6 Respect

7 Autonomy/ 8 Veracity/ 9 Fidelity

Respect
Respect is our moral duty to treat people
in certain ways
It is the characteristic of these norms that
determines what is morally right rather
than the consequences
These views are called formalism or
deontology, which means certain
behaviours are our duty even if there is no
benefit, eg. Avoidance of killing or lying

Biomedical
Those who refer to the principle of respect
for persons then derive the duty to respect
autonomy, to tell the truth, to keep
promises and to avoid killing people
Beauchamp and Childress included the
principle of respect for autonomy as one
of four (beneficence, nonmaleficence,
justice) principles of Biomedical ethics

Persons
Some commentators define a person as
a being who is self aware or self
conscious
This definition means that many living
human beings such as babies or
individuals with alzheimers are not
persons
Whereas others believe the opposite

Code of Ethics
It seems arguable that some living
humans who might not be considered
persons, deserve maximum respect
The first statement in the ANA code of
ethics states: The nurse in all professional
relationship, practices with compassion,
and respect for the inherent dignity, worth
and uniqueness of every individual

7 Autonomy
It is believed that we owe others respect
for the autonomy and that showing such
respect might be more important than
producing benefits for others
Often the goals of doing good and
avoiding harm come into conflicts with
other principles as respect for autonomy,
truth-telling and promise-keeping

Decision making
Respecting autonomy means that persons
with decision-making capacity have the
right to make these decisions.
Decision making capacity is: a. the ability
to comprehend information, b. able to
deliberatein accordance with his own
values and goals, c. ability to
communicate with caregivers

Incompetence
Medical ethics recommends a sliding scale
model of capacity determination, with
consent or refusal being more stringent
Strictly speaking only the courts have the
authority to declare a person incompetent
We can refer to individuals who lack
capacity as one who lacks decision-making
capacity

Choices
In respect for persons who support
respect for autonomy, one would need to
accept the individuals choices even if its
not in their interest
Internal constraint on autonomy is that
small children or severely retarded has
never had that capacity

8. Veracity
Another characteristic that people believe
is morally required for reasons other than
producing good consequences is telling
the truth in personnel communication
The nurse needs to assess whether
communication is honest
We might face situations at times when
being honest will be inconvenient to staff
and harmful to pt.

9. Fidelity
Fidelity is about a moral obligation to keep
commitments that are made
If you fail to do this, it is a mark of
disrespect. Part of commitment is making
a promise
When a promise is made there is an
ethical obligation to keep it as a principle
of fidelity

Breaking a promise
The duty of fidelity is not rigid and has
exceptions
If remaining fateful to ones commitment
would result in serious harm being done to
another, the requirement of doing good and
avoiding harm may conflict with fidelity
Beneficence would pull in the direction of
breaking the promise

Explicit/ Implicit
An implicit promise is a commitment that
all parties assume to exist even if no
specific act of promise occurred
An explicit promise is a commitment made
to another

10. Sanctity of Human Life

The reason for killing in the healthcare
sphere are usually related to mercy
Someone makes a judgement that the pt
would be better off dead
If its the health professionals duty to
benefit pt and protect them from harm,
may they assist in putting a suffering pt
out of misery???

Mercy killing
The principle of beneficence and
nonmaleficence, of doing good and
avoiding evil, provides ready arguments to
support mercy killing as well as withhold or
withdraw treatment
For pts who are competent, autonomy
provides a moral basis for approving of or
tolerating treatment-refusal decision by
these pt

Rules of conduct
Some people who believe ethics is a
matter of consequences nevertheless
maintain that consequences should be
used to judge rules of conduct involving
killing
The believe that a rule against killing even
for mercy will have better consequences

Withhold
Does the avoidance of killing apply only to
active killing or does it also extend to
decisions to let a person die?
Is there a difference between actions and
omissions
If a pt is inevitably dying , many people
believe that it is morally preferable to
withhold or withdraw treatment, than to
intervene actively to kill a pt

Intended killings
Sometimes persons are killed without the
intention of doing so, as in anesthesia
accident
Some theology or philosophic debates make
a distinction between accidental and
intended killings
The doctrine of double effect holds that
some deaths are morally permissible, if four
conditions are met

Conditions are
1. The action is good or indifferent in itself
2. The intention of the agent is upright, the
evil effect is sincerely not intended
3. The evil effect is equally immediate
causality with the good effect; it is not a
means to good effect
4. There must be a proportionally grave
reason for allowing the evil to occur

Euthanasia
Some people are now advocating the
legalization of assistance suicide or mercy
killing, when a competent pt wants life
ended
In Netherlands physicians who commit
euthanasia is not prosecuted and it is now
legal
Jack Kevorkian has done a number of
assisted suicide on request of pt

ANA
ANA believes that the nurse should not
participate in assisted suicide
Such an act is a violation of the Code for
Nurses with interpretive statements and
the ethical tradition of the profession
Nurses have no obligation to provide
compassionate end-of-life care

Withholding
Controversial decisions are withholding
medications, CPR, medically supplied
nutrition and hydration (Terri Schiavo
case)