Fundamentals of Nursing and Midwifery 2e

Chapter 11 Values, ethics and advocacy

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to see the range of opinions among your classmates. Reflect on what it is that causes people to reach differ- ent conclusions about what is the ethically right thing to do. How might you use this knowledge as you experi- ence ethical conflict in your professional practice?

c. Keep any promises made to a patient or another professional carer d. Avoid causing harm to a patient 6. Nurse or midwifery advocates are often conflicted about respecting a patient’s right to be self-determining, while at the same time wanting to do everything in their power to promote the patient’s best interests. Which is the best general guideline for situations like these? a. Patient rules! ‘It’s my life!’ b. Nurse rules! ‘It may be your life but in this instance you don’t know enough to make the right choice!’ c. When in conflict, weigh the benefits and risks of following each option and then choose wisely. 1. The correct response is d . When rewarding and punish- ing are used to transmit values, children are rewarded for demonstrating values held by parents and punished for demonstrating unacceptable values. 2. The correct response is c . While it is true that value neu- trality commits nurses to care for patients whether or not the nurse and patient hold the same value, it is not true that nurses should sacrifice their moral integrity and compromise their beliefs or values to please a patient. 3. The correct response is a . The ability to be ethical, to make decisions, and to act in an ethically justified manner, begins in childhood and develops gradually. 4. The correct response is e . Non-maleficence is defined as the obligation to prevent harm. Autonomy is respect for another’s right to make decisions, beneficence obligates us to benefit the patient, justice obligates us to act fairly, and fidelity obligates us to keep our promises. 5. The correct response is a . The principle of autonomy obligates us to provide the information and support patients and their surrogates need to make decisions that advance their interests. 6. The correct response is c . Neither respecting and sup- porting patient preferences (a) nor ignoring patient preferences to achieve a medical benefit (b) routinely trump all other considerations. When a nurse cannot do both simultaneously, she must carefully weigh the ben- efits and risks of each option and then choose wisely. Answers with rationale

Review questions

1. Five-year-old Bobby has dietary modifications related to his diabetes. His parents want him to value good nutritional habits and they decide to deprive him of a favourite TV program when he becomes angry after they deny him foods not on his diet. This is an example of what mode of value transmission?

a. Modelling b. Moralising c. Laissez-faire d. Rewarding and punishing e. Responsible choice

2. Which of the following is the best professional response to a patient who tells you that she believes that ‘White midwives are smarter than Asian/Indigenous midwives’ and then asks if you agree? a. ‘You are right!’ (The patient/customer is always right!) b. ‘What I think doesn’t matter. What’s important is whatever you believe.’ (Value neutrality) c. ‘I don’t believe being smart is related to race or eth- nicity.’ (Commitment to human dignity) 3. When an older nurse complains that nurses just aren’t ethical anymore, the reply that reflects the best under- standing of moral development is: a. ‘The ability to behave ethically must be carefully cultivated; maybe we don’t value this sufficiently to pay it the attention it deserves.’ b. ‘I don’t agree that nurses were more ethical in the past. It’s a new age and the ethics are new!’ c. ‘Ethics is genetically determined—it’s like having blue or brown eyes. Maybe we’re evolving out of the ethical sense you and your generation had.’ d. ‘No kidding! Who could be ethical in a practice setting like this!’ 4. A community nurse who performs a careful safety assessment of the home of a frail elderly patient to prevent harm to the patient is acting in accord with which of the principles of bioethics? a. Autonomy b. Beneficence c. Justice d. Fidelity e. Non-maleficence 5. A professional nurse committed to the principle of autonomy would be careful to: a. Provide the information and support a patient needs to make decisions to advance the patient’s own interests b. Treat each patient fairly, trying to give everyone their due

Bibliography

Australian Commission on Safety and Quality in Health Care (ACSQHC). (2009). Australian Charter of Healthcare Rights. Chart. Canberra: ACSQHC. Accessed March 2013 at www.safetyandquality.gov.au/ publications/the-australian-charter-of-healthcare-rights/. Australian Nursing & Midwifery Council (ANMC). (2008a). Code of Ethics for Nurses. Downloaded March 2013 via Nursing and Midwifery Board of Australia at www.nursingmidwiferyboard.gov.au. —— (2008b). Code of Ethics for Midwives in Australia. Downloaded March 2013 via Nursing and Midwifery Board of Australia at www.nursingmidwiferyboard.gov.au.