Ethical Decision Making and Accountability
Informed Consent is an area of legal and ethical obligation that sometimes leads to conflict in the health care setting. As a health care leader, we are responsible to be knowledgeable to the federal and state laws, regulatory bodies, policies and codes of ethics that apply around informed consent.
The Oath of Hippocrates, better known as the Hippocratic Oath could perhaps be credited as being the birth of written medical ethics. The oath commits to preventing both harm and injustice to patients. Its statements even then address the issue and importance of confidentiality also.
The U.S. Department of Health and Human Services (HHS) Code of Federal Regulations (CFR) part 45 known as "the Common Rule" (1991) describes general requirements of basic ethical principles around informed consent. This rule was impacted upon all departments under HHS and directed at all considerations around the protection of human subjects in a variety of applications.
Like many individual states, the Commonwealth of Massachusetts General Laws (MGL Title XVI Sec. 70E) also upholds this expectation of "informed consent to the extent provided by law"[DR3] .
The American Medical Association (AMA) developed a Code of Ethics in 1847. Today this code has in this body Opinion 8.08 - Informed Consent. AMA describes that the patient must be armed with sufficient information to be considered ‘informed' in order to justly enable the patient to consent. It holds that the physician is ethically obligated to provide for this.
American Nurses Code of Ethics section 1.4 declares the nurses obligation to assure a patients right to self-determination or autonomy as a basis for informed consent in decision making around their health plan. It addresses the assessment of a patient's decision making capacity as well as recognizing the patient's personal values in considering this. Nurses by profession spend more time at the bedside with patients than any other caregiver. This opportunity gives light to patient perspectives and understandings which may not be evident to other practitioners. Nurses are often in situations as liaison between patients, families and physicians.
In 1996 The American Counseling Association (ACA) credited Kitchener's Moral Principals as a foundation of ethical guidelines. Autonomy, Justice, Beneficence, Non-maleficence and fidelity. These guiding principles help expose underlying issues in resolving an ethical dilemma (Kitchener, 1984).
When examining an ethical dilemma using the Ethical Decision Making Model at a Glance:
Identify the problem.
Apply the ACA Code of Ethics.
Determine the nature and dimensions of the dilemma.
Generate potential courses of action.
Consider the potential consequences of all options, choose a course of action.
Evaluate the selected course of action.
Implement the course of action.
By nature, ethical dilemmas do not usually have black and white answers. Utilizing these guiding principles and similar ethical decision tree models help us work the issues objectively and often guide us to the solution by means of the process.
References:
American Medical Association (AMA) Code of Ethics
https://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion808.page
U.S. Department of Health and Human Resources (HHS) Federal Policy for the Protection of Human Subjects
https://www.hhs.gov/ohrp/humansubjects/commonrule/
Massachusetts General Laws (MGL) 2014
https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter111/Section70e
American Nurses Association Nursing World Code of Ethics
https://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/EthicsStandards/CodeofEthics.aspx
American Counseling Association (2014). ACA Code of Ethics. Alexandria, VA: https://www.counseling.org/knowledge-center/ethics#sthash.G8zpUV9i.dpuf