Sister Thea Krause, CSFN, PhD, ACNP-BC MERCY STREET: A CASE STUDY IN MORAL DECISION MAKING THEN AND NOW

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1 Sister Thea Krause, CSFN, PhD, ACNP-BC MERCY STREET: A CASE STUDY IN MORAL DECISION MAKING THEN AND NOW

2 DISCLAIMER I have no financial relationships with commercial interests to disclose. I am not presenting on behalf of my employer(s), hence, I am not serving as an agent of the federal government. I do not have any stock or influence in the film industry or PBS. The only agency I can not separate from is my own one which, admittedly, has been inspired by many people, places and situations.

3 OBJECTIVES At the completion of this discussion participants will be able to: recognize that moral consequences, intended or not, are imbedded in all clinical behaviors; discuss an ethical framework based on value analysis and virtue ethics that can be used when considering moral consequences of behaviors inconsistent with ones personal value system; apply an ethical framework to current clinical situations in which values conflict pose moral dilemmas for professional caregivers.

5 THE CHARACTERS Moral dilemmas have to do with PEOPLE.

6 MORAL MATURITY Moral Maturity is marked by depth and consistency of moral judgement; recognition that moral judgement may be fallible; an awareness that moral judgement is complex Moral maturity is a requirement for a person who is to apply a body of knowledge to the solution of a problem; the understanding of a situation

7 MORAL DEVELOPMENT Moral development is the process through which we develop proper attitudes and behaviors toward other people in society. Moral development is based on social and cultural norms, rules, and laws. Piaget Kohlberg Gilligan Bronfenbrenner

8 RELIGIOUS DEVELOPMENT

9 BUT.WHAT ARE ETHICS? Simply stated, ethics refers to standards of behavior that tell us how human beings ought to act in the many situations in which they find themselves.

10 WHAT ETHICS ARE NOT Ethics are not the same as feelings. Ethics are not about religion. Ethics are not adhering to the law. Ethics are not adoption of culturally accepted norms. Ethics are not science.

11 1. Well Founded Standards 2. Study and development of ethical standards MAKING/WHAT-IS-ETHICS/

12 IDENTIFYING ETHICAL STANDARDS *If our ethics are not based on feelings, religion, law, accepted social practice, or science, what are they based on? *There are two problems when identifying ethical standards : 1. On what do we base our ethical standards? 2. How does we apply those standards to specific situations?

13 SOURCES OF ETHICAL STANDARDS Utilitarian Rights Fairness/Justice Common Good Virtue

14 HOW DO THE THEORIES DIFFER? Theory Utilitarianism Rights Justice Common Good Virtue Premise A perspective that judges something on the basis of its utility or usefulness. Best protects and respects the moral rights of those affected. Claims that equals should be treated equally. Ethical actions treat all human beings equally-or if unequally, then fairly based on some standard that is defensible. Interlocking relationships of society are the basis of ethical reasoning and that respect and compassion for all others-especially the vulnerable-are requirements of such reasoning. Ethical actions ought to be consistent with certain ideal virtues that provide for the full development of our humanity.

15 PROBLEM DIFFERENT APPROACHES Each of the approaches helps us determine what standards of behavior can be considered ethical. There are still problems to be solved, however. The first problem is that we may not agree on a single approach. The second problem is that the different approaches may not answer the question "What is ethical?" in the same way.

16 A FRAMEWORK FOR DECISION MAKING Recognize Ethical Issue Get the Facts Evaluate Options Make a Decision Act and Reflect

17 LET S TRY IT A CASE FROM MERCY STREET

18 FRAMING ETHICAL REASONING - THEN

19 LET S TRY IT A CASE FOR TODAY S NP

20 FRAMING ETHICAL REASONING - NOW

21 man's humanity to man rather than man's inhumanity to man people hunger for compassionate interactions so much that it transcends all of culture."

22 REFERENCES American Society of Bioethics + Humanities. Core Competencies for Healthcare Ethics Consultation. Second Ed. Glenview, IL: American Society of Bioethics + Humanities, Cherry, MJ. Re-Thinking the Role of the Family in Medical Decision-Making, Journal of Med Philosophy (2015) 40 (4): Ford, PJ and Dudzinski, D. eds. Complex Ethics Consultations: Cases That Haunt Us. Cambridge: Cambridge University Press, Junkerman, C, Derse, A. and Schiedermayer, D. Practical Ethics for Students, Interns, and Residents: A Short Reference Manual, Third Ed. Hagerstown, MD: University Publishing Group, McCullough, LB. Physicians Professionally Responsible Power: A Core Concept of Clinical Ethics. Journal of Medical Philosophy (2016) 41 (1): 1-9. Post, SG, ed. Encyclopedia of Bioethics, Third Ed. New York: Macmillan Reference USA, Post, LF, Blustein, J. and Dubler, NN. Handbook for Health Care Ethics Committees. Baltimore, MD: The Johns Hopkins University Press, PBS Mercy Street - Santa Clara University -

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