Ethical Decision Making

Prepared by

Taiseer Ali

Under Supervision of:

Dr / Esteer Ibrahim

First term master 2023-2024

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Objectives:

At the end of these presentation, every candidate will able

to:-
➢ Define some terms related to ethical decision making.

➢ Identify purpose of decision making.

➢ Enumerate types of decision making.

➢ Identify steps of decision making.

➢ List factors affecting decision making.

➢ List Obstacles of decision making.

➢ Discuss Role of nurse in ethical decision making.

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Outlines:

❑ Introduction.

❑ Definitions of terms.

❑ purpose of ethical decision making.

❑ Types of ethical decision making.

❑ The steps of decision making.

❑ Factors influence ethical decision making.

❑ Obstacles of decision making.

❑ Role of nurse in ethical decision making.

❑ References.

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Introduction:
Every organization or individuals has take a lot of decision on daily
basis ,Individual values, beliefs and personal philosophy play a major
role in moral or ethical decision making.

Acting ethically is the right thing to do but it is not always easy.

Definition of decision making: -

Is a cognitive process resulting in the selection of a belief or a course
of action among several possible alternatives option.

Definition of ethical decision making:-

Is not a purely cognitive and liner process that follows clearly defined
and predictable steps or The process of evaluating and choosing among
alternatives in a manner consistent with ethical principles .

Definition of ethical Decision-Making in Nursing

refers to a framework that nurse professionals use in making informed

decisions while evaluating the impacts of their actions.

Purpose of ethical decision making:-

❑ Ethical decisions generate and sustain trust.
❑ demonstrate and respect responsibility, fairness, and caring .

❑ consistent with good citizenship.

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Types of ethical decision making:
1. Programmed &non-programmed
2. Active decision
3. Passive decision
4. Rational decision
5. Irreversible decision
6. Reversible decision
7. Quick decision
8. Delayed decision
9. Conditional decision

1-Programmed decisions:

- It involves situations that occur often enough to enable

decision rules to be developed and applied in the future.
-Non-programmed decisions:

- Are made in response to situations that are unique, are

poorly defined and largely unstructured.
2- Active decision:

• Involve a choice between at least two alteratives in making active

decision, people consider their feelings, and their beliefs.
3 - Passive decision:-

• Are those when the person has a choice, but allows someone else,
or time or chance to decided.
4- Rational decision:-

• Has sequence of steps starts with identifying the situation at hand

then compelling all the facts and information necessary to create
a solution.

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5- Irreversible decision:-

• From the term itself, irreversible decision is permanent choices.

People usually back for irreversible decision when there are very
limited.
6- Reversible decision making:-

• This kind of decision is not finding and may be temporary. At any

point reversible decision can be change.
• Ex: when the decision made is not right.
7_Delayed decision:-

• It is termed as such because the decision maker set the decision

aside until the right time comes for it to be implemented.

8- Quick decision:-

• Not everyone is able to make quick decision so only good decision

makers arrive at instant and correct decision easily the long term
outcome must be considered in making quick decision.
9_Conditional decision:-

• The person opens other possibilities or other alternatives, when

the initial decision fails there are other option to choose from
it.

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Factors influence ethical decision making:
1-Ethical Issue Intensity

2- Individual factors

3-Situational factors (organizational factors)

4-Opportunity

1-Ethical Issue Intensity:

 Perception of ethical Issue Intensity can be influenced By:

-Management’s use of rewards & punishments

-Corporate Policies

-Corporate Values

2- Individual factors:-
• There are personal factor about individual may sensitivity to
ethical issues, judgment about such issues include:
Age:

• The older you are, the more ethical you are

Locus of control:

External control versus internal control: relates to authority/power

• -External control: see themselves as going with the flow because

that’s all they can do.
• -Internal control: believe that they control the event in their lives
by their own effort and skill.
Education:

• The more education that one has, the better he or she is at ethical
decision making.

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Culture:

• Appears to be significant in affect of ethical decision making.

Stress:

• Situation of extreme stress can have negative impact affect

thinking and ability of decision making such as inadequate
staffing, interpersonal conflict, lack of supportive resource &
dealing with death.
Experience and knowledge:

• The more experienced person has the ability to rapidly identify

the important facts, limits and all alternatives to help in ethical
decision making.
Religious beliefs and morals:

• When an individual’s intentions and behavior are inconsistence

with his or her religious beliefs and morals the person may feel
guilty.
3-Situational factors (organizational factors):-
Corporate culture:

• The set of values, beliefs, norms, polices, overall organization

culture and ways to solve problems that an organization’s
member’s share.
Interpersonal conflict:

• Those who have influence in a work group including peers,

managers, coworkers, and subordinates.
• As the ethical decision making is a social activity involving health
team member and the patient, so we need to identify
fundamental communication pattern used by nurse & other
health team.
4-Opportunity:
• Condition that limit or permit ethical or unethical behavior.

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 • Opportunity to engage in unethical behavior can be limited
through formal codes of ethics, policies, and rules that are
adequately enforced

The steps of decision making:

1. Identify the problem
2. Apply code of ethics
3. Determine the nature and dimensions of the dilemma
4. Generate potential courses of action
5. Concider the potential consequences of all options and determine a
courses of
6. Evaluate the selected courses of action
7. Implement the courses of action
Ethical decision making according to nursing process

1-Assessment:
(Collect, analyze, interpret the data and state the dilemma)

• Is the process of collecting information as much as possible about

the particular ethical dilemma.

• Include (the problem itself actual or potential problem , identify

the people involved in the problem, available resource, patient
family)

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 Example:

(Whether or not to resuscitate a hospital patient with a terminal

disease after physician’s instructions not to code or resuscitate )

• Questions as:

• How mentally competent the patient is to make a no resuscitation

decision?

• Also include the patient’s wishes and the family’s wishes.

2-Planning:-
*Consider the choices of action (all the possible courses of action that
can resolve the dilemma without considering their consequences)

*The process of idea development requires inputs from outside sources

such as colleagues, supervisor or even experts in the ethical field.

Two approaches can be used in determining the choice:

As previous example:

Questions may be:

*Resuscitating the patient despite the physician has requested.

*Not resuscitating the patient at all.

*Seeking another assignment to avoid dealing with the situation.

*reporting the problem to supervisor

*Confronting the physician about the question.

*Clarifying the question with the family.

— After considering all choices the consequences of different actions

are considered.

— Analyze the advantages and disadvantages of each course of

action help the decision maker to select the most realistic action.

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As in the previous example:

Course of action analysis is:

*Discussing the decision with physician may lead to an angry physician

and no longer trust in the nurse.

— *disciplinary action if successful resuscitation despite orders to the

contrary. Make the decision :

The most difficult part of the process is actually making the decision and
then living with the consequences.

The best decision that we hoped for is one that is based on ethical
decision making process.

Collaborative decision making among patient, physician, nurses and

family about resuscitation is the ideal and tends to produce fewer
complication in the long term resolution of such questions.

3-Implementation:-
To decide ethically is the moral ability and to act ethically is the physical
ability.

— The decision must be done in a caring way.

(Would I like to be treated in this way?)

(The most appropriate person should do it in the most appropriate way)

4-Evaluation:
— Evaluation of the action is crucial ,but not easy

— *example:

— If the decision was that active treatment should be stopped for a

dying person, then perhaps the person will die.

— Evaluation in this situation may be: how the death took place and
how the family reacted may be taken as an evaluation.

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Obstacles of decision making:-
1- Poor moral awareness:-

• Can either result in a failure to perceive the problem as being an

ethical problem at all.
2- Failure to gather relevant facts:-

• Good practical decision requires that know important facts

relevant to the decision.
3- Rationalizing ourselves out of good moral decision making:-
• We can do what we like.
• The following are poor, but unfortunately all too common.
• It’s just a part of the job.
• It’s legal, and then it’s moral.
• It doesn’t hurt anyone.
4- Slippery slope arguments (SSA):-
• People are willing to do unethical things because they have
already done smaller less extreme acts that make the bigger
choice appear less unethical.
5- Confirmation bias:-
• Is the tendency to notice and remember evidence that supports
our beliefs and to ignore evidence that contradicts them. So
when we are making decision and problem solving, we have a
tendency to make evidence fit our desired outcome.

6- Not weighing consequences:-

• Another obstacle to decision making is not weighing
consequences.

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 • Sometimes we see a solution or decision making that we really
like and we will committee and jump in before we consider how
that solution or decision we impact others lives.

Role of the nurse in ethical decision making:

1-Facilitator:
By utilization different frameworks and models as the ANA code of
ethics which offers a statement of every nurse’s ethical obligations and
duties.

2-Advocator: For the rights of their patients (patient’s access to care –

refuse treatment –informed consent)

3-Promoting justice:
Individuals should be treated the same, unless they differ in ways that
are relevant to the situation in which they are involved

4-Being accountable:
From the nurse’s responsibility in the process of decision making and
caring process, accountability arises through information and to what
extent she participates in the decisions.

5-Maintaining privacy:
The right to make decisions for oneself and right to control information
about oneself also the right to control certain extremely personal
decisions and information helps determine the kind of person we are
and the person we become.

6-Clarifier and educator:

Through giving information about disease process and translate
medical terms and clarifying any meaningless information to the
family.

7-Preserving dignity:

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 By ensuring involvement of patient and family in any decision that
affects their care.

References:
➢ Tschudin. V, (1992), 2nd ed., Ethics in nursing the caring
relationship, Butterworth – Heinemann company, USA, pp (96-
133).

➢ Thompson, (1994), 3rd ed., Nursing Ethics, Churchill Livingstone

company, London, pp ( 106 – 117).

➢ Burkhardt. M, (2007), Ethics& issues in contemporary nursing, 3rd

ed.,Thompson Company, USA, pp (214 – 242).

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