Foundations in Evidence Based Practice

1. Foundations in Evidence Based Practice • Introduction to Ethics

2. 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 shouldn’t be doing as nurses • ..having a strong sense of what our priorities ought to be

3. 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

4. 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

5. 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 shouldn’t I? • Weighing up the potential impact of your decisions or actions • A dilemma – making a difficult choice

6. 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 patient’s choices • These ‘principles’ are encompassed in the NMC code • The code is a useful source of ethical principles in health care

7. 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

8. 4 Key Ethical Principles • autonomy • beneficence • non-maleficence • justice

9. Autonomy • Respect a person’s 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

10. Beneficence (to do good) • Our actions must aim to ‘benefit’ people – health, welfare, comfort, well-being, improve a person’s potential, improve quality of life • ‘Benefit’ should be defined by the person themselves. It’s 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

11. 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

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

13. 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 ?

14. 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

15. 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

16. 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

17. 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)

18. 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.

19. 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.htm#SH2a http://www.nursingethics.ca/articles.html http://www.freedomtocare.org/iane.htm http://www.lib.flinders.edu.au/resources/sub/healthsci/a-zlist/ethics.html