Decision Making and

Problem Ethics

By :
Tri Anjaswarni Harsono

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 HOW TO MAKE
THE BEST DECISIONS

Ethical & Moral theory

Ethical Values & Principles
Basic Moral Concepts
Problems in Clinical Practice
Process for resolving the ethical
Problems
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Problems in Clinical
Practice

Ethical Issue
Ethical Problem
Ethical Dilemma
Bio-ethical
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 Ethical Issue

One in which one or more

moral norms or principles
are present, but do not
create a problem

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 Ethical Problem

One in which two or more

moral norms or principles
create a challenge about
what to do

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 Ethical Dilemma
Problem that involves two or more morally
correct courses of action, but you can’t do
both.
It is difficult to determine the right decision
or action
A difficult problem that seems to have no
satisfactory solution
A choice between equally unsatisfactory
alternatives
An ethical dilemma exists when the moral
claims conflict with another (What should I
do or What is the right thing to?)
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Bio-Ethic
Asal kata: Bios = hidup dan ethos = adat
istiadat / moral
Bioetik adalah penerapan etika dalam ilmu-
ilmu biologis, obat, pemeliharaan kesehatan
dan bidang terkait
Kaedah dasar biotika adalah karakteristik yg
unik dari prinsip yg dapat digunakan untuk
menganalisis lbh tajam standar/prinsip/
aturan yg digunakan utk pengambilan
keputusan klinis (afandi, D., 2017)

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 Three Type of
Moral and Ethical Problems
Jameton (1984)
in Taylor, Lillis, LeMone (1989)
Moral Uncertainty, where the nurse is
unsure of which moral principles or value
apply.
Moral Dilemma, where two or more clear
moral principles apply but support mutuality
inconsistent courses of action.
Moral Distress, where the nurse knows the
right thing to do but institutional constraints
make it nearly impossible to pursue the right
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action
Type of
Moral and Ethical Problems (Cont.)

Nurses and Clients

Nurses and Physician
Nurses and Other Nurses
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Type of
Moral and Ethical Problems (Cont.)

Nurses and Difficulty identifying

primary client
Clients Paternalism
Deception
Confidentiality
Informed consent
Conflict between
the client’s and
nurse’s interest

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Type of
Moral and Ethical Problems (Cont.)

Nurses and Disagreements

about the
Physician proposed
medical regimen.
Conflict regarding
the scope of the
nurse’s role.
Physician
incompetence

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Type of
Moral and Ethical Problems (Cont.)

Nurses and Claim of

Other Nurses loyalty
Nurse
incompetence

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 Ethical Decision Making
Comparison of Nursing Process And Ethical
Decision Making Model
Nursing Process Ethical Decision Making
Model
Assess Clarify the ethical
dilemma
Gather additional data
Analyze & diagnoses Identify option
Plan Make a decision
Implement Act
Evaluate Evaluate
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Process for resolving the ethical
Problems
Step I : Identify The problem (Clarify
the ethical dilemma)
Step II : Gather additional data
Step III : Identify option
Step IV : Make a decision
Step V : Act
Step VI : Evaluate

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 Process (Cont.)
Step I :
Identify The Problem
(Clarify The Ethical Dilemma)
What is the specific issue ? State the problem
Clearly
Who owns the problem and should actually
make the decision ?
Who is affected by the dilemma ?
Determine the ethical principle or theory related
to the dilemma !
Are there value conflict ?
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Step II
Gather additional data

Gathered many facts about the

situation as possible
describe the situation that gives rise to
the problem : main people involved
(view & interest), client overall nursing,
medical and social situation, relevant
legal, administrative, and staff
consideration.
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Step III : Identify Option

List all alternatives to solve the

problem
Give reason on each alternatives
Consider immediate consequences to
the people involved as well as long
term consequences to the institution /
society
Brainstorm with others and consider
every possible alternative.
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 Step IV : Make Decision

Think through the option that are identify

and determine each options’ impact.
Ethical principles and theory may help
determine the significance of each
option.
Choose a course of action that best
reflect your considered judgment,
consultation with an institutional ethics
committee or other staff may be helpful.

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 Step V : Act

Once a course of action has

been determined, the decision
must be carry out
Implementing the decision
usually involves working
collaboratively with others.

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 Step VI : Evaluate

It is important for decision makers to

determine the impact this decision.
If the action accomplishes its purpose,
the ethical dilemma should be
resolved.
If the dilemma has not been resolved,
additional deliberation is needed.
How can you improve the decision
process next time.
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Factors Affecting Decision
Making Process
Personal values (client, nurse, other
professional)
Institutional Values
Social values
Individual purpose
Institutional Purposes
Nurse’s Knowledge

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