University of Jordan

Faculty of Nursing

Health policy, politics, and professional

ethics

supervisor:Prof. Fathieh Abu-moghli

presented by : Khalid Yaseen
2022

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 Objectives
 Identify a brief overview about ethics

 Discuses the main concepts underlying the ethics

 Distinguish between the ethics and moral, value and dilemma

 Recognize what are the principle of ethics

 Discuses the ethics in nursing

 Integrate the ethics in policy.

 Ethics and work environment policies

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 Thinking together …

“To see what is right and not do it

is want of courage.”

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Introduction :
Three paramount human questions lie at the heart of bioethics:

• What kind of person ought I be to live a moral life and make good
ethical decisions?

• What are my duties and obligations to other individuals whose life and
well-being may be affected by my actions?

• What do I owe the common good or the public interest in my life as a

member of society?

Encyclopaedia of Bioethics, Dan Callahan

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Introduction… cont.

The authors of this chapter believe that too few nurses take seriously
their responsibilities as citizens,

in spite of being frequently reminded that their sheer numbers as the

largest group of health professionals (3.1 / 4.2 (2021) million) and as
the public’s most trusted professionals (Gallup,
2018,2019,2020,2021),
all of that make us a formidable force.

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Introduction… cont. Make us a formidable force … IN JORDAN

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Introduction… cont. Make us a formidable force … IN JORDAN

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Introduction… cont. Make us a formidable force … IN JORDAN

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Introduction… cont. Make us a formidable force … IN JORDAN

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Introduction… cont. Make us a formidable force … IN JORDAN

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Introduction… cont. Make us a formidable force … IN JORDAN

Link
here

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Ethics in health care
Designing a system for delivering health care that adequately meets the needs of a
diverse public is a complex challenge.

Health care planners have always worried about access, quality, and cost.

 Who should get what quality of care and at what cost?

 What you think about health care in the United States largely depends on your
past experiences.

 If you are well insured or independently wealthy, you can access the best
health care in the world.

 If you lack insurance and have limited financial resources, you may die of
a disease
that might have been prevented or treated at an early stage if you had had
access to quality care.

 The U.S. system has been criticized for providing too little care to some and too
much of the wrong type of care to others…. In Jordan !!??
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Ethics in health care

Many now believe that ..

a moral society owes health care to its citizens.

What do you think ??

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Ethics in health care

Health care is like clean water, sanitation, and basic education.

Owning a Car example !!

Others believe that health care is a commodity, like automobiles, to be sold and
purchased in the marketplace.

If you lack the funds to buy a car, that may be unfortunate, but society has no
obligation to purchase a car for you.

We need to ask ourselves what do we believe about health care??

Is it simply unfortunate if people cannot afford the health care they and their
families need?

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Ethics in Nursing ..

 People’s health, well-being, and dying, as well as our daily nursing practice, are
directly affected by decisions made by governments, insurers, and health care
institutions.

 Nursing needs a seat at these decision-making tables, and nurses must be

prepared and willing to take these seats.

 As the country’s most trusted health care professionals, the nurses in the seats
must be committed to ethical decision making.

 Drivers for much of human enterprise are power, position, prestige, profit, and
politics

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Ethics in Nursing ..

 Strikingly absent from this list are people, patients, the public, and the poor!
Nursing’s challenge, as profits and politics increasingly dictate health priorities, is
to keep health care strongly focused on the needs of patients, their families, and
the public.

 Health care in the United States is a business, revenues need to be generated to

make care possible, but health care can never be only a business.

 First and primarily, it is a service a moral society provides for its vulnerable
members.

 Our relationships with patients are fiduciary, not merely contractual.

 Nurses play a critical role in keeping health care centered on the people it purports
to serve.

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Definition of Ethics :

Ethics may be defined as the formal study of :

• who we ought to be,

• how we should make decisions and behave, in light of our
identity.

This chapter centres around what it is reasonable to expect of

professional nurses as citizens…

in regard to designing and delivering a just health system that

meets the needs of all, with special concern for the most
vulnerable.

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Definition of Ethics…. Cont.

Ethics – Is a derivative of the Greek word ethos, meaning customs,

conduct, or character.

Focuses on the virtuousness of individuals and their motives Ethics is

the science of morality. It deals with the right or wrong of any activity.

Ethics is a discipline that includes the study of ideals for human

conduct for and an understanding of the normal life in which actions
are judged as right or wrong and persons and institutions are taken as
praiseworthy and blameworthy.

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Ethics v/s Morals

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Ethics v/s Values

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 The ethics of influencing policy
 An ethical critique of human behavior involves paying attention to :

 the intention of the moral agent,

 the nature of the act performed,
 the consequences of the action,
 and the circumstances surrounding the act.

 Ethics has to do with right and wrong in this world, and policy and politics
has everything to do with what happens to people in this world.

 Both ethics and politics have to do with making life better for oneself and
others.

 Surely both deal with :

 power and powerlessness,  with justice and fairness,

 with human rights and balancing  and with good and evil.
claims,
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The ethics of influencing policy…cont.

 good and evil are not the same as right and wrong.
 Right and wrong pertain to adherence to principles;
 good and evil pertain to the intent of the doer and the impact the deed has on
other people.

 Surely policy and politics involves :

 justice in the distribution of social goods;
 fairness and equity in relationships among and between people of different
races, genders, and creeds;
 and access to education and assistance when one is in need.

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The ethics of influencing policy…cont.

 Although the goodness of an action lies in the intent and integrity of the human
being who performs it,
the rightness or wrongness of an action is judged by the difference it makes in the
world.

 Therefore the principles applied in ethical analysis generally derive from a

consideration of the duties one person owes another by virtue of commitments
made and roles assumed, and/or a consideration of the effects that a choice of
action could have on one’s own life and the lives of others.

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The ethics of influencing policy…cont.
 In a perfect world, legislators would all intend the good of the public they serve
and use ethical means to achieve good outcomes.

 In the real world, legislators and lobbyists intend many things other than the good
of the public and some use unethical means to achieve dubious ends.

Therefore, we may ask :

 Which strategies to influence policy can nurses use without sacrificing
personal and professional integrity?

 Each advocacy strategy involves a variation of the same question—that is,

what means can be legitimately used to achieve an end that someone
believes to be good?

 Should we assure the passage of health care insurance reform (a good end) by
strong-arm tactics (an evil means)?

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The ethics of influencing policy…cont.
The price we pay for freedom and human rights is to grant them to all people, not
just a favoured few.
And yes, it is risky and it may reduce our “efficiency,” and in some cases it
may even lead to loss of life,

but the alternative is that no one has rights ; rights become the privilege of a
favoured group, whereas all other individuals are utterly helpless before the
power of the state.

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The ethics of influencing policy…cont.
Certainly the electorate does not consent to the corruption of the legislative process, and
even if a majority did approve of bending the rules of fair engagement to ensure that a
particular piece of legislation is passed, would that make it right?

 Would it not end up threatening the very foundations of a free society ?

 What are the differences between normal legislative wrangling and abuse of power?
 What does it mean when political parties refuse to participate in the legislative
process and/or use blatant scare tactics?
 What is legitimate dissent, and what is a refusal to accept democratic outcomes unless
you happen to agree with them?

Therefore :
Without civil disobedience, we would still have the Jim Crow laws. And
without respect for the law, a society degenerates into either despotism or anarchy.

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The ethics of influencing policy…cont. Telling Lies

What is a true difference of judgment about what would benefit society versus
knowingly lying to deceive the public to achieve a political end?

Why do we now have numerous resources to uncover media bias and to fact
check?

When people ask whether it is wrong to lie about something (e.g., the number of
people affected by a particular disease) to get funding for research and/or treatment
of patients with a particular disease, in a word the answer is yes. It is wrong.

Why is lying wrong?

It’s wrong because it undermines the foundation of any relationship: trust.

Trust is the fabric that holds society together.

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The ethics of influencing policy…cont. Telling Lies

 In like manner, lying to further a political agenda is wrong not only because
it undermines trust, but also because it fosters further dishonesty.

 Judging by the amount of political dishonesty reported in the media, one is

led to the conclusion that there is a lot of lying going on!

 Adding to it, telling more lies to further our own agenda will only make
matters worse.

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 Reflective practice:
Sarah Palin
PolitiFact awarded Palin with the 2009 Lie of the Year for the death panel

claim and it made the list of FactCheck’s “whoppers,” but the political impact

of her statement is hard to overstate.

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 Professional ethics and moral agency
 A professional ethic is built around three essential components:
1. its purpose,
2. the conduct expected of the professional,
3. and the skills and outcomes expected in professional practice.

 Society demands that professionals be held to a separate moral standard of

conduct because the choices professionals make affect other people’s lives
more than their own.

Nursing’s foundational documents make each nurse’s advocacy and health policy
responsibilities clear.

Although some may think that advocacy and health policy are an ethical ideal, they
are rather a nonnegotiable moral obligation embedded in the nursing role.

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 Professional ethics and moral agency cont.

 The American Nurses Association (ANA) Code of Ethics for Nurses states:

 “The nurse promotes, advocates for, and protects the rights, health, and
safety of the patient” (2015).

 Provision 8 of the code, reflecting the stronger emphasis of the 2015 edition on
nursing’s advocacy responsibilities, reads:

 “The nurse collaborates with other health professionals and the public to
protect human rights, promote health diplomacy, and reduce health
disparities.

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Professional ethics and moral agency cont.
Once professional nurses understand what is reasonable for the public to expect of
them,
the next step is to determine if one has the capacity to meet these expectations—that
is,
“Am I trustworthy?”

Moral agency is quite simply the ability to be what is professed: a human, a parent, a
professional nurse.

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Professional ethics and moral agency cont.
 Moral agency in any specific situation requires more than knowing what is the
right thing to do; it also :

 entails moral character,  moral responsiveness,

 moral valuing,  ethical reasoning and
 moral sensibility, discernment,
 moral accountability,
 and transformative moral
leadership.
 Nurses who value their moral agency are familiar with the principles of bioethics
which commit them, all things being equal, to :
(1) respect the autonomy of individuals,
(2) act so as to benefit (beneficence),
(3) not harm (nonmaleficence),
(4) give individuals their due (justice).
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 Reflective practice: Conscientious objection
As nurses, we have :

 long been aware of our right to opt out of processes or procedures that violate
our
conscience or religious values.

 These acts may include assisting in a

 surgical abortion,
 participating in assisted suicide,
 withdrawing life-sustaining treatments,
 deceiving patients,
 or administering blood products.

 The basis for this right of refusal is the protection of our moral integrity as health
professionals and the preservation of our autonomy as individuals
(Lewis-Newby et al., 2015).
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Reflective practice: Conscientious objection cont.

 Moral integrity is a highly desirable professional trait and acting against our
beliefs would constitute a form of self-betrayal or loss of self-respect
(Magelssen, 2012).

 Provision 5.4 of the Code of Ethics for Nurses (2015) supports nursing’s
right to act with moral courage but likewise identifies corresponding obligations.

 As professional nurses, knowing our obligations to patients in the situation of

conscientious objection (CO), will help ensure compliance with ethical
standards.

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Reflective practice: Conscientious objection cont.
 An important deliberation in a claim of CO is the impact on those affected by our
decision.
Most significant is the question of harm.

 Magelssen (2012) points out four types of burdens to patients:

(1) delay in care,
(2) restricted access to treatment,
(3) lack of information,
(4) patient’s sense of moral disapproval for his or her choices.

Will my decision harm my patient? If so, how can I mitigate or reduce the harm? The
more life threatening a situation, the less acceptable it is for a professional to refuse to
treat, especially if the care can’t be transferred to a competent colleague.

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Reflective practice: Conscientious objection cont.
Remember that :

 We must also remember that under no circumstances should CO be based on

medically irrelevant factors such as race, gender, religion, or sexual
orientation.

 Doing so represents invidious discrimination, which is prohibited by law

and discouraged by the Code of Ethics for Nurses (ANA, 2015; Lewis-
Newby, 2015).

As professionals, we are obligated to maintain patient safety, avoid patient

abandonment, and ensure proper care is available.

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Reflective practice: Conscientious objection cont.

Asking ourselves :

1. Do health care settings where you work have policies on CO?

2. As the nurse leader of a mother-baby nursing unit, you receive a report that your
newest employee is refusing to educate her patient on a new contraceptive
medication. The nurse claims it’s against her religious beliefs to do so.

How would you address the situation? Which obligation should trump and
why—the nurse’s duty to provide a standard of care or the nurse’s duty to
protect her moral integrity?

3. Many ethicists believe protecting the moral integrity of clinicians may result in
changes to professional norms and practices. What changes would you like to
see?
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 Dilemmas
 It a situation in which an individual is compelled to choose between two
actions that will affect the welfare of a human being.
 An ethical dilemma occurs when an individual must choose between two
unfavorable alternatives.
 Ethical dilemmas usually have no perfect solution, and those making
decisions may find themselves in the position of having to defend their
decisions.
 Dilemmas for health professionals (Life and death, quality of life, design of
life, alternative treatment issues, offering cure for another, informed consent,
medical confidentiality, right to decide).

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 U.S. health care reform
What is health care reform in the US?

In the U.S., Health Care Reform refers to the overhauling of America's healthcare
system. This includes changes that affect the ever increasing costs of national
health care by individuals, families, and the government. Also, addressing the
benefits people receive and how people obtain health insurance.

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 Allocating scarce resources
Principles of distributive justice
1. To each the same thing.
2. To each according to his need.
3. To each according to his ability to compete in the open marketplace.
4. To each according to his/her merits (desserts) :
• Contribution: People should be rewarded for their work activity
according to the value of their contribution to the social product.
• Effort: People should be rewarded according to the effort they expend in
their work activity.
• Compensation: People should be rewarded according to the costs they
incur in their work activity.

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Reflective practice: Barriers to the treatment
of mental illness

Discussion

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 Health care disparities
 Reverend Martin Luther King is often quoted as saying that of all the forms of
inequality, injustice in health care is the most shocking and inhumane (1966).

 Some nurses can identify with Bill Gates when he noted during his 2007
commencement speech at Harvard:

I left Harvard with no real awareness of the awful inequities in the world—the
appalling disparities of health, and wealth, and opportunity that condemn
millions of people to lives of despair. . . . But humanity’s greatest advances are not
in its discoveries—but in how those discoveries are applied to reduce inequity.
Whether through democracy, strong public education, quality health care, or broad
economic opportunity—reducing inequity is the highest human achievement.

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Health care disparities cont… Definition of few terms :
Health equity: This means efforts to ensure that all people have full and
equal access to opportunities that enable them to lead healthy lives. No one
should be denied this chance because of who they are or their socio-
economic opportunities.
(Health Equity Institute:
http://healthequity.sfsu.edu/content/defining-healthequity).

• Health inequities: Differences in health that are avoidable, unfair, and

unjust. Health inequities are affected by social, economic, and environmental
conditions.

• Health disparities: Differences in health outcomes among groups of

people.
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Health care disparities cont…

 Nurses can be on the frontlines of reducing inequities but many of us are

affronted at the thought that we aren’t treating everyone with the same
degree of respect, compassion, and responsiveness.

 We are all too easily blind to implicit bias and institutional racism.

 Example : disparity in research dollars to treat cystic fibrosis

(predominantly a White disease) versus sickle cell disease—many
fewer research dollars for a much larger Black population—
becomes shocking when known.

 Reflective practice: Immigration.

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 Ethics and work environment policies
 Politics, defined as “any activity concerned with the acquisition of power,
gaining one's own ends,” is not just for elected officials.

 Politics are alive and well in every aspect of health care, from the operating room
of a small community hospital to the board room of a multibillion dollar pharmaceutical
company.

 Every day, health care administrators make decisions that impact both nurses and the
populations of patients they serve.

 Nurses are in key positions to influence hospital decision makers and to share the
realities of the day-to-day care of patients.

 Nurses have the greatest influence when they are well-informed, open-minded,
collaborative, and willing to do what is right even if there is a personal cost.
Mandatory flu vaccination: The good of the
patient versus
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 Conclusion

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