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KNOWLEDGE COMPETENCIES
Characterize the nurse’s role in recognizing and addressing ethical concerns.
Recognize situations that warrant ethical analysis.
Describe the influence of environment in resolving ethical issues and the nurse’s contribution to the work environment.
Identify the steps involved in analyzing an ethical issue.
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Ethical issues are pervasive in progressive care settings. Serious illness and its treatment constrain patient autonomy. Countless ailments bring prognostic uncertainty for patient outcomes in progressive care, which can result in the patients, their loved ones, and healthcare teams struggling to determine the best ethical course of action. The COVID-19 pandemic both illuminated and exacerbated the ethical issues that progressive care teams face.
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The first step to managing ethical issues is the recognition that they exist, referred to as ethical sensitivity. Because of the complexity of the healthcare environment, differentiating issues that require moral reasoning from other common problems such as poor communication, differences of clinical opinion, or compassion fatigue can be challenging. Resolution of ethical issues depends on the ability to apply ethical decision-making skills and arrive at a conclusion about the best course of action for the situation in hand, knowing that many ethical dilemmas involve picking from bad options. Whether or not that action is taken depends not only on the motivation of the individual clinician but also on the environment in which treatments are provided. This chapter introduces the elements that serve as a foundation for addressing ethical issues including exploring terms, an introduction to and application of ethical frameworks, an overview of common ethical issues, a process to engage in ethical analysis, and problems that commonly occur in progressive care setting are discussed.
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FOUNDATIONAL TERMS: DEFINING ETHICS AND MORALITY
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Many use the terms morality and ethics interchangeably. In this chapter, we use the terms differently to highlight difference between making a judgment and engaging in an ethical analysis. Vaughn’s definition classifies ethics as the application of a moral theory, or theories, to sustain an ethically permissible argument. Whereas morality focuses on beliefs and judgments about what is “right” and what is “wrong” or what is “good” or what is “bad.” Morality often makes a judgment and does not require supporting evidence or rationale. Ethics requires building and framing a stance using supportive rationale, it is not about right or wrong, or good or bad—ethics is about why a course of action is permissible. The practice of healthcare ethics seeks to unpack values to help clinicians, patients, and their surrogates make ethically informed decisions.
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TYPES OF ETHICAL ISSUES
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The most often cited ethical issues in health care are ethical dilemmas, moral uncertainty, moral hazard, and moral distress. While the issues are discussed from the nurse’s perspective, all members of the healthcare team face similar ethical challenges. An ethical dilemma occurs when the nurse identifies two (or more) ethically permissible courses of ...