Behaviour & Application Of

Ethical Decision Making

Principles

Presented by:
Maqsooda sttar
Lecturer, snc
RN, RM, Post RN BSN

Dip in paediatric health nursing

 Objectives
At the end of this session each student will be able to:
 Define ethics
 Discuss ethical behavior.
 Describe nursing ethics and its types
 Define ethical dilemma and types.
 Explain ethical decision making & Framework for understanding ethical decision
making
 Identified factors effecting decision making?
 Enlist Ethical decision making principles
 Definition of Ethics
 The branch of philosophy that deals with morality. Ethics is concerned
with distinguishing between good and evil in the world, between right
and wrong human actions, and between virtuous and nonvirtuous
characteristics of people.
 Ethics are a system of moral principles and a branch of philosophy which
defines what is good for individuals and society.
 a set of moral principles, especially ones relating to or affirming a
specified group, field, or form of conduct.
 Ethics is concerned with the norms of human behavior.
 Ethical Behavior

Ethical behavior is characterized by honesty, fairness and equity in

interpersonal, professional and academic relationships and in all other activities.
Ethical behavior respects the dignity, diversity and rights of individuals and
groups of people. This definition is not a denial of the existence of other ethical
duties with respect to practice, professional service delivery, and research.
 What Is Ethical Behavior?

• Law, Values, and Ethical Behavior:

 Legal behavior is not necessarily ethical behavior.

 Personal values help determine individual ethical behavior.
 Nursing Ethics

Nursing ethics provides the professional standards for nursing activities, which help
to protect not only the nurse but also the patient. In 1973, the International Council
for Nurses (ICN) adopted the code of ethics and implemented a rule that all nurses
must follow this code. The main objectives of the code of ethics as described by the
ICN are as follows
 Conti….

 Promote health and well-being

 Prevent illnesses and complications
 Restore the health and alleviate the suffering of the patient without any
complications
 Code of Ethics

 The code of ethics states the kind of conduct expected from the members of a
profession and the responsibilities of its members towards those whom they
serve, their co-workers, the profession and the society as a whole.
 It would be easier in decision-making if the member understands what the
wrong or right behavior in different situations is. The first such code of
ethics, called the International Code of Nursing Ethics, was adopted by the
Grand Council of the ICN at Sao Paulo, Brazil, in 1953.
 Types of Ethics

Metaethics:
It was introduced by G.E.Moorre:
Meta ethics means understanding the concept of ethics. It
is about how we learn and understand ethics. What do we
mean by doing right or wrong? It forms the basis of any
ethics.
 He has explained about naturalism/naturalistic fallacy and he
openly rejects the naturalism intervening ethics.
 The focus of meta ethics is on analytical philosophy and
logical positivism.
 Conti…

Normative Ethics:
Normative ethics is otherwise known as moral theory of ethics. By dealing
with the principles of right and wrong, it helps to solve difficult issues. At
the turn of the 20th century, the focus of this theory on the right and wrong
actions diminished and it concentrated on diversified moral actions. It
created a renewed interest in normative ethics
 Conti….

Descriptive Ethics:
It is a kind of ethics that describes the aesthetics, beauty, and art of living,
thus giving more importance to social science than humanity. It gives
importance to the ethical principles that are derived from the observation of
people as activities and choices made in practice. This is also called as
situational ethics.
 Conti…

Military ethics:
It is a branch of ethics having its own set of practices and philosophy that guides the
armed force members to act consistently with the values and standards as established
by the military tradition and to enforce these conditions in the administrative
structure
 Ethical Dilemma

 It is similar to the two faces of coin, wherein importance needs to be given to

two equally desirable and undesirable outcomes.
 Ethical dilemma arises when a decision needs to be taken in a situation
wherein two different controversial options, sometimes equally undesirable ,
exist.
 Example

 Ethical dilemma is encountered in the case of

tubectomy , which is a family planning method.

 It is well known that family planning is good for the

health of mother. however, according to Catholic
belief, childerns are God's gifts and therefore ,
performing tubectomy is against christian Law .
 Conti…

For a catholic family, family planning is like doing a sin. There are still some
Roman Catholic hospitals, where family planning operation is not done to
anybody, irrespective of whether the person a Hindu, Christian or Muslim.
On one hand ,family planning is good for mother's health on the other
hand ,stopping children is a sin. Thus,there are two different conflicting ides
 Types of ethical dilemma
There re two main types of ethical dilemma :
Internal dilemma
( Can be with patient or with nurse)
External dilemma
( pertains to the environment or society)
 Internal dilemma

Occurs when an individual faces an issue that interferes with his/her own believes
and practices.
For example:
A nurse, as an individual , tries to give treatment to a dying patient because he or
she respects the patient's rights and believes that he/she doing good to the patient .
However ,the patient believes that he/she is going to die ,asks for euthanasia or
mercy killing and refuses to take the treatment.
 Conti…

 In this case, the dilemma involves internal conflicting ideas between the care
provider and the recipient .
 The nurse wants to do good but the patient wants to refuse it.
 The patients right, in terms of dignity, privacy, information
accessibility ,autonomy, culture etc should be respected & an internal dilemma
arises when the patient refuses care ,but the nurse wants to provide care .
 External dilemma

Arises when other individuals apart from the nurse and the patient are involved.
For example:
While treating a child that is dying or terminally ill, it is necessary to involve the
child's parents and let them see how treatment is being given for their dying child.
However, we never allow the parents to see what is being done to the child.
 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.
 Conti….

Ethical decision making is a cognitive process

that considers various ethical principles, rules
and virtus or the maintained of relationships
to guide or judge individual or group
decisions or intended actions.
 Nine Points for Ethical Decision
Making
1. Awareness: Recognize there is a moral issue.
2. Actor: Whose dilemma is this?
3. Facts: Gather all relevant details.
4. Right vs Wrong: Test for wrongdoing.
5. Right vs Right: Determine the paradigms.
6. Resolution: Apply the resolution principles.
7. Trilemma: Is there a third way out?
8. Decision: Decide what to do.
9. Reflection: Revisit the decision later.
Framework for understanding ethical
decision making
 Ethical issue intensity

Ethical issue intensity can be defined as the relevance or importance of an ethical

issue in the eyes of the individual, workgroup and /or organization.
Ethical issue intensity reflects the ethnical sensitivity of the individual or workgroup
that faces the ethical decision making process.
 Individual factors

Gender-women are generally more ethical than men.

Education or work experience-the more education or work experience that one
has, the better he or she is at ethical decision making.
Nationality-culture appears to be significant in affect of ethical decision making.
 Conti…

Age-the older you are ,the more ethical you are.

Locus of control-external control vs. internal control

 external control, see themselves as going with the flow because

that’s all they can do.
 Internal control, believe that they control the events in their lives
by their own effort and skill.
 Organizational factors

• The organization’s values often have greater influence on decisions than a

person’s own values.
• The more ethical employees perceive an organization’s culture to be ,the less
likely they are to make unethical decisions.
 Opportunity
Opportunities describe the conditions in an organization that limit or permit
ethical or unethical behaviour.

opportunity results from conditions that either provide rewards, whether internal
or external, or fail to erect barriers against unethical behaviour.
Ethical decision making
 Identify the Ethical problem

The decision maker must be able to determine:

If there is a possible violation of an important ethical principale, societal law
or organizational standard or policy.

If there are potential consequences that should be sought or avoided that

emnate from an action being considered to resolve the problem.
 Collect relevant information

The decision maker should seek to gather as much information as possible about
which rights are being for saken and to what degree.

A consequential focus would prompt the decision maker to attempt to measure the
type ,degree and amount of harm being inflicted or that will be inflicted on others.
 Evaluate the information
Once the information has been collected, the decision maker must apply some type
of standard and assesment criterion to evaluate the situation.

The decision maker might use one of the predominant ethics

theories_Utilitarianism,rights or justice.
 Consider alternatives

The decision maker needs to generate a set of possible action alternatives such as;
Confronting another person's action

seeking a high authority

Stepping in and changing the direction of what is happening.

 Make a decision
• The decision maker should seek the action alternative that is supported by
evaluation criteria used in evaluation.

• Adecision maker selects a course of action that is supported by al the ethics

theories or other evaluation criteria used in decision making
 Act or implement
The decision maker ,if truly seeking to resolve the problem being considered, must
take action

Once the action Alternatives have been identified in( consider alternatives) and the
optimal response is selected in( Make a decison) , the action is taken in
implementation.
 Review the action

• Once the action has been taken and the results are known, the decision
maker should review the consequences of the action.

• If the optimal resolution to the problem is not achieved, the decision maker
may need to modify the actions being taken or return to the beginning of
the decision making process
 Ethical Theories

The ethical decision making process applies following ethical theories:

• Utilitarian perspective
• Rights perspective
• Justice perspective
 Utilitarian Perspective

Where the decision maker considers the consequences or outcomes of an

action and seeks to maximize the greatest good for the greatest number of
those affected by decision.
There are types of utilitarian perspective
_Act
_rule
 Rights perspective

A decision maker whoconsiders a right perspective would consider the entitement

of those affected by decison.
 Justice perspective

• A justice perspective may focus on either the equitable distribution of the benefits
and costs resulting from the plant closing and employee layoffs( distributive
justice) or the maintainence of rules and standards.