Final Exam- Week 11, 12, 14 PPTS (main part of test) Flashcards
(73 cards)
What are two interesting facts about Relational Ethics?
Our first and only Canadian ethical theory!
Also a theory created specifically in a nursing context in response to traditional ethical theory.
Criticism of Traditional ethical theories?
Here, “traditional ethical theories” means the utilitarian, deontological, and virtue traditions.
Such theories are alleged to:
Deny an “embodied self” (Pollard, 2015, p. 363)
Be universalistic in their approach to ethical issues (ibid.).
Consider that, e.g., to a utilitarian the only ethically significant relation one may bear to another is utility-based. (Ross, 1930)
Explain relational ethics .. anything you know and understand. (info from article)
Relational ethics is defined as an action ethic that is
placed within the interpersonal relationship. The action
ethics include engagement, mutual respect, embodiment,
and interdependent environment [11,12]. The relational
ethics is a new approach to ethical practice in health care.
Moreover, relational ethics may be another framework for
nurses and other health professionals in considering how
to help patients and families [13,14]. For example, a study
found that relational ethics help nurses acknowledge the
importance of opening dialogue, considering a diversity of
perspectives, and understanding the need for attention to
environment in order to provide appropriate health care
Explain relational ethics (from PPT)
“[RE] puts relationships, rather than principles, virtues, or problems, in the foreground of the analysis” (66)
It begins with the idea that everyone is always and everywhere embedded in a series of overlapping and inter-related relationships
These are based on embodied experience with the world.
Have an ethical content.
“… the project of [RE] is to ‘create an ethics of healthcare that is grounded in our commitments to each other’” (66)
Takes a “phenomenological critical social theory perspective” (Pollard, 2015, p. 362)
Negotiates the requirements of care and responsibility with patients rather than for patients.
E.g. The case of Fred revisited
note this article is free online and will probably help with the exam
What type of ethical question does relational ethics ask?
how is this different from other ethical theories?
“what relationships and commitments already inform the person that I am, and the persons others around me are, in this particular situation?” (66)
Patients are not static bearers of rights, and nurses not static bearers of duties (see Pollard 2015, p. 364)
Differs:
The main question is not “what type of person should be” or “what should i do” as with other theories
What are the central tenants and themes of relational ethics?
Mutual respect: “…inspired by responsibility to the other” (Pollard 2015, 365). Part of any healthy relationship.
Engagement: identifying, from another’s perspective, “the unique needs, talents, and capacities of [one’s] patients” (ibid, p. 366)
Embodied Knowledge: A recognition that knowledge has cognitive, affective, and emotional dimensions (ibid.)
Environment: recognizing the self cannot be detached from the environment (ibid., p. 366-7)
Uncertainty: recognizing the myriad of experiences that result when ethics is not so clear or we are caught in “a storm of values” (ibid. p. 367)
“Uncertainty is a truth that asks for humility rather than power, understanding rather than information, and relationship rather than ideology” (ibid.)
What are the arguments against relational ethics? which one is arguably not a weakness?
A relational focus in ethics “does not preclude attention to and reflection upon principles, virtues, problems, or dynamics of power” (67) (i have no idea why he listed this as a criticism– it doesn’t sound like one at all)
“Relational ethics does not furnish us with moral rules or prescriptions for action” (67)
This is arguably a feature rather than a bug, but if we want specific guidance in a situation, you won’t get it with this theory. you must start with who you are and then where you are and the relationships and obligations that tie you to it.
Who said “Not that you lied to me, but that I no longer believe you, has shaken me”
–Nietzsche Beyond Good and Evil § 183
History of truth in ethics- How does truth in health care differ historically from other professions?
Like autonomy, truth-telling was once considered a distant priority in patient interactions in healthcare.
“While it would be unacceptable for lawyers or accountants to deceive their patients, in medicine deception has been widely practiced, if not prescribed” (208)
This was done in the the service of beneficence and non-maleficence — for the patient’s own good.
Truth in ethics- What do healthcare professionals think about truth nowadays? Why might this be?
The norms in healthcare have shifted around truthtelling, as they have shifted around autonomy.
“being truthful with patients is less associated with harm than it used to be” (209)
“Today, there is a greater recognition of the therapeutic benefits of information disclosure in general” (209)
“Beneficence – especially as associated with paternalism – has been devalued in proportion to the ascent of patient autonomy as a value” (209).
“The ethical consensus today, although by no means unanimous, is that patients have a right to know the truth, even if disclosure is likely to be harmful” (209)
How do we use truth to promote informed decision making? A value of nursing!! This is written into our code of ethics
The following is just a snippet of how truth is written into the COE. There are other ethical principles related to:
maintaining privacy, promoting justice and so forth.
C1. Nurses provide persons in their care with the information they need to make informed and autonomous decisions related to their health and well-being. They also work to ensure that health information is given to those persons in an open, accurate, understandable and transparent manner.
Truth in Ethics- What is the difference between a factual truth and truthfulness?
Factual truth: Something that is accurate against the facts.
Factually true statements are assessed for their truth or falsity.
Truthfulness: Not intending to mislead.
Truthful statements are assessed for their misleadingness
Can you think of a statement that is factually true but not truthful?
If I was late to school because I wanted to sleep in but said “I hit traffic on the way to school” so i wouldn’t be lying but I would be purposely misleading my instructor
Or in health care if you said “ you have many treatment options” this could be true, but if you know many of them have poor results and the prognosis of disease is poor, it could mislead the patient into thinking that they have very good odds. This would be diverging from the truth by omission of not giving the complete information.
Can you think of a statement that is truthful but factually false?
If I said “spanking your child is the best way to teach them to behave” I may have good intention and not mean to mislead, but it might be false, and not properly based in evidence
If I said “the test is easy!” and i think i am being truthful but you found it very hard
How can people depart from the truth?
The distinction between telling the truth and being truthful means there are several ways to depart from the truth.
a lie: saying something we know to be false for the purpose of deceiving another
Using “gestures, false clues, understatement, exaggeration, manipulation, the use of jargon, withholding information, evasion, and silence” to deliberately conceal something from another (216)
Whether and to what extent these are departures from truth is context dependent.
But at the very least it’s clear that factual truth is only part of the truth!
Arguments for and against truthfulness related to beneficence and maleficence
Beneficence and non-maleficence
Even if truthful disclosure is harmful, should this outweigh other values?
Is truthful disclosure even harmful? “A blanket assumption that disclosure will prove harmful is dubious at best” (210)
Can the harm of truthfulness in clinical contexts be mitigated by a “thoughtful and sensitive” relational approach to clinical practice?
Beneficence and non-maleficence
What about the benefits of truthfulness?
“Disclosure makes it possible for patients to express their feelings, and this alone may have therapeutic value” (211)
Helps to allay “needless fears and anxiety” (212)
what are Arguments for and against truthfulness related to autonomy?
Autonomy.
Having the relevant information “on board” is a condition of informed consent and of effective decision-making for patients.
“[T]ruthfulness also promotes autonomy by helping patients to maintain a sense of control over their lives” (212)
In the limiting case, truthfulness could harm autonomy if the patient does not want to know (213).
What are arguments for and against truthfulness that are related to patient- practitioner relationships?
The practitioner-patient relationship
Tends to support “openness and disclosure” (213)
Reciprocity with patients who “are expected to disclose all relevant information fully and frankly” (213)
What are arguments for and against in general? Hint- information gap
The knowledge gap: if patients lack the requisite knowledge to assess, understand, and interpret information, perhaps this supports less than full disclosure.
But being unable to understand fully doesn’t preclude being unable to understand at all.
Even if it is impossible to provide complete information to patients, we can still be “open and accurate about what we do know” (214)
Exceptions from these general considerations are possible, but must be justified (214)
How should truth be told?
The goal is generally not just to say factually true things…
…It is also to say them honestly, i.e. without the intention to mislead.
This means in the ongoing dialogue with patients one has to get a sense of the specific…
wishes, interests, and capacities
…of each patient that go into what, when, and how to communicate information to that patient.
This is onerous, but it reflects the fact that the truth is not simply factual and telling it can cause varying amounts of good and bad.
What are some issues with truthfulness and scope of practice?
Sometimes, the ability of a nurse to be truthful is limited by workplace policy and professional role.
As the text points out (219-20), these rules may not be as defensible as rules that allow the nurse more ability to communicate with patients and families.
“The reality in many practice settings is that disagreement with the physician concerning disclosure may be costly to nurses, both personally and professionally” (220)
This can raise issues of integrity, moral distress, and moral residue.
What is privacy?
Certain self-regarding information is private
E.g. the contents of a letter to a friend.
Some ideas:
“the control we have over information about ourselves” (247).
“right to be left alone” (ibid.)
“the claim of individuals, groups, or institutions to determine for themselves when, how, and to what extent information about them is communicated to others” (ibid.)
Can be thought of as a normatively loaded or neutral concept.
What are the three dimensions to privacy?
For Gavison (1984), it’s the extent to which we are non-accessible to others in that …
we keep information about us non-accessible.
we keep our physical selves non-accessible.
we keep attention away from ourselves. (248)
Privacy is thus a matter of secrecy, solitude, and anonymity.
Is there anything missing here?
Are each of these aspects of privacy equally valuable
Why might some people decide to keep their individual information private? (related to stereotyping and groups)
Groups prone to stereotyping may choose to keep private individual data
The text mentions research on indigenous health problems leading to stereotyping of all indigenous people (248)