margot phaneuf inf. phd.1 ethics elements - serious thoughts in a cartoon - 3rd part: applications...

Margot Phaneuf Inf. PhD. 1

Ethics ElementsEthics Elements

- Serious Thoughts in a Cartoon -- Serious Thoughts in a Cartoon -3rd part: applications 3rd part: applications

20062006

Margot Phaneuf, inf., Ph.D.Margot Phaneuf, inf., Ph.D.

OBJECTIVESOBJECTIVES

.. To broach the principles of confidentiality, To broach the principles of confidentiality,

the right to information, informed consent,the right to information, informed consent,

benevolence, etc.benevolence, etc.

. To think about their day-to-day application.. To think about their day-to-day application.

. To be aware of some of our professional . To be aware of some of our professional

duties.duties.

WARNINGWARNING

This document has no theoretical pretentions: it This document has no theoretical pretentions: it aims only to bring some concepts to the aims only to bring some concepts to the

students’reach. students’reach.

The main topic here is applied ethics.The main topic here is applied ethics.

All the principles of ethics are not dealt with in All the principles of ethics are not dealt with in this document and as for the Professional Code, this document and as for the Professional Code,

only the general articles are mentioned.only the general articles are mentioned.

The images of this document belong to diverse The images of this document belong to diverse sites identified in the webography. We thank sites identified in the webography. We thank

them.them.

La personneLa personneLa personne

Whatever our work field is, we must Whatever our work field is, we must remember that the individual must be the remember that the individual must be the

center and the measure of everything.center and the measure of everything.

SOME PRINCIPLES

OF ETHICS

6Margot Phaneuf Inf. PhD.

Let’s not lose heart! There are still some more!!!

Mister Owl,are there any other

principles?

There are so very many…!!!


We come now to a most important principle, confidentiality!

I am always discreet!!!!

Principle of confidentialityPrinciple of confidentiality

Principle related to the integrity of the Principle related to the integrity of the individual and the obligation to respect his individual and the obligation to respect his intimacy which consists of the moral and intimacy which consists of the moral and professional obligation to keep secrets that we professional obligation to keep secrets that we have seen, heard and understood about the have seen, heard and understood about the patient’s health or private life, or about his patient’s health or private life, or about his family. family.

That information can only be revealed to That information can only be revealed to professionals directly concerned with this professionals directly concerned with this patient. patient.


As a patient, my private life is no concern of

yours…!!!


From what we learn during our work with patients, we cannot reveal their

health problems, their individual habits, or their dubious company…


ConfidentialityConfidentiality

Elevators, corridors and cafeterias are Elevators, corridors and cafeterias are places where indiscretions are often places where indiscretions are often committed. One seethes with impatience to committed. One seethes with impatience to repeat what has been seen or heard repeat what has been seen or heard concerning patients. concerning patients.

The hairdresser on the corner or friends are The hairdresser on the corner or friends are first-rate confidants for our indiscretions. first-rate confidants for our indiscretions.

However: be professional. Keep the secret.However: be professional. Keep the secret.


What you learned about us,the family, is also bound by the

professional secret …!!!

Confidentiality…!!! Confidentiality…!!!

If we do not gossip anymore, what are we going to

jabber about !!!???

Polly, you must close your beak!!!

Keep your fine words for the patients!!!

Professional secretProfessional secret

Consequently, from the ethical principle of Consequently, from the ethical principle of confidentiality ensues the deontological rule of confidentiality ensues the deontological rule of the professional secret for the nurse. the professional secret for the nurse.

The nurse must maintain silence or discretion The nurse must maintain silence or discretion about any confidential information which about any confidential information which comes to her knowledge in the exercise of her comes to her knowledge in the exercise of her functions functions (Div. II, art. 31.1).(Div. II, art. 31.1).

It also protects the private life and the interests It also protects the private life and the interests of the concerned person. of the concerned person.

It is a part of a fundamental right stated in the It is a part of a fundamental right stated in the Code of professions Code of professions (Art. 60.4).(Art. 60.4).

Did you hear about Mr. X.? He…

We must even refrain from taking part in

indiscreet conversations! (Div. II, art. 36)

Careful! Everything that concerns the patient or his medical

record is secret!


All kinds of indiscretion are banned…!!!


You know, Polly, that a nurse cannot even disclose that some- one has asked for her service,

except if such disclosure is necessary in the interest of the client.

(Div. II, art. 2.32)

19

Nor can the nurse take advantage of confidential information to gain

personal benefit. (Div. II, art. 1.34)

You know I witness many things.


The patient’s medical record is also secret!

Except for the patient himself!!!


But did you know that you can refuse to give the patient access to his

medical record, if this disclosure could lead to some kind of prejudice to him or to a third party?

(Div. VII, art. 63)

And in such event, the nurse shall notify the client accordingly in writing.

(Div. VII, art. 63)


The nurse must not distort, change, falsify or leave information

out of the patient’s medical record !!! (Div. I, art. 2.14)

The respect of the individual, of his integrity and what concerns

him, leads us to other obligations!


The right to informationThe right to information Principle following from the respect of the Principle following from the respect of the patient’s dignity, integrity, autonomy and liberty. patient’s dignity, integrity, autonomy and liberty. It consists in the obligationIt consists in the obligation

- to give him all the useful information needed for - to give him all the useful information needed for decision-making. decision-making.

- to explain to him the proposed nursing to explain to him the proposed nursing interventions.interventions.

- to transmit information in a clear manner, in a to transmit information in a clear manner, in a rhythm that he can follow and in an acceptable way rhythm that he can follow and in an acceptable way according to his physical, cognitive and affective according to his physical, cognitive and affective capacities. capacities.

You must inform me well!!!


According to this principle, the nurse must give the patient

all information needed to undestandthe care she is giving him.

(Div. III, art. 1.40)

Thus, she must explaineverything she is doing to me!

When the patient gives his consent When the patient gives his consent for a nursing or medical for a nursing or medical intervention, he must know into intervention, he must know into what kind of experience he is diving. what kind of experience he is diving. For important decisions, he must For important decisions, he must give informed consent. give informed consent.


The right to informationThe right to information We often assume that we can have access to the We often assume that we can have access to the

patient’s body for our nursing care and that patient’s body for our nursing care and that the patient will automatically accept all the the patient will automatically accept all the treatments we must carry out. treatments we must carry out.

In fact, the individual always keeps his In fact, the individual always keeps his

free will and can refuse any intervention.free will and can refuse any intervention. It is our reponsibility to inform him It is our reponsibility to inform him

appropriately about what we have to do, to appropriately about what we have to do, to seek his adherence with care and to stimulate seek his adherence with care and to stimulate his motivation. his motivation.


Don’t you think that I have the right to be informed about what

is in store for me???(Div. III, art. 1.40)

What does a patient need to give informed consent?

Informed consent

To give informed consent for an intervention or a specific treatment a patient must:

be in a state of conciousness allowing be in a state of conciousness allowing the patient to understand the conditions the patient to understand the conditions and risks inherent to care,and risks inherent to care,

sign the consent formula. sign the consent formula. The family can also sign if the patient is The family can also sign if the patient is

unable to do so (for a child, the elderly, a unable to do so (for a child, the elderly, a psychiatric patient, a mentally retarded psychiatric patient, a mentally retarded child).child).

The nurse must provide all the required The nurse must provide all the required information information (Div. III, art. 1.40).(Div. III, art. 1.40).


I must give informedI must give informedconsent!consent! For goodness’sake! What For goodness’sake! What

does that imply ???does that imply ???

Informed consentInformed consent The patient must willingly, thoughtfully and The patient must willingly, thoughtfully and

consciously accept treatments? consciously accept treatments? This obligation issues from the patient’s right to be This obligation issues from the patient’s right to be

informed which consists in shedding light on what informed which consists in shedding light on what we are going to do and seeking his adherence to all we are going to do and seeking his adherence to all the required decisions. the required decisions.

It presupposes: It presupposes: clear and sufficient information, clear and sufficient information, the absence of influence, constraint or pressure,the absence of influence, constraint or pressure, the patient’s capacity to decide for himself. the patient’s capacity to decide for himself. if he is not capable to do so, a guardian, also well- if he is not capable to do so, a guardian, also well-

informed, must take his place. informed, must take his place.


PrinciplePrincipleof benevolence and of benevolence and

non-malfeasancenon-malfeasance

In nursing care we must always respect the dignity of individuals and

their right to liberty!

Listen! What do you do with the benevolence

principle?

http://www.icone-gif.com/gif/animaux/escargots/escargot012.gif


Principle of benevolence and non-malfeasance

Obligation to treat the patient in our care Obligation to treat the patient in our care as if he were ourselves, with a warm as if he were ourselves, with a warm welcome, a helping availability, welcome, a helping availability, everything that is favourable to his well-everything that is favourable to his well-being. being.

Obligation to avoid any unnecessary Obligation to avoid any unnecessary and avoidable prejudice to him. and avoidable prejudice to him.


Principle of benevolence and non-malfeasance

This principle is often used under the term of This principle is often used under the term of balance of advantages and disadvantages balance of advantages and disadvantages. .

It is very important among the serious decisions It is very important among the serious decisions to be taken for patients suffering from a to be taken for patients suffering from a serious, incurable illness. serious, incurable illness.

It relates to realities such as quality of life, It relates to realities such as quality of life, appropriate pain relief, prolonging life with appropriate pain relief, prolonging life with technological means, etc. technological means, etc.

Modern ethics requires that this balance of Modern ethics requires that this balance of considerations be positive for the patient. considerations be positive for the patient.

And what brings him the fewest disadvantages?

That is exactly what the principleof benevolence and non-malfeasance is about…!

What is best for the patient???


PrinciplePrincipleof freedom/libertyof freedom/liberty


The principle of freedomThe principle of freedom

Prompts us to respect the patient’s capacity to: Prompts us to respect the patient’s capacity to: decide for himself without fear, constraint or decide for himself without fear, constraint or

servility, servility, think, express himself and make his own think, express himself and make his own

choices,choices, act according to his best interests, without the act according to his best interests, without the

control of other people, but always with respect control of other people, but always with respect for others. for others.

39

The principle of freedomThe principle of freedom

It does not mean the right to do whatevercomes to mind, but to decide

by ourselves what is good for us!


The principle of autonomy

This principle is related to the respect of This principle is related to the respect of the patient and of his freedom. the patient and of his freedom.

It is the obligation to respect the It is the obligation to respect the individual in his possibilities to be, to individual in his possibilities to be, to become, in his capacity to choose, to become, in his capacity to choose, to decide for himself, to function physically, decide for himself, to function physically, intellectually or socially whether by intellectually or socially whether by himself or with assistance.himself or with assistance.


You must respect what I can do, let me decide for myself, if possible let me stand

on my own feet, fly with my own wings, even if you often have to help me orcompensate for what I cannot do!!!


The principlesThe principlesof loyalty and fidelityof loyalty and fidelity


Principles of loyalty and fidelityPrinciples of loyalty and fidelity

These ethical principles These ethical principles create a peculiar professional create a peculiar professional bond of responsibility with bond of responsibility with the patient and urge us to the patient and urge us to answer his realistic answer his realistic expectations with honesty, to expectations with honesty, to care for his interests and to care for his interests and to defend them if need be. defend them if need be.


The loyalty the nurse owes to the patient obliges her to be available and to show conscientiousness

in what she does. (Div. I, art. 6.25)

She must also avoid situations where conflict of interest

may affect her loyalty. (Div. I, art. 4.23)


Loyalty and fidelity, are traits we know very well !

We also have to defend those for whom we live!!!


The advocacy roleThe advocacy role

The nurse not only has the duty to The nurse not only has the duty to respect the rights of the patients she is respect the rights of the patients she is taking care of, but also the confidence taking care of, but also the confidence relationship she maintains with them relationship she maintains with them and her professional nursing role give and her professional nursing role give her the ethical obligation to protect her the ethical obligation to protect them. them.

It is what we call her It is what we call her advocacyadvocacy role. role.


The protection role of the The protection role of the patient patient

In accordance with the principle of

benevolence and non-malfeasance

and of her right to disagree with the

decisions of other members of the team,

the nurse has a protection role for the patient

she is taking care of. (advocacy)


The role of advocacyThe role of advocacy

According to this role, the nurse must According to this role, the nurse must make sure that the rights of the make sure that the rights of the concerned patients are respected.concerned patients are respected.

That they will not That they will not be submitted to any be submitted to any risk, discomfort, risk, discomfort, influence or unjustified influence or unjustified indiscretions. indiscretions.

In this role, the nurse must defend the patients in her care.


The patient’s rights The patient’s rights

The right to be relieved of pain and to have a certain quality of life.

The right to decide freely for himself, if he is able

The right to be respected in his body and his identity

The right to be informed of the goals, methods and secondary effects of his drugs and

treatments.

ETHICS

ADVOCACY

The right to be himself


The right to dissidence for the nurseThe right to dissidence for the nurse

When some important decisions are made When some important decisions are made concerning a patient, the nurse can express her concerning a patient, the nurse can express her disagreement. disagreement.

But only if she is convinced that it is for the But only if she is convinced that it is for the greater good of the patient. greater good of the patient.

It is also important that she knows the ethical It is also important that she knows the ethical principles that support her arguments well.principles that support her arguments well.

She expects to be respected, but she must also She expects to be respected, but she must also always respect others. always respect others.


The right to be dissident The right to be dissident

This principle is the result of the nurse’s loyalty This principle is the result of the nurse’s loyalty to the patient and respect for his dignity and to the patient and respect for his dignity and uniqueness. uniqueness.

It comes also from the right to otherness of the It comes also from the right to otherness of the nurse as a person and as a professional. nurse as a person and as a professional.

It gives her the possibility to express an opinion It gives her the possibility to express an opinion which differs from that of her colleagues or the which differs from that of her colleagues or the people who have authority or to withdraw from people who have authority or to withdraw from a situation she cannot accept because of her a situation she cannot accept because of her ethical values and her beliefs.ethical values and her beliefs.


Our professional Our professional responsibilities responsibilities


Professional responsibilities Professional responsibilities

As a nurse I must always take into account the limits of my

knowledge and skills (Div. I, art. 4.17)

Rabbit, you cannot avoid that responsibility!!!


Professional responsibilities Professional responsibilities

We are always accountable for judgements made and actions taken in the course

of our nursing practice.

Whatever our work load???


Professional duties of the nurseProfessional duties of the nurse

In order to respect ethical principles, In order to respect ethical principles, nurses also have an obligation to be and nurses also have an obligation to be and stay competent, i.e. they have the duty to stay competent, i.e. they have the duty to keep their knowledge up-to-date by keep their knowledge up-to-date by refreshing acquired techniques and refreshing acquired techniques and knowledge and by continuing their knowledge and by continuing their training so they can follow the evolution training so they can follow the evolution of their profession. of their profession.

We must not forget that our professional competence must

constantly be nourished by continuing education

(Div. I, art. 4.18)


So I must keep my knowledge up-to-date in order to give

care which is up to the recognized standards of practice.

(Div.I, art. 4.18)

Good gracious…!

But there is something more! As much as possible, the nurse must share

her knowledge with her colleagues and with the students…

(Div.I, art. 1.8)

This is not so widely known!

I am really astonished!!!!


Gosh!

It is not all! Our professional standards

must reflect nursing responsability to society. Thus, we may deduct from our

ethical principles that the nurse must maintain a state of personal health such

that the quality of care is not compromised and that the health of

patients is not at risk.

But there is an other dimension. Interprofessional relations

are sometimes stormy. But we must respect each other and

make ourselves respected!!

I want to assert my point of view !

I want to be respected too!!!

It is better to establish harmonious and constructive relations with

the other professionals!

Collaboration is better than competition.

And the nurse cannot refuse to collaborate with another

professional (Div. III, art. 2.46)

All that is fine forpatient care, but if I do research,

am I concerned by the Code of Ethics?

For sure! There are special articles for

that. Consult your Code!

CONCLUSIONIn fact, ethics leads us towards harmonious and respectful relations with our fellow creatures

in a just balance between our rights and duties and those of others!

And deontology sets up

professional safeguards.


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margot phaneuf inf. phd.1 ethics elements - serious thoughts in a cartoon - 3rd part: applications...

Documents

margot phaneuf

principles of ethics

professional secret

professional obligation

professional code

professional duties

principles of confidentiality

private life