MODULE III: DECISION MAKING IN VALUE ISSUES

Value Confrontation:

Health care is an arena in which values play a commanding role in determining what is
right and good for patients. It is our values that tell us what is right and wrong, good and evil,
and imply preference in regard to correct human behavior. This rather subjective screen with
which we surround ourselves often countenances strong feelings or intense attitudes that are
backed by rational justifications. Although we tend to think of value problems in the “big ethics”
sense—those problems involved in choices dealing with life and death—we are also bedeviled
by rather everyday questions that call for judgment based on the perception of right and wrong.
Perhaps the most frustrating aspects of value choices is that honorable individuals often
come to very different positions based on reasoning from their particular worldviews. Some will
base their opinion on formal philosophical or religious beliefs, while others will to try to weight
the potential outcomes—seeking to choose that provide the greatest good for the greatest
number. Still others really don’t use a formal system at all to determine the right answer that will
rely on current practice or past experience as their guides.
As professional, it is necessary, even in our opposition, to attempt to be constructive, not
destructive, in the methods we use when we come to disagreements over issues involving
personal values. Foe example, accommodation with regard to the issue of abortion might be
more easily attained if each side had not cast the others as “baby killers” or “antiwomen.” When
trying to come to mutual understanding regarding value disagreement, it is wise to follow the
admonition of the Scottish author J.M. Barrie, “Never ascribe to an opponent motives meaner
than your own.” Question regarding health care ethics rarely have easy answer; in fact, there are
no easy answers. If the answer were easy, these problems would not be called dilemmas.
To acknowledge that individuals can come to different opinions in regard to value issues
is not to say that all opinions have the same worth and credibility, or that one particular answer is
better than another. Often we find ourselves with no “right” answer or several right answers that
seem to fit the situation. Several theoretical positions have been proposed that allow us to
examine value-laden issues. In all cultures there are variety of common worldviews and ethical
systems. One polar dichotomy found is that of the consequence-oriented and duty-oriented
worldviews and theories.
Essential Mental Attributes for Ethical Reasoning

Ethical Humility Awareness of the limits of one’s own ethical insights

Ethical Courage Willingness to assess fairly ideas, beliefs, and viewpoint

differing from our own

Ethical Empathy A willingness to attempt to understand the opinions of

others and try to see the issue from their position

Ethical Fair- To hold one’s own beliefs and opinions to the same
mindedness
standard of proof and evidence that we require for opinions of other

Teleological (Consequence-Oriented) Theories

Consequence-oriented theories judge the rightness or wrongness of decision based on
outcomes. Those following a consequences-based theory would decide that what is right also
maximizes some good. The right thing to do, then, is the good thing to do. These theorists argue
what constitute the good, but once agreed, they would have no problem, theoretically, in
deciding on the right course of action.
Jeremy Bentham (1748-1832) and John Stuart Mill (1806-1873) are considered the
fathers of utilitarianism, the most common form of consequences-oriented reasoning. To

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utilitarian, the good reside on the promotion of happiness or the greatest net increase of pleasure
over pain. To elevate the theory beyond a “pig philosophy”, where a satisfied pig enjoying its life
would constitute a higher moral state than a dissatisfied Socrates, Mill defined happiness as a set
of higher-order pleasures such as intellectual, aesthetic, and social enjoyment rather than mere
sensual pleasure.
The purest form of this line of reasoning is act utilitarianism, in which the decision is
based on listing the possible alternatives for action, weighing each in regard to the amount of
pleasure or utility it provides, and selecting the course of action that maximizes pleasure. There
is some criticism that this hedonistic from of reasoning might lead to situations in which one
group derives pleasure from pain of others and justifies its action on the basis of utility. To
overcome this objection, some newer consequentialist formulations have required the principle
of equal consideration of interest be shown. In which the individual is not allowed to increase his
share of happiness at the expense of another. The basic formulation to act utilitarianism can be
captured in the principle: One ought to act so as to provide the greatest balance of happiness over
unhappiness, everyone considered. One of the real problem of act utilitarianism is that individual
must somehow predict and calculate the various levels of happiness promoted by each choice.
Utilitarian systems are referred to as teleological theory, taken from the Greek word telos,
which means ends. Often, individual attempt to use utilitarian theory when they seek to divide
scarce resources such as health care. They might justify the denial of single individual access to a
heart transplant if the money could be spent on providing vaccine for thousands.

Describe List Compare Arrive at

Problem Solution Solution Correct
s with Utility Answer

Criticisms of Utilitarianism
1. The calculation of all possible consequences of our action, or worse yet our inaction,
appears impossible.
2. Utilitarianism may be used to sanction unfairness and violation of rights. To maximize
one person’s or one group’s happiness, it may be necessary to infringe on the happiness
of another individual or group.
3. Utilitarianism does not seem to give enough respect to persons. Under this theory, the
ends justify the means, so it may be moral to use person merely as a means to our ends.
4. Utilitarianism alone does not provide a basis for our own moral attitudes and
presuppositions. If followed, utilitarianism may recommend behaviors that are in conflict
with personal fundamental moral beliefs and give rise to a sense of loss of self.
This theory holds that an action deemed to be right if it conforms to a rule that has been
validated by the principle of utility. The principle of utility requires the rule bring about positive
results when generalized to a wide variety of situations. Rules forbidding the abridgment of free
speech might qualify as suitable, even if under certain rare situation they might bring about a
decrease in happiness or pleasure.

Deontological (Duty-Oriented) Theories

Duty oriented ethics feel the basic rightness or wrongness of an act depends on its
intrinsic nature rather than on the situation or the consequences. This position is often described
as a deontological theory, taken from a Greek word for duty. An act in itself would be either
right or wrong; it could not be both. Immanuel Kant (1724-1804) held that the consequences of
an action were essentially irrelevant. Kant based his moral philosophy on the crucial fact that we
are rational being, and a central feature of this rationality was that principles derived from reason
are universal. He held that morality is derived from rationality, not from experience, and
obligation is grounded not on the nature of man or in the circumstances of the world but in pure
reason.

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 These universal truths applied to all people, for all times, in all situations. Kant held that
human mind works in the same way, regardless of who you are, where you are, or when you are.
An action could be known to be right when it was accordance with a rule that satisfied a
principle he called a categorical imperative. By “categorical” he meant they do not admit
exceptions. An “imperative” is a command derived from a principle. These imperative were
formulated by finding a maxim that could be understood as universal law. The imperative seems
to have three elements: (1) universal application (i.e., binding on every individual), (2)
unconditional, and (3) demanding an action.
One maxim relevant to health ethics is, “We must always treat others as ends and not as
means only.” Kant saw people as having an absolute value based on their ability to make rational
choices. Accordingly, our dignity was derived from this capacity, and this was violated whenever
a person was treated merely as a means to an end (a thing) and not as person.
Consequence-Oriented Reasoning
Describe Problem

List Solutions

Compare Solutions with

Principles

One Compliant Several Compliant Compliant/Conflicting

Alternative Alternatives Principles

Correct Answer Select among choices Rank Principles

Select Choice

Criticism of Kant
1. The exception less character of Kant’s moral philosophy makes it to rigid for real life.
Real-life situations are so varied that it is impossible to create rules that can guide us in
all circumstances.
2. Morality cannot be derived from pure reason. The fact we can feel pain and pleasure is
central to morality. It is unlikely we would care about morality if we did not feel pain or
pleasure.
3. The disregard of the consequences of our actions can lead to disastrous results. We all
have been hurt by well-meaning people who were overly concerned to “obey the law.” It
is often the spirit of the law, rather than the letter, that provides arena for rational
decisions.
4. Even though nonhuman animals feel pain and pleasure, for Kant they do not have any
independent moral standing since they are not rational beings.

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 5. It is possible to be faced with conflict between two duties equally supported by an
imperative. (The therapist who promises not to reveal that a patient has asked questions
about euthanasia is asked by the family if the matter was discussed.)
Virtue Ethics
Aristotle is following not duty or consequence-oriented traditions but rather a third path
known as aretaic ethics (Taken from Greek arête, which can be translated as either excellence or
virtue). The primary focus of primary ethics is the heart of the moral agent making the decision
rather the reasoning to right action. Virtue ethics places its focus on the sorts of characteristics,
traits, or virtues that a good person should have. The belief is that someone who has appropriate
moral virtues such as courage, temperance, wisdom, and justice will naturally act in certain
ways. A good virtuous character manifests itself in display of traits such as courage,
magnanimity, honesty, justice, and temperance. Virtue ethics is primary is about personal
character and moral habit development rather than a particular action.
The moral virtues, then, are produced in us neither by nature nor against nature. Nature,
indeed prepares in us the ground for their reception, but their complete formation is the product
of habit.
Aristotle (384-322 B.C.)
In his teaching, Aristotle saw a function or essence for humanity. As examples, doctors were
to make the sick well, rulers were to govern wisely, and citizens were to place their individual
reason in the pursuit of a good life. This essence or function was considered neither natural nor
unnatural, and it was thought to be produced by the practice of virtue. Goodness of character,
then, was brought about by the practice of virtues such as courage, honesty, and justice. This
practice created the habit of taking pleasure in virtuous acts, which then acted as a sign of good
life. One becomes just and temperate by doing just and temperate things. Aristotle’s traits of
virtuous character provided:
1. Virtuous acts must be chosen for their own sakes.
2. Choice must proceed from a firm and unchangeable character.
3. Virtue is a disposition to choose the mean
Beyond character or moral virtues, Aristotle also believed in intellectual virtues, such as
practical wisdom. This defined the power of deliberation about things good for oneself. While
intellectual virtues could be directly taught, moral virtues or character virtues must be lived in
order to be learned. Arguments and instruction by themselves do not have the power to make the
individual good. Goodness is a matter of character, and character is developed by actions over
time. One attempted to live well by practicing right habits. These right habits through practice
became intrinsic to the individual and thus became the individual’s virtues. Practices are the
arena in which virtues are exhibited, and it is only in terms of the particular practice that virtues
can be defined.

Describe List Compare Arrive at

Problem Solutions Solutions with Correct
traditions Answer

Virtue-Oriented Reasoning

Another form of virtue ethics is known as the Ethics of Care, which originated from the
feminist moral development writing of psychologist Carol Gilingan. Gilingan advance the
important thesis “women speak in a different form”—a voice that traditional ethical theory
drowns out. She did not claim the female and male modes of thinking were gender exclusive,
with all males following one path and females another, but only that males tend to embrace ethic
of right and justice, using quasi-legal terminology, while females tended to affirm an ethic of are
centered on responsiveness towards the need of others and prevention harm.

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 While consequentialists and deontological theories emphasis universal standards and
impartiality, the Ethics Care emphasizes the importance of response. Instead of question “What
is just?” the Ethics of Care asks. “How do I respond?” Ethics of Care theorists criticize the
application of universal standards as morally problematic, because it breeds indifference or
moral blindness. Important virtues that form the basis for the development of and the expression
of caring in health care practice are: compassion, discernment, trustworthiness, integrity, and
conscientiousness. These provide a moral compass fro decision making in the Ethics of Care.

Divine Command Ethics:

The idea is simple one: there is a divine being who has set down finite series of rules that
adherents claim can provide guidance to most, if not all, moral decisions. An important example
is the set of rules known as the Ten Commandments taken from Judeo-Christian traditions. It
include key moral prohibitions common to most cultures, as well as some specific rules set down
to exact adherence to a particular religion. These basic rules are taken as guides to behavior in a
wide range of cases by extending the reasoning behind each of the rules to related kind of cases.
Hence the rule against murder is claimed by some to imply euthanasia and abortion are wrong.
A variant of divine command theory is a command theory based on a nondivine but morally
exemplary individual such as the Buddha. Buddhism’s Four Noble Truths and the related Eight-
Fold Path, as well as sets rules for nuns and monks, follow the same logic as divine command
theory, the only difference are being their origin is the teaching of a nondivine person. In both
cases, the Judeo-Christian religion and the Buddhism religion, the logic of teachings is the same.
There are central moral injunctions that we are supposed to obey upon pain of divine retribution
in the Judeo-Christian tradition, or failure to achieve nirvana in the Buddhist tradition.

Criticisms of Divine Mandate Theory

1. Command theories assume belief in either divine beings or exemplary individuals. To the
extent that these beliefs can be questioned, so can the theory.
2. Command theories cannot cover all possible cases of moral decision. This problem often
leads to either a fundamentalism, which merely states the extensions of the basic rules to
other cases are unproblematic, or it leads to differences in interpretation of the basic rule and
therefore differences in people’s moral views.
3. Command theories generally have a “no exceptions” clause, ether explicit or implicit. This is
a problem for people living in morally complicated times.
4. Command theory has what may be called the “Euthyphro Problem. The question arises, is an
action morally unacceptable because the divinity or exemplary individual is basing the rule
on some justifying reasons? Is an action good because God loves it, or does God love it
because it is good? If it is the former, it is hard to imagine why we would feel compelled to
obey a rule so arbitrary chosen. If the latter, then we can eliminate the middleman and refer
directly to the justifying reason. In either case, one could question assenting to rules
provided by command theory.
It is clear that divine command ethics often provide a meaningful system for decision making
for those who believe in a higher power. Yet this is a world of believers and nonbelievers, a
world of complex problem never before faced by previous generations. It is difficult to imagine
that the ancient text will resolve with a high level of certainty issues such as cloning, or whether
it is appropriate to collect and freeze the sperm from a dying spouse so that artificial
insemination can take place at a later time.

Desired Lesson Learning Outcome: Utilize ethical reasoning and

decision-making in selecting and performing nursing intervention
during nursing ethical dilemma

5
Enabling Learning Outcome

You, as the learner, are expected to do the following

Key Concept: Duty-oriented, consequence-oriented, divine mandate, and virtue ethics

Enabling Lesson Learning Outcome I: Justify a problem using ethical reasoning

Read and answers the case studies base on the principles of consequence-oriented, duty-oriented,
divine mandate, and virtue ethics.

Case Study

On October 2014 issue of the Atlantic contained an article by Dr. Ezekiel Emanuel
advocating ending the desperate medical quest for continued life after the age of 75. He was not
advocating euthanasia or suicide, but only that he would personally cease to take yearly
physicals, refuse vaccine, and all efforts to extend his life beyond that age. His opinion is
important for several reasons not the least for which is that he is one of the important architects
of the affordable Care Acts and is a chief medical advisor to the Obama administration.
His analysis is that essentially, if an individual were going to do anything useful, he or she
would have already done it by 75 years of age. He feels after age 75, the manic effort to keep an
individual alive are not leading to a high quality of life, but rather to a life of continued
enfeeblement, of both mind and body. According to his view, not only is the effort to keep one
alive only extending the process of dying, but also gobbling up collective health resources that
could be put to a better use.
Questions:

1. Consider this in light of the right action being that which create the best outcome. If we
decided to make his ideas a law, we could free up additional money for vaccines, prenatal
care, and other important health initiatives. Is that the best outcome? Briefly and ethically
support your answer.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
___________________________________________________________.
2. If this makes sense in regards to the elderly, why not the mentally infirmed, perhaps the
comatose? Briefly and ethically support your answer.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
______________________________________________________________.
3. If someone was willing to pay all additional medical cost after age 75, would that be
acceptable, even if it only allowed the affluent to extend their lives? Briefly and ethically
support your answer.
_________________________________________________________________________
_________________________________________________________________________

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 _________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
__________________________________________________________.
Rubric
Unacceptable 0 Marginal 1 Acceptable 2 Exceptional 3 Points

Able to analyze Student show no Student appear to Student Student is able to

a situation for awareness of be aware of some demonstrate analyze a complex
potential ethical potential ethical ethical problems understanding of ethical situation and
problems problems in their in case study but major ethical demonstrate an
response to the are not using problem in the case understanding of
case study appropriate study and are major and subtle
tool/principle to applying the problem/s in the
analyze the tools/principle they case study
problem have learned to
analyze the
situation

Awareness of No evidence that Student appear to Student is aware of Student is aware of

Code of Ethics the student is aware of the Code the Code of Ethics the code of ethics or
or ethical aware of the Code of Ethics or or ethical principles ethical principles
principles of Ethics or ethical ethical principles and use it to when and use it routinely
principles but is not making faced with a to work in a
use of it as he/she potentially professional and
approach ethical unethical situation ethical manner
problem

Awareness of No evidence that The response to The response to the The student
their the student the case study case study indicates demonstrate ethical
responsibility to consider ethics or indicate that the that the student is and professionalism
work in an professionalism as student do not aware that he/she in his/her response/s
ethical and he/she consider fully understand have responsibility to the case study
professional the case study what it means to to work in an
manner work in an ethical ethical and
and professional professional
manner manner.

Case Study
Act Utilitarianism: Calculating the Pleasure and Pain
Mr. Jimenez is a 78-year old chronic pulmonary disease patient (emphysema) who has
smoked two packs a day for 40 years. He takes great enjoyment and satisfaction in smoking and
does not want to quit.
In that his illness is exacerbated by smoking, his physician is demanding that he quit. Each
time he quit smoking, Mr. Jimenez becomes irritable and unhappy. His wife and family hate it
when he is not smoking because he becomes difficult to live with.
1. Consider this case from the position of act utilitarianism and create a Pleasure-Gained
and Pain-Avoided list to see if you can determine whether Mr. Jimenez would continue
or quit smoking. Justify your list and your conclusion with an ethical principle. Figure:
Consequence-Oriented Reasoning Arrow may guide you in making your Pleasure-gained
and Pain-avoided list.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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 ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
__________________________________________________________.

Rubric
Unacceptable 0 Marginal 1 Acceptable 2 Exceptional 3 Points

Able to analyze Student show no Student appear to Student Student is able to

a situation for awareness of be aware of some demonstrate analyze a complex
potential ethical potential ethical ethical problems understanding of ethical situation and
problems problems in their in case study but major ethical demonstrate an
response to the are not using problem in the case understanding of
case study appropriate study and are major and subtle
tool/principle to applying the problem/s in the
analyze the tools/principle they case study
problem have learned to
analyze the
situation

Awareness of No evidence that Student appear to Student is aware of Student is aware of

Code of Ethics the student is aware of the Code the Code of Ethics the code of ethics
or ethical aware of the Code of Ethics or or ethical principles ethical principles
principles of Ethics or ethical ethical principles and use it to when and use it routinely
principles but is not making faced with a to work in a
use of it as he/she potentially professional and
approach ethical unethical situation ethical manner
problem

Awareness of No evidence that The response to The response to the The student
their the student the case study case study indicates demonstrate ethical
responsibility to consider ethics or indicate that the that the student is and professionalism
work in an professionalism as student do not aware that he/she in his/her response/s
ethical and he/she consider fully understand have responsibility to the case study
professional the case study what it means to to work in an
manner work in an ethical ethical and
and professional professional
manner manner.

Case Study:

Duty-Oriented Reasoning: A Matter of Principle

Juan and Joe are good friends. They both graduated from the same program and have gone to
work in the same radiography department. Part of their duties is to be sure that the standby
equipment is ready for service on the wards. Juan and Joe are working the night shift, and while
playing around, Juan inadvertently bums the equipment, tips it over, and breaks the standby
instrument.
In that it was an accident, Juan asks you as a friend, not to tell anyone it was his fault.
“Accidents do happen.” The two of you switch out the equipment, sending the broken piece
down to maintenance, and put the working instrument on standby.
In the morning your boss comes in and notices that the equipment has been sent down to
maintenance. He asks what happened, and Juan says, “I don’t know. Someone from out of the

8
department must have bumped it or something.” The boss looks at you and asks you the same
question.
1. Solve the problem using duty-oriented or principle reasoning. Remember that in this form
of reasoning, it is not the consequences that are considered but rather the principles
involved.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
___________________________________________________________________.
2. What principles are involved in this case?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________.

Rubric
Unacceptable 0 Marginal 1 Acceptable 2 Exceptional 3 Points

Able to analyze Student show no Student appear to Student Student is able to

a situation for awareness of be aware of some demonstrate analyze a complex
potential ethical potential ethical ethical problems understanding of ethical situation and
problems problems in their in case study but major ethical demonstrate an
response to the are not using problem in the case understanding of
case study appropriate study and are major and subtle
tool/principle to applying the problem/s in the
analyze the tools/principle they case study
problem have learned to
analyze the
situation

Awareness of No evidence that Student appear to Student is aware of Student is aware of

Code of Ethics the student is aware of the Code the Code of Ethics the code of ethics or
or ethical aware of the Code of Ethics or or ethical principles ethical principles
principles of Ethics or ethical ethical principles and use it to when and use it routinely
principles but is not making faced with a to work in a
use of it as he/she potentially professional and
approach ethical unethical situation ethical manner
problem

Awareness of No evidence that The response to The response to the The student
their the student the case study case study indicates demonstrate ethical
responsibility to consider ethics or indicate that the that the student is and professionalism
work in an professionalism as student do not aware that he/she in his/her response/s
ethical and he/she consider fully understand have responsibility to the case study
professional the case study what it means to to work in an
manner work in an ethical ethical and
and professional professional
manner manner.

Case Study
Katrina
It is hard to imagine that the City of New Orleans could have been less prepared for for
what happened in the aftermath of Hurricane Katrina. But the unfolding horror went well beyond

9
the Superdome and the people stranded without water and food on the overpass, as even those
who were prepared were overwhelmed by the event.
John was employed as a staff nurse in a major 300-bed tertiary care facility in New Orleans
during Katrina. The hospital had an emergency plan to assure adequate staffing during
hurricanes. Essentially the plan created three-level nursing response team. The nurses assigned to
level 1 and 2 were considered the first responders and were expected to report to the hospital 8
hours before the arrival of the storm and remain for 12hours after its departure.
During this time hospital would be in lockdown were no employees were allowed to leave or
enter the facility regardless of their shift assignments. Once the lockdown phase ended, nurse
assigned to level 3 would take over and provide relief for levels 1 and 2.
John did not accept level 1 and 2 positions that would have designated him among the first
responders. This was because his wife was an insulin-dependent diabetic who was on strict
dietary. Medication, and exercise regime. John had, however assumed the role of a level 3
responder and, previous trial exercises, had reported as a level 3 relief nurse.
Unsure of where the approaching hurricane would make landfall, John and his wife prepared
to evacuate the city to wait out the storm. It is then that he got a call from his friend, a fellow
nurse, who was assigned as level 2 personnel, requesting he drop by his friend’s apartment and
bring him some necessary medications and toiletries he had forgotten to bring with him to the
hospital. John agreed and picked up the requested items, planning to drop them off as he left the
city.
However, when John arrived at the hospital, everything had changed. More than half of
those who had been designated as level 1 and 2 responders had not come to the hospital and
instead had joined the mass exodus fleeing the city. The nursing administrator pled with John to
stay in the hospital; to assist with the care of the patients; he was assured his wife would be
appropriately lodged and that her medical and dietary needs would be cared for.
John and his wife joined the several thousand staff, family members, and pets that were
sheltering the hospital. Ten hours post-Katrina, the situation deteriorated to the point where
essential electricity, food, and water had to be rationed. There was no hope of assistance from
other level 3 personnel as all roads into the city were closed.
Completing a shift, John faced a crisis as his wife’s blood sugars were out of control and
they could no longer rely on the food (dietary needs) or medication supply at the hospital. He
contacted the nursing supervisor to tell her he had decided to take his wife from the hospital and
try to get out of the city. The nursing supervisor assured him that they would do everything
possible to take care of his wife and ordered him to remain at his post. She also informed him
that should he leave, it would constitute jab abandonment, and she would report his actions to the
Louisiana State Board of Nursing.
Think of this problem in light of the Ethics of Care:
1. If you were John, would stay or leave? Ethically explain your decision.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________________.
2. List all the ethically sound options that john might consider. Ethically support your
answer._________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________.
3. Do you think the nursing supervisor’s decision was correct? Ethically support your
answer.
________________________________________________________________________
________________________________________________________________________

10
 ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_____________________________________________________________.
4. If John leaves, should he receive reprimand for his action? Potentially lose his license?
Ethically explain your answer.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_______________________________________________________.
5. Regardless of whether John receives a reprimand, what should be done about the level 1
and 2 nurses who failed to come to the hospital to assume their roles? Ethically support
your answer.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_____________________________________________________.
Rubric

Unacceptable 0 Marginal 1 Acceptable 2 Exceptional 3 Points

Able to analyze Student show no Student appear to Student Student is able to

a situation for awareness of be aware of some demonstrate analyze a complex
potential ethical potential ethical ethical problems understanding of ethical situation and
problems problems in their in case study but major ethical demonstrate an
response to the are not using problem in the case understanding of
case study appropriate study and are major and subtle
tool/principle to applying the problem/s in the
analyze the tools/principle they case study
problem have learned to
analyze the
situation

Awareness of No evidence that Student appear to Student is aware of Student is aware of

Code of Ethics the student is aware of the Code the Code of Ethics the code of ethics or
or ethical aware of the Code of Ethics or or ethical principles ethical principles
principles of Ethics or ethical ethical principles and use it to when and use it routinely
principles but is not making faced with a to work in a
use of it as he/she potentially professional and
approach ethical unethical situation ethical manner
problem

Awareness of No evidence that The response to The response to the The student
their the student the case study case study indicates demonstrate ethical
responsibility to consider ethics or indicate that the that the student is and professionalism
work in an professionalism as student do not aware that he/she in his/her response/s
ethical and he/she consider fully understand have responsibility to the case study
professional the case study what it means to to work in an
manner work in an ethical ethical and
and professional professional
manner manner.

11
Source: Ethic of Health care
A guide for Clinical Practice
Fourth Edition
Raymond S. Edge
J. Randall Groves

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