Ethical Decision Making: Nursing

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Ethical Decision Making: Uustal’s Model

Introduction

Just as nursing applies a systematic process for evaluating the condition of a given population to determine an appropriate intervention, health care providers must also utilize a systematic process to assess the nature of an ethical dilemma to determine a reasonable solution.

Ethical decisions are reasoned choices based on:

  • The dilemma itself.
  • The principles in conflict.
  • The people involved.
  • The outcome of the proposed action.
  • The ethical reasoning process selected.

Ethical Decision Making

It is helpful to use a decision-making model for ethical dilemmas in order to guide one’s decision making from an objective, cognitive perspective, rather than a purely affective or emotional perspective. Uustal (1993) proposed the following steps to guide one’s ethical decision making.

Uustal’s model not only follows the nursing process, but also includes values clarification when applying an ethical decision-making model.

Step 1: Identify the problem. Ask:

  • Who are people involved in the dilemma?
  • How are they related or interrelated?
  • What is involved in the situation?

After answering the above questions, identify the ethical dilemma and make a concise statement of the problem. Then, state the conflict in values.

Step 2: State your values and ethical position related to the problem.

  • How does the issue fit with your personal values?
  • Are they congruent or incongruent?

Step 3: Take into consideration factors that relate to the situation and generate alternatives for resolving the dilemma.

Step 4: Examine and categorize the alternatives. Identify those that are consistent and inconsistent with your personal values.

If the most appropriate alternative is inconsistent with your personal values, another provider may be needed to facilitate resolution. This eliminates bias and preserves your own ethical integrity.

Step 5: Predict all possible outcomes for those acceptable alternatives.

Consider physical, psychological, social, and spiritual consequences, both short-term and long-term.

  • What might happen if you follow Alternative A?
  • What might happen if you follow Alternative B?

Step 6: Prioritize acceptable alternatives. List them in order from the most acceptable to the least acceptable.

Step 7: Develop a plan of action utilizing the list of acceptable alternatives. Determine what you are going to do about this dilemma.

Step 8: Implement the plan.

Step 9: Evaluate the action taken. Ask yourself the following questions:

  • Did I do the right thing?
  • Were my actions ethical?

Characteristics of Ethical Dilemmas

Following is a review of the characteristics of ethical dilemmas:

  • The choice is between equally undesirable alternatives.
  • Real choice exists between possible courses of action.
  • The people involved in the dilemma place a significantly different value judgment on possible actions or on the consequences of actions. That is why there is a conflict. If everyone involved agreed, there would be no ethical dilemma.
  • Data alone will not help resolve the dilemma. One always wants more data, but it is not available.
  • Answers to the ethical dilemma come from a variety of disciplines (e.g., psychology, sociology, theology).
  • Actions taken in an ethical dilemma will result in unfavorable outcomes and/or constitute a breach of one’s duty to another person. Although the action taken may meet the needs of one person or party, it may result at the expense of another.
  • The choices made in an ethical dilemma have far-reaching effects on our perception of human beings and definition of personhood, our relationships, and people in society as a whole.
  • Any ethical decision involves the allocation and expenditure of resources which are finite. If there were an infinite amount of resources to share with everyone in need, there would be no dilemma in deciding who gets the scarce resource.
  • Ethical dilemmas are not solvable, but rather resolvable. A solution would mean that the problem is fixed. A resolution means that a decision has been made to determine a course of action in the situation.

When one is faced with an ethical dilemma, there are specific ethical questions to address:

  • What ought to be done in this case?
  • Who should be involved in the decision making process?
  • Who has the right to make the final decision? Why?
  • For whom should the decision be made: for oneself, someone for whom you are acting as a proxy, or others?
  • What criteria should be used in a dilemma? Psychological condition only? Physiological status, economic concerns, legal factors, social and family perspectives, or spiritual considerations?
  • What degree of consent should be obtained from the client?
  • What harm or benefits will result from the decision and resulting actions?
  • Does the ability to intervene justify the intent to do so? Just because it is possible, does it make it right?

Ethics Committees

As a response to the growing number of ethical questions stemming from scientific advancement, President George Bush established a President’s Council on Bioethics in January of 2002. A significant step to approaching ethical dilemmas was made when the council mandated the creation of ethics committees in acute care settings. These committees are comprised of members from different disciplines in and outside of health care as well as laypersons from the community. Committees often include an ethicist (educated in ethical consultation), a lawyer, a quality improvement manager, a physician, a nurse, a clergyman or other spiritual director, and an individual from the community at large.

In the coming together of differing experiences, educational backgrounds and unique perspectives, the committee as a whole can produce a well-balanced discussion of alternatives. In addition, these committees can provide recommendations intended to advocate for patient’s rights and promote shared decision making, even in the face of the most challenging of ethical dilemmas. While the alternatives and recommendations offered by an ethics committee do not have the weight of law, they make a significant influence on decision making at the bedside and have the power to influence a judge or jury during any deliberation involving patient rights.

Conclusion

As long as the delivery of health care involves human life, changing technology, and finite resources, health care professionals will face ethical dilemmas on a daily basis. Often times, life-changing decisions must be made quickly. Because of the long-term and life-altering effects of many actions, it is important that ethical dilemmas be resolved in accordance with ethical principles and theories. Just as health care professionals practice CPR in order to be able to perform it efficiently in a real situation, it is important that health care professionals practice ethical decision making in a classroom setting so that they are in tune with their own values and are better prepared to make ethical decisions when they occur in the clinical setting.

References

Uustal. D. B. (1993). Clinical ethics & values: Issues and insights. East Greenwich, RI: Educational Resources in Healthcare.

 

 
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Confronting Gun Crime

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Anthropology 157: The Ecology of Crime

Research Paper

CONFRONTING GUN CRIME
After more than two decades of steady decline in crime in the
United States, 2015 saw a sharp increase, particularly in
violent crime. Gun crime makes up a significant fraction of the
most serious violent crime in the United States and few would
disagree that this is the case. There is little agreement,
however, on what can and should be done about gun crime.
Your task is to present a compelling, evidence-based argument
for a gun crime prevention strategy.
Your research project has several components:
1. Provide a quantitative characterization of the problem
(backed up by well-sourced numbers)
2. Pick a domain and develop a solution in that domain
a. Gun “culture”
b. Gun markets
c. Gun laws
d. Gun design (engineering)
e. Other (written approval from Prof B. required)
3. Provide a practical justification for the solution
4. Project the impact of the solution
GUIDELINES FOR PRODUCING A SUCCESSFUL PAPER
This research project is NOT a standard class paper. Simply
describing the results of past gun crime prevention strategies
conducted by other researches will earn you a “D.” You need to
push the envelope and try to come up with novel, practical
interventions and clearly articulate how and why you expect them
to work. This means you really need to endeavor to understand
the problem.
It is important to ground your intervention strategy in theory,
but is equally important to consider whether your solution is
practical. Your grade will reflect whether it is possible to
implement your solution given existing economic, political,
social or constitutional constraints. Do not neglect these
issues in your paper.
2
ITS TIME TO PROVE THAT YOU HAVE WHAT IT TAKES TO COMPETE IN THE
REAL WORLD. Therefore I want you to assume that you are actually
generating the proposal for a city or government official and
that you are really trying to fix the problem. Your paper
should therefore be scientifically convincing and practical as
well as professional in its organization and presentation.
Note that this project is a LIBRARY RESEARCH PAPER. Common sense
may be useful in when seeking inspiration for how to best
accomplish crime prevention. However, you MUST also back up your
ideas and perspectives using information gathered from
acceptable SCIENTIFIC SOURCES.
LIBRARY RESEARCH & ACCEPTABLE SCIENTFIC SOURCES
You MUST cite and correctly reference 5-10 journal articles or
book chapters from acceptable SCIENTIFIC SOURCES. One important
type of acceptable scientific source is an article from a peer
reviewed journal. Peer review means that the article has been
evaluated by two or more experts in the field. The reviewers
have checked to make sure that the authors of the paper have
used state-of-the-art theory and methods and are not
inadvertently (or deliberately) misleading the reader.
Publication in a peer reviewed journal does NOT mean that the
paper is necessarily correct, nor that the reviewers necessarily
agree with the arguments in the paper. It only means that the
paper can be read as an honest presentation of perspectives and
data.
Books and book chapters from reputable scientific publishing
houses and from University presses are generally also peer
reviewed, but not with the degree of intensity that journal
articles are reviewed. Books and book chapters may also be
acceptable scientific sources, but you should be more cautious
in accepting what is said in these sources. Authors have much
greater freedom in a book to present ideas, opinions and data
that might not pass muster in a peer reviewed journal.
Journal articles obtained from journals accessed through UCLA
databases ISI Web of Science and J-Store are guaranteed to be
acceptable. Most books on the shelves of the UCLA libraries are
acceptable scientific sources.
UNACCEPTABLE SOURCES
All other information from the web should be treated as
unacceptable. This means information from websites such as
wikepedia.org, britannica.com, joesacriminal.com, latimes.com,
3
etc., are ALL UNACCEPTABLE as scientific sources. Web pages and
blogs are not peer reviewed by experts in the field and
therefore they are under no obligation to use state-of-the-art
theory and methods, nor are they required to be honest. In fact,
it is not unreasonable to expect that blog authors are simply
interested in attracting as much attention as possible. Why be
careful and honest, if playing fast and loose earns you more
eyeballs?
Main stream newspapers such as the LA Times do hold themselves
to a higher standard than bloggers. However, the journalistic
standard is one of “confirmation” from multiple sources not
scientific accuracy. Thus if two or more people confirm the same
outlandish story, then it is fit to print. If you see something
in a news story that attracts your attention, you must back up
the claims in that story with information data from other
sources.
One final unacceptable source: Lectures. If you hear something
intriguing in lecture, you must find acceptable scientific
sources that back that up. Do not cite (Brantingham, Lecture
15)!
WARNING: I WILL DEDUCT ONE WHOLE LETTER GRADE FROM YOUR PAPER
SCORE FOR EACH CITATION TO UNACCEPTABLE MATERIALS. FOR EXAMPLE,
CITE WIKIPEDIA ONCE AND YOUR GRADE WILL GO FROM A- TO B-
.
PAPER FORMAT
Your paper MUST adhere to the following formatting guidelines:
• 5 page maximum, EXCLUDING references, tables and figures.
• Double-spaced, 12 pt font
• 1” (inch) margins top, bottom, left right (not more not
less)
• Citations and references in Chicago B format:
http://www.chicagomanualofstyle.org/tools_citationguide.htm
l
Note: You must be on UCLA campus, or using the UCLA VPN if
off-campus to access the Chicago Manual of Style.
It is recommended that you write your paper working from a point
form outline. Make sure you have all the pieces of your argument
together before you start turning it into prose.

 
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Have you ever thought about why people sleep or what purpose sleep serves? This is something that many have wondered for years. Studying what happens when the average person sleeps, how long that person sleeps, and how he or she feels after sleep has taught

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Have you ever thought about why people sleep or what purpose sleep serves? This is something that many have wondered for years. Studying what happens when the average person sleeps, how long that person sleeps, and how he or she feels after sleep has taught us a great deal about sleep. Case studies of individuals who have abnormal sleep patterns or sleep needs have also been considered. Some people called nonsomniacs need very little sleep to feel restored. In addition to studying the amount of sleep each person needs, scientists have considered the possible reasons we have different stages of sleep. Scientists have pondered many other things, such as why the amount of time that people spend in different stages of sleep changes over a lifetime.

Answer the following questions:

  • Recent studies indicate that the brain takes mini naps when a person is sleep deprived. What role does sleep play in restoring one’s mind? Consider the cognitive changes that a person experiences when sleep deprived. What is it about nonsomniacs that seems to contradict what most believe about the role of sleep?
  • What is REM sleep, and what role does it play in memory consolidation? Is the hippocampus, a structure known to play a role in the consolidation of memories, active during REM sleep? Might REM-related dreams be related to one’s actual experiences?
  • Why does the amount of time that infants spend sleeping differ from adults? Does REM sleep play a role in the neural development of a young brain? Compare the amount of time people spend in sleep stages over a lifetime. How does slow-wave sleep change over the life span?

When asked, also utilize outside sources. As in all assignments, make sure to cite your sources in your work and provide references for those citations utilizing APA format. Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between one or more lines of reasoning in the discussion. Complete your participation for this assignment by the due date assigned.

 
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