Ethical decision-making frameworks and informed consent in nursing

¶ … ethical decision making in general and then in the nursing profession. It addresses two key questions. What are the different ethical decision making processes? How could the ethical dilemma of informed consent in the nursing profession be resolved using one of these processes? The sources used to collect information are books and academic journals. The teleological approach suggests that informed consent is ethical because its benefits exceed its costs. In other words, its consequences are more unfavourable than opposite.

Ethical decision making is the process by which individuals choose an approach to deal with a moral issue they encounter. In everyday life, professionals often have to deal with moral issues. Therefore, frameworks for dealing with ethical dilemmas are required.

"Ethics is the science of the moral life. It is concerned with human conduct in relation to character and a conception of the good, commonly referred to as the highest good. It considers conduct with reference to the right and wrong, good and evil, the basis of moral obligation, the nature of duty, conscience, freedom; and the problems of egoism, altruism, social service and development in the light of the highest ideals."(Dresser, 1925).

Most ethical decisions are based on Deontological, Utilitarian and Relativistic theories. Deontological theories are based on obligation, moral absolute and the golden rule. Utilitarian theories are based on consequences and cost benefit analysis of actions. While relativistic theories postulate that moral decisions are situational, two individuals or two cultures can have a different approach to same moral issue and both can be right (Caples, Hanna & Phelps, 2008).

SECTION I: COMPARE AND CONTRAST TWO ETHICAL DECISION MAKING PROCESSES

The ethical decision making processes chosen are the Deontological and Teleological theories.

Both Deontological and Teleological theories are ethical decision making theories. Both can be used to assess the ethical issue at hand, and what can be done to resolve it. Any of them can be used by individuals in professional settings when faced with an ethical question. However, the theories differ in how they approach the moral action under consideration.

Deontological approach

Deontologists hold that actions are moral in and of themselves and are not dependent on the consequences (Caples, Hanna & Phelps, 2008). An action is ethical because it meets the criterion of moral absolutes, justice and duty to fellow men. For example, theft and lying are always wrong, no matter what the situation is. People have an obligation to behave in certain ways irrespective of the consequences. Religious guidelines, such as the Golden Rule, form the foundation of Deontological approaches to ethical decision making. Immanuel Kant holds that one should perform right actions because it is one's moral duty to do so. Moral principles are absolute and unconditional. They are binding, no matter what the consequences. Kant formulated that:

"Humans should behave in such a way that they would will their behaviour to become a universal rule and that we should treat humans as ends in themselves, never solely as a means to an end."(Caples, Hanna & Phelps, 2008, para. 14)

Teleological approach

Teleological or consequentialist approaches consider the rightness of a decision on the basis of the good it produces (Caples, Hanna & Phelps, 2008). The consequences of an action are the sole factors to be considered in determining the morality of an action. The act in itself is not considered, rather the costs and/or benefits it brings are focused. In other words, if an action brings the greatest amount of good for the greatest number of people affected by it, then it is good and ethical. For example, the teleologist would argue that lying is bad because it undermines trust and dependable relationships in society, which is costly in the longer term. On the other hand, truthfulness will lead to amiability and trust in social relationships. Teleologists would argue that lying is not always immoral. Cost benefit analyses are required to appreciate an ethical situation.

"The right decision is one that balances benefits and costs among all parties affected."(Caples, Hanna & Phelps, 2008, para. 17).

Benefits

The patient is involved in deciding his/her treatment, whether it should be initiated or not. Any fears and anxieties of risk averse patients can be mitigated. Any risks or limitations of the expected benefits will be known to the patient beforehand.

It would enhance the relationship between the provider and the patient, which would be necessary afterwards, if not currently.

The urge to think that the patient should be passive while doctor knows best will be diminished. This participation will be helpful during patient-provider interaction later.

The quality of patient history and work up will be enhanced.

The doctor can present himself as an advocate in an otherwise threatening medical setting.

Commitment, cooperation and self-monitoring on the patients part will be attained.

In serious patients, commitment to a lifestyle that can prolong their life will add value to their treatment plan (Wear, 1998).

In the event that the treatment has legal repercussions such as going bad, the patient will have accepted some responsibility for his own treatment by signing informed consent forms (Lachman, 2006).

Costs

A great deal of information will often be required to transfer it to the patient, leading to information overload. This information will include comprehensive information about the selected and alternate treatment options, and their risk benefit analysis etc. Collecting information can be costly and time consuming.

Delay in treatment due to time consuming information gathering can be caused which might not be good for the patient.

It is often in the interests of the critical patient that he/she should not be informed about his diagnosis because it could cause more harm than good. For example, it will render him depressed or low in morale.

Informed consent and patient authorisation will be costly to society if, for example, the patient suffers from a contagious disease such as tuberculosis (McConnell, 2000).

SECTION IV: CONCLUSION, WHAT IS THE RELEVANCE FOR THE PROFESSION OF NURSING?

The issue of informed consent is much debated in the nursing profession. This paper uses teleological approach to informed consent and suggests that it should be carried out because the benefits to the patient, provider and society are greater than the costs to them. The patient understands treatment overcoming anxiety, uncertainty and fear. The doctor benefits by gaining trust, commitment and cooperation from the patient helping treatment. Also, because the patient takes some legal responsibility by authorising treatment himself. The society will benefit from the value added to healthcare by professionals, acting in ethical ways.