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 Ethics Elements - Serious Thoughts in a Cartoon 1 st part: fundamental concepts Ethics Elements - Serious Thoughts in a Cartoon 1 st part: fundamental concepts 2006, revised nov. 2012 Margot Phaneuf, inf. , Ph. D.

OBJECTIVES . Think about some ethical aspects related to nursing care. . Clarify some OBJECTIVES . Think about some ethical aspects related to nursing care. . Clarify some basic principles that are likely to orient our care. . Realize the sources of our professional Code. . Discover how language and culture might influence our understanding of professional ethics. Ph. D. Margot Phaneuf Inf. 2

WARNING This document has no theoretical pretentions: it aims only to bring some concepts WARNING This document has no theoretical pretentions: it aims only to bring some concepts to the students’ reach. The main topic here is applied ethics. All the principles of ethics are not dealt with in this document and as for the Professional Code of Quebec, only the general articles are mentioned. The images of this document belong to diverse sites identified in the webography. We thank them.

Whatever our work field is, we must remember that the individual must be the Whatever our work field is, we must remember that the individual must be the center and the measure of everything. La personne Margot Phaneuf Inf. Ph. D. 4

A basic knowledge of ethics is needed to work with sick people and a A basic knowledge of ethics is needed to work with sick people and a good understanding of our professional Code is essential.

This course is about ethics. I do not know much about that. Is it This course is about ethics. I do not know much about that. Is it going to be hard? Do you know what it is, Leo? No, but Mister Owl knows everything. He must be able to explain it…

Mister Owl, what are ethics? Yes, I would also like to know! Mister Owl, what are ethics? Yes, I would also like to know!

Mister Owl, what does the word ethics mean? From its etymology “ ethos ” Mister Owl, what does the word ethics mean? From its etymology “ ethos ” this term means: Habit, house Use, way of live A way of being in oneself in order to live better.

Hum ! Hum!!! Let’s see…! You know I am no specialist! Mister Owl, you Hum ! Hum!!! Let’s see…! You know I am no specialist! Mister Owl, you are wise. Please explain what it is used for.

It helps us to be in harmony with well-considered principles and morally accepted reasoning. It helps us to be in harmony with well-considered principles and morally accepted reasoning. Ethics allows us to live better in our society by respecting ourselves and by respecting others.

Our ethical principles allow us not to hide our heads in the sand to Our ethical principles allow us not to hide our heads in the sand to see our responsibilities more clearly!

But Mister Owl, how can we find our way among all those terms which But Mister Owl, how can we find our way among all those terms which are not very familiar to us?

It is true that there are many terms, but, little Frog, some explanations will It is true that there are many terms, but, little Frog, some explanations will follow!

There is the term ethics which we will see later, morals and bioethics… Quite There is the term ethics which we will see later, morals and bioethics… Quite a lot. . !

Yet they are so important for the serious decisions we have to make while Yet they are so important for the serious decisions we have to make while caring for patients. And, dear friend, do not forget clinical ethics !!!

But nurses do not make those serious decisions! Right! But they must consider situations But nurses do not make those serious decisions! Right! But they must consider situations in the care teams… and they often can give knowledgeable opinions!

You have to know, Mister, that there are situations where we do not really You have to know, Mister, that there are situations where we do not really know what to do!!! Yes, when we are on the tight rope of some serious decisions, ethical notions can shed light on the situations!!!

In fact, ethics applied to nursing care … n n Deals with what we In fact, ethics applied to nursing care … n n Deals with what we must do or not do in a care situation. Proceeds by reasoning in order to fix the course of action we must take in view of a decision or a difficulty with moral implications. Still a little bit abstract. . !!

All right, but how does that affect nurses in their everyday work? All right, but how does that affect nurses in their everyday work?

But Kitten and Polly… the ethical principles … Guide our important decisions about patients But Kitten and Polly… the ethical principles … Guide our important decisions about patients and orient our professional daily behaviour. n They stimulate our honesty and our kind consideration for the patients, our intellectual rigour in care organisation, our technical accuracy for its application, and respect of the standards and asepsis. n

And, ethical principles… n n Act upon the way we approach patients, communicate with And, ethical principles… n n Act upon the way we approach patients, communicate with them and offer them help when they have some problems. They set guidelines for our professional and interprofessional relations.

 My friends, ethical principles… Are like personal points of reference for our behaviour My friends, ethical principles… Are like personal points of reference for our behaviour in society whatever the situations in which we evolve, whatever their nature, social or professional. n

Ethical principles are like professional landmarks for our behaviour in care situations. It is Ethical principles are like professional landmarks for our behaviour in care situations. It is serious. An infraction of the Code of ethics can even lead to a professional sanction !!!

That is really something!!! Gosh! I did not know that it went that far! That is really something!!! Gosh! I did not know that it went that far!

 In every aspect! Most definitely! But Dino, except for infractions, should we bother In every aspect! Most definitely! But Dino, except for infractions, should we bother about ethics and principles in our daily work?

Can you shed light on that? ? ? As for me, I am lost…!!! Can you shed light on that? ? ? As for me, I am lost…!!! Ethics, morals… what are they exactly ?

 «Morals and ethics feed each other. Morals are to ethics what north is «Morals and ethics feed each other. Morals are to ethics what north is to a compass. » (Jacques Benoit, 2000, p. 33) But they do have differences! I am anxious to know what they are!

Dear colleague, please give us precise definitions. We need more complete explanations and if Dear colleague, please give us precise definitions. We need more complete explanations and if possible more concrete…

Listen carefully, Kitty… § Morals is a normative construct of good and evil. § Listen carefully, Kitty… § Morals is a normative construct of good and evil. § It imposes duties, taboos and interdictions. § Its ultimate goal is good. § It raises the individual awareness of good and evil and makes one conscious of their relations with others.

Be attentive Puppy…!!! § Ethics is the fundamental art of managing our personal conduct. Be attentive Puppy…!!! § Ethics is the fundamental art of managing our personal conduct. § It covers a large field of human consciousness. § It opens us to values of integrity and social responsibility, to public spiritedness, environmental protection, humanism in patient care, life’s value, quality of life, etc. § It applies to all human beings whatever their religion.

Hey! Kittens, do you see how marvelous and important it is for our profession!!! Hey! Kittens, do you see how marvelous and important it is for our profession!!! § Ethics introduces reflection on principles common to all mankind. § It tends to make all human groups more aware and focused and to penetrate our functioning in society. So our professional lives are happier and more fulfilling

Is it now a little clearer? I will see with the applications. Differences between Is it now a little clearer? I will see with the applications. Differences between morals and ethics Morals Ethics - has a religious connotation, - has a non-religious connotation, - it is outside of the - it comes from our inner self, individual, - it calls upon us with authority, - it presupposes obedience - it is an unbreakable rule. - it makes us aware of our responsibilities, - it brings discernment and knowledgeable judgment, - it is judged individually. (Jacques Benoit, 2000, p. 33)

I think that in spite of the numerous current references to ethics, morals maintain I think that in spite of the numerous current references to ethics, morals maintain all their value. They support all the reasoning in our personal and professional conduct. But if we have ethics, are morals still needed? What do you think, Toucan?

 Morals are at the base of all those ethical principles ! Morals are at the base of all those ethical principles !

Thus, morals remain the basis for our conduct? ? ? Oh yes, Little Devil!!! Thus, morals remain the basis for our conduct? ? ? Oh yes, Little Devil!!! They are not outdated. . !

We need more clarification! Mister Owl, please give us some concrete definitions before Kitty We need more clarification! Mister Owl, please give us some concrete definitions before Kitty is tangled up! With pleasure, Toucan! Yes, that might help me!

Applied ethics Gosh! Another term!!! Oh la la! It’s getting complicated!!! n n Is Applied ethics Gosh! Another term!!! Oh la la! It’s getting complicated!!! n n Is an ethical problem-solving approach as those problems lived and dealt with are in various milieus of life. To solve them calls for an individual and collective critical-thinking process. It took root in the situational ethics movement introduced by Joseph Fletcher and Jonsen and Toulimin.

Watch out kittens!!! Applied Ethics n This philosophical way of thinking distanced itself from Watch out kittens!!! Applied Ethics n This philosophical way of thinking distanced itself from traditional moral thinking and renewed casuistry (part of morals which tries to solve consciousness problems) by urging ethicians to play a part in social issues. http: //www. usherbrooke. ca/cirea/recherche/lexique. html#%C 9 thique %20 appliqu%E 9 e

Clinical Ethics § introduces thinking about ethics in the core of the practices in Clinical Ethics § introduces thinking about ethics in the core of the practices in the field of health. § it deals with clinical practice and patient care. § Its objectives are: § clinical consultation, § lines of action and recommendations about the norms to be applied for ethical problems in the hospital, § ethical sensitisation to the milieu. (information & formation). http: //www. ethique. msss. gouv. qc. ca/site/download. php? id=3758544, 75, 1

Bioethics n n n I knew that bio means life… but I never thought Bioethics n n n I knew that bio means life… but I never thought it would imply such complex realities!!! “It is a thoughtful consideration of moral problems related to research on living beings and its applications. Bioethics deals with ideas to ensure the respect and protection of individual life in the face of the evolution of scientific knowledge and its possible applications: for example, euthanasia, organ transplant, cloning, stem cell research, etc. Bioethical rules are those which regulate research on living beings and its uses”. (http: //www. dictionnairebiologie. com/biologie/definition_48. html 40

It is important to understand those concepts well ! Yet one more thing!!! It is important to understand those concepts well ! Yet one more thing!!!

Are there any other terms? ? ? Yes! Because we live in Quebec, We Are there any other terms? ? ? Yes! Because we live in Quebec, We also need to have an idea of the term deontology. What is that Prof. Bookworm?

The French language makes a difference between the words ethics and deontology and their The French language makes a difference between the words ethics and deontology and their application to a profession like nursing. Why do I have to know that? Yes why? ? ? 43

Because if you ever work in a hospital or an organization where French is Because if you ever work in a hospital or an organization where French is spoken, you will have to make the distinction. Yes, that’s interesting! But tell us what it is ? 44

Deontology was developed by the philsopher Kant. It encourages us to act so that Deontology was developed by the philsopher Kant. It encourages us to act so that we treat humanity, both in our own person and in that of another, always as an ends and never merely as a means.

This principle is interesting! It is a program in itself. Here a few details This principle is interesting! It is a program in itself. Here a few details about it

Deontology is a duty-based ethics: it judges morality by examining the nature of actions Deontology is a duty-based ethics: it judges morality by examining the nature of actions and the will of agents rather than goals achieved. But Kitty, deontology applies to a limited field of a profession or a corporation. Listen to the next definition. I am not sure I understand!!!

Differences between deontology and ethics in French § The word deontology comes from the Differences between deontology and ethics in French § The word deontology comes from the Greek root “deont” which mean “need” or “obligation”. § “ Deontology is a standard of behaviour, but it operates within a corporate domain. § A professional community is linked by a savoir-faire that its standards aim to protect and promote ”. Then this is the difference!!!

Differences between deontology and ethics § § “ Deontology is not universal, but unique Differences between deontology and ethics § § “ Deontology is not universal, but unique to a given community. Interesting!!! As with law, deontology is sanctioned ”. (Jean de Maillard, magistrate, and André Comte-Sponville, philosopher) http: //www. bourinconseil. fr/com/focus/citoyenneteuk. php

Differences between deontology and ethics § Some ethical principles are assembled in a Code Differences between deontology and ethics § Some ethical principles are assembled in a Code of deontology (what we call our Code of ethics) particular to each profession. § Within this Code are added some professional rules (OIIQ c. 1 -8, r. 4. 1) We have to be careful!

 All those principles are listed in a professional Code of deontology which is All those principles are listed in a professional Code of deontology which is the equivalent of our Code of ethics. We have to walk the line.

So if I understand, there is always a moral responsibility in our actions. . So if I understand, there is always a moral responsibility in our actions. . . !!!? ? ? And this responsibility is made explicit in our Code of Ethics…

 It is absolutely essential!!! Is it not Mister Owl? But do we really It is absolutely essential!!! Is it not Mister Owl? But do we really need that in nursing? ?

That is right, Kitty and for many reasons… That is right, Kitty and for many reasons…

We need ethics in nursing Because of the need to adapt our behaviour rules We need ethics in nursing Because of the need to adapt our behaviour rules to the constant changes in our society. the pressure for individual rights and the need to find an optimal balance between individual rights and collective rights.

We need ethics in nursing Because of the evolution in mentalities and values influenced We need ethics in nursing Because of the evolution in mentalities and values influenced by social development and the fast circulation of information. the progression of knowledge and the dehumanising progress of technology.

 Everywhere and always? ? ? But where can we apply that ? Everywhere and always? ? ? But where can we apply that ?

 Assessment and data/communication Interpretation/ nursing diagnosis Ethics applies to all the steps of Assessment and data/communication Interpretation/ nursing diagnosis Ethics applies to all the steps of the nursing process Decision making/ planning Execution /protocols & technical applications/ helping relationship Evaluation Care documentation

 It also applies to diverse nursing functions !!! It also applies to diverse nursing functions !!!

 Ethics applies whatever your professional status and the type of your work… If Ethics applies whatever your professional status and the type of your work… If you are a manager, or work with patients in a hospital, in the community, in research, or in teaching!!!

n Ethics must really penetrate all the actions of our lives, whether personal or n Ethics must really penetrate all the actions of our lives, whether personal or professional, in order to give all of us a just, logical orientation.

 Mister Wizard, is there a recipe for ethics? To continue… Yes, serious thinking, Mister Wizard, is there a recipe for ethics? To continue… Yes, serious thinking, and a few principles…

 End of the 1 st part. Come and visit us for the 2 End of the 1 st part. Come and visit us for the 2 nd part…! 63

Bibliography § § § § § Badiou, Alain (1993) L'éthique. Paris, Hatier. Beauchamp, T. Bibliography § § § § § Badiou, Alain (1993) L'éthique. Paris, Hatier. Beauchamp, T. L. et J. F. Childress (1984) Principles of biomedical Ethics. 2 e N. Y. Oxford University Press. Benoit, Jacques (2000) Graine d’éthique. Paris, Presses de la Renaissance. Blondeau, Danielle (1986) De l'éthique à la bioéthique. Montréal, Gaétan Morin. Bologne J. C. (1986) Histoire de la pudeur. Paris, Olivier Orban. Davis, Ann J. in Marsha D. M. Fowler et June Levine-Ariff, (1989) Éthique des soins infirmiers, traduit par Françoise Bourgeois. Paris, Medsi/Mc. Graw-Hill. 1989, p. 95). Dictionnaire Grand Robert, 2001, Windows Dictionnaire Petit Larousse, 2006, Paris Larousse. Dupouey, Paul (1998) Éthique et formation. Paris, Insep Éditions. Durant, Guy (1999) Introduction générale à la bioéthique. Montréal Fides.

Bibliography § § § § Flynn, Patricia A. R. in Marsha D. M. Fowler Bibliography § § § § Flynn, Patricia A. R. in Marsha D. M. Fowler et June Levine-Ariff, 1989, Éthique des soins infirmiers, traduit par Françoise Bourgeois. Paris, Medsi/Mc. Graw-Hill. 1989, p. 95). Fortin Jacqueline (1985) L'euthanasie, conflit de valeurs et dissidence in Viateur Boulanger et Guy Durand. L'Euthanasie. Montréal, Fides, 1985. Hoerni, B. (1996) Éthique et déontologie médicale. Paris, Masson. Husted, gladys. L. et James H. Husted. Ethical Decision Making in Nursing. St-Louis, Mosby, 1991. Jameton, Andrew (1974) Nursing Practice: the Ethical Issues, Englewood Cliffs, Prentice-Hall 1984, p. xvi) Maillard, Jean de & André Comte-Sponville Citizenship and business is it possible? Human and Social Relation News ( http: //www. bourinconseil. fr/com/focus/citoyenneteuk. php Monette, Marcelle (2004) La prise de décision en éthique clinique. Montréal, Hôpital Maisonneuve-Rosemont, Qué. OIIQ. Code d’Éthique. Montréal, OIIQ.

Bibliography § § § § Phaneuf, Margot (1997) L'importance de l'éthique dans la formation Bibliography § § § § Phaneuf, Margot (1997) L'importance de l'éthique dans la formation des infirmières cliniciennes. Conférence prononcée dans le cadre du Congrès Européen des infirmières cliniciennes, Paris, France, mars 1998. Phaneuf, Margot (1998) Les interrogations éthiques dans « Démarche de soins face au vieillissement perturbé » . Paris Masson, p. 246 -268. Phaneuf, Margot (2000) L'éthique au quotidien: respect du malade et respect de soi. Conférence prononcée dans le cadre de la journée clinique. Hôpital général de Perpignan, France. Ricoeur, Paul (1990) Soi-même comme un autre. Paris, Seuil. Roy, David J. et al (1995) La bioéthique. Montréal, ERPI. Speaman, Robert (1997) Bonheur et bienveillance. Essai sur l'éthique, Paris, PUF. Stanford Encyclopedie of Philosophy http: //plato. stanford. edu/entries/self -consciousness-phenomenological/ Suler, John (2001) Ethics in cyperspace. In Psychology of cyberspace, p. 1. Veatch, Robert et Sara Fry (1987) Case Studies in Nursing Ethics. Boston, Jones and Bartlett.

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