware of the policies and procedures regarding advance directives
where we work
Ethical Decision Making Process
Problem Analysis
Problem is a discrepancy between the current situation and a desired state.
Before you can begin to solve a problem, you must be able to identify and categorize it
Moral Uncertainty
occurs when we sense that there is a moral problem, but are not sure of the morally correct action
Moral/ethical dilemma
is a problem that requires a choice between two options that are equally unfavorable and
mutually exclusive
Pattern of decision making
1. Recognizing a problem
2. Gathering data
3. Comparing options/action implies uncertainty
4. Making a choice/implemented decision
Nursing Process and Ethical Decision Making
⮚ Ethical decision making models are related to nursing care in the ethical
realm in the same way that the nursing process is related to nursing care in
the physical realm.
⮚ As nurses we commonly use the nursing process model for decision
making.
⮚ Utilizing logical thinking and intuitive knowing, the nursing process is a
deliberate activity that provides a systematic method for nursing practice
Attributes of an Effective Ethical Decision Maker
1. 2. 3. 4.
Bioethics and Research and
Guidelines in Documentation
Principles of Ethics and Research
1. Nuremberg code of 1947
⮚ Ethics principles for human experimentation resulting from Nazi
⮚ Focus on human rights and welfare
Declaration of Helsinki
⮚ Statement of ethical principles for medical research involving human
participants, including identifiable human material and data; doctors doing
medical research on patients
For all involved in medical research
Basis for Good Clinical Practice (GCP)
GENERAL PRINCIPLES
⮚ Purpose: understand disease, improve interventions
⮚ Human participants necessary
⮚ Primacy of patient’s best interest: health, well-being, rights
⮚ Duty and responsibility of researcher even if with consent of participants
⮚ Subject to ethical standards: International and national guidelines cannot reduce Helsinki
⮚ Respect and protect participants
⮚ Minimize harm to environment
⮚ Qualified researcher
⮚ Fair access to research
RISKS, BURDENS, AND BENEFITS
⮚ Pre-assess then monitor
⮚ Importance of objectives outweigh R/B for participants
o Benefits outweigh risks for participants and groups affected and managed
⮚ Measures to minimize implemented
⮚ Once risks outweigh the benefits or if there is already a clear outcome:
assess if research should be continued
VULNERABLE GROUPS AND INDIVIDUALS
⮚ Increased likelihood of wrong and harm – Special protection
⮚ Responsive to their health needs
⮚ Cannot be done on non-vulnerable
⮚ Stand to benefit from result
SCIENTIFIC REQUIREMENTS AND RESEARCH
PROTOCOLS
⮚ Conform to accepted scientific principles
⮚ Respect animals
⮚ Complete protocol including addressed ethical considerations
⮚ Post-trial provisions indicated
RESEARCH ETHICS COMMITTEES
• Transparent, independent, and qualified
• Follow norms
• Approve protocol
• Monitor study, approve amendments, and receive final report
PRIVACY AND CONFIDENTIALITY
• protect the privacy of research subjects
• INFORMED CONSENT
• For capable: voluntary, informed
• For not capable: legally authorized representative;
Belmont Report 1976
⮚ The Belmont Report is a report created by the National Commission for
the Protection of Human Subjects of Biomedical and Behavioral Research
⮚ summarizes ethical principles and guidelines for research involving
human subjects
The three fundamental ethical principles for using any human
subjects for research are:
1. Respect for persons: protecting the autonomy of all people and treating
them with courtesy and respect and allowing for informed consent.
2. Beneficence: the philosophy of "Do no harm" while maximizing benefits
for the research project
3. Justice: ensuring reasonable, non-exploitative, and well-considered
procedures are
• administered fairly
Ethical Issues Related to Evidenced Based Practice
⮚ Evidence-base practice is a systematic inter connecting scientifically
generated evidence with the tacit knowledge of the expert practitioner
Ethical issues involved in EBP
1. Status of evidence
2. Client Autonomy
3. Conflict of interest
ETHICO-MORAL OBLIGATIONS OF THE NURSE IN
EVIDENCE-BASED PRACTICES
1. Golden Rule
2. The principle of Totality – The whole is greater than its parts
3. Epikia – There is always an exemption to the rule
4. One who acts through as agent is herself responsible – (instrument to the crime)
5. No one is obliged to betray herself – You cannot betray yourself
6. The end does not justify the means
7. Defects of nature maybe corrected
8. If one is willing to cooperate in the act, no justice is done to him
9. A little more or a little less does not change the substance of an act.
10. No one is held to impossible
Guidelines and Protocol in Documentation and Health Care
Records
The NCCS Documentation Standard
- Documents are permanent legal records that provide a comprehensive
sequential description of relevant facts, data, and information about the
patient’s health status.
Documentation of nursing actions done to a patient is critical to determine if
the expected standard of care was rendered to a particular patient.
Importance of documentation
1. Facilitates interdisciplinary communication
2. Coordinates care
3. Provides information
4. Serves as bases for reimbursement
5. Reflects quality and timeliness of nursing care
6. Is utilized as legal document during permissible courtroom
CHARACTERISTICS OF GOOD DOCUMENTATION
1. Factual
2. Complete
3. Current (Timely)
4. Organized
5. Compliant with standards
6. Accurate
GUIDELINES IN DOCUMENTATION
1. Objective/Factual Documentation Direct observations and objective descriptions of
interventions rendered to clients are recorded
2. Timeliness Refers to completion of health care notes immediately within time specific care
3. Use of Space Empty lines or spaces are avoided to prevent late-entry of data.
4. Use of Abbreviations Abbreviations or acronyms that are internationally/institutionally
accepted
5. Follow-up All follow-up activities related to client care
6. Correcting Errors In isolated cases when errors in documentation are committed it is
advised that the SLIDE rule (Baker, 2000) be utilized
GUIDELINES IN DOCUMENTATION
7. Recording Medication Administration Administration of medications are
immediately documented after administration
8. Recording Assistance with Care There are numerous circumstances that one nurse is
assisted by another nurse in performing a specific nursing intervention
9. Designated Recorder in Emergency Situations During emergency situations there
must be a designated recorder
10. Clarification of Orders Medical orders that are poorly written require nurses to call
the writer for clarification.
11. Recording a Telephone Conversation with a Client Telephone conversation with a
client does not give the nurse the benefit of verifying objective findings
GUIDELINES IN DOCUMENTATION
12. Interactions with other Health-care Professionals It is the responsibility
of the nurse when formulating nursing care plans to include outcomes
13. Client Education Educational interventions and related health teachings
that provide comprehensive information to clients must be documented
14. Documenting an Incident in the Health-care Record It is imperative that
all incidents that occured with its corresponding pertinent data are
documented in the client’s health record.
Thank you!
