The progress that humanity has developed in science, technology and genetic medical treatment during the last two decades of the century and this century have created a gap between the values ethical, legal, human and the same evolution of humanity. In a universal dilemma of ethics and bioethics in humanity, especially in the career of nursing because it carries a set of values in binding regulations, which may perhaps lead to contradictions.
Within the power nurse is not free of this situation, since we are the people who remain in direct contact with the user and their needs and potential. Also, the nurse is part of the team research, of teaching and administration, making regulated progress of science, his commitment to humanity, to life with the environment, ie everything.
The ethics and bioethics leads to pass to the nurse about the various fields either practical or theoretical, and that is where da-binding code of ethics also entails practice from the race in order to make the nurse faces several problems.
1.1 ETHICAL. CONCEPT
On the Ethics of Professional training, Guido Gatti said that “… The high professions themselves can become a place of true self, only if done with a social concern …”
Ethics is considered as the science of goodness and badness of human action but if you talk as it already covers profession as the professional setting in a stable manner and honored the service given to other individuals and for personal profit, driven by their own vocation and the dignity which is the individual human.
This includes the sense of the word refers only to the university, but broadly speaking, also covers offices and permanent jobs and renumbered, although it requires a college degree.
Both the choice of vocation should be completely free to be understood as the provision that makes the subject particularly suitable for a particular occupation and that if he chooses his own vocation is a guaranteed success in their professional field, in exchange if the Choosing a career without taking into account the qualities and preferences, but, for example, some parents’ tastes or interests of some cases with some family that leads to a failure to translate the best would be a change of career.
1.2 PRINCIPLES ETHICS
To talk of ethics is important to have a vocabulary that can be understood, although some words have different meanings, provide written about ethics in the context where they can understand and discuss the ethical issue.
It means the independence of an individual to determine their own destiny in matters of health and disease. The respect for the autonomy of the client is fundamental to the practice of care medical and health professionals, are committed to respect the autonomy of the client.
Is making actions positive help to others. It also helps when treatment decisions can be questioned for his risk.
It is to prevent injury or damage. Tension health ethics is not only do good but also the commitment to do no harm and in extreme cases strives to do the least damage possible.
It refers to the equity and the task of health professionals to achieve justice in health care.
It is the agreement to keep promises, even in cases of disagreement with the decisions of the client, you must provide the necessary care.
1.3 ETHICAL ASPECTS
All people need others throughout life. Dependency levels vary throughout the life cycle and function of living situations. The problems of health often involve higher levels of dependence, and respond to it is a fundamental part of the professional content of the nurses.
One characteristic of sick people is that others see in them greater levels of dependency in the life of a person healthy. In turn, the dependence can be interpreted as a deficiency in the ability to make decisions, and empower people who are sick may be restricted, especially in situations of loss of health and contact with health framework.
The autonomy of persons is frequently compromised in the life of the person when facing health problems, physical or mental disabilities. This is often compounded by adding see the difficulties of the process of aging. It may seem that decisions must be left in the hands of the family and professionals.
To push the responsibility is to look professional care that any decision should have as objective to preserve, promote and defend the good of the person treated. The human rights in the context of health are shared responsibilities of all professionals, require careful consideration of all those involved in the process of care.
Finally be regarded as professional decision-making is highly influenced by the values of personal nurse and the emotions. Knowing your values, identify the emotions arising from the relationship with the patient and his family, is a prerequisite and essential to be able to understand the values and emotions of others. The nurse is professional and wing see is a person that can not forget.
Neither can be neglected the stress and / or anxiety that leads to health and relationship decisions. The self-analysis and the analysis in the group help to differentiate the nurse as a person as a professional nurse, and therefore help to better focus on patient needs and not on the needs that the nurse assumes that the patient has. The interpretation of the demand for care and the planning of them must be as patient centered as possible, therefore, identify personal emotions help us be more objective and to listen more readily to the patient and family. Most people are ethical dilemmas, and create conflict between the ways of doing what is right.
To be able to resolve an ethical problem, you must first understand the conflict that is occurring between different moral positions. Yet all of these different ethical positions derive from theories that can be based on the result or the duty or obligation, and theories relating to care. This is the framework in which the staff of nursing is faced with clinical dilemmas, such as telling the truth or respect the privacy and confidentiality.
The problem with that position should nurses take on if it is an ethical problem to be solved in different ways, resorting to the authority of an official document, taking an individual decision by consensus with the rest of the nursing staff through one dialogue between the profession and the public.
The theories used for various purposes, an overview is designing the duties and rights of individuals within a given space. To determine the structure of a theory ethics is necessary to define whether certain objectives, duties or rights are basic or subordinates.
While providing a framework and general guidelines applicable to our activities and moral doubts, can not give rules specific to be sought by going to the principles that leave the basic underlying theory
Theory of consequence:
“In ethics, it places the good or evil of a share in the outcome of the same” (Fundamentals of Nursing, 2003)
It is a formulation of the theory of consequence. Desarrollado por Jeremy Bentham (1748-1832) y Jhon Stuart Mill (1806-1873), Developed by Jeremy Bentham (1748-1832) and John Stuart Mill (1806-1873), his proposition is that the good of all those affected by a situation rather than an individual.
And from the point of view, the action of saving a life or end it is neutral, ie not specifically good or bad. The will depend on its consequences.
Beneficence / paternalism
According to this proposition is not just charities do good more than the patient, but it had the voice of nurses does not match that of the one and when the nurse’s opinion conflicts with the patient’s welfare paternalism becomes , acts and attitudes paternalistic are those which limit the freedom of the patient for his own good nursing paternalism involves the use of some forms of taxation for the benefit the patient not considered beneficial the outcome you are trying, or not as a good important to remedy suffering to achieve this.
Theory of Liability:
Any person has the obligation to seek the welfare and reduce suffering in the world scale, these are some of the duties of active nurses. The theory is located on right and wrong of an action on the principles that drive the behavior.
Kantianism: A fundamental ethical perspective, called Kantianism.
Write Emmanuel Kant (1724-1804):
“There are consequences that make an action good or bad if not righteousness that morality depends on the actions you are consistent with a principle whatever consistent results by the concept is fundamental goodwill necessary to assess the overall good of an act, also this theory does recognize the man deserves respect for all this is contrary to what is said in theory result, the obligation to treat the rest as findings in themselves and not as means to an end places the man in the center of moral decision and finally also has a moral obligation to act based on the respect for rights and acceptance of responsibility therefore to meet this mandate is clear and clearly define the principles and responsibilities and follow the moral imperative to act on them. ”
The fundamental ethical principle comes from the perspective of Kantian ethics: respect for autonomy. The nurse takes this respect and makes the patient advocacy through work.
With a theory based on universal principles and abstract (as defined by Kant and Mill) or nurses or patients are moral agents are only specific individuals and individuals, each one with its own history, opinion and desires.
This view of morality contradicts everything that the nurse knows about himself and about his patients as people, within and outside assistance rather than healthy.
This framework stresses the importance of morality in practical situations those establishing relationships, care, communication, the desire not to harm others and responsiveness are some very fundamental aspects of ethics.
About care, Nel Noddings (1984) states that “The theory describes a female carefully distinguishes between” caring “and” worry. “Caregiving nurses away from patient and is impersonal and” depersonalization “.” Worrying about “is based on emotion, feelings and attitudes.”
But it ignores the ethical theories assume that only traditional but some moral life richer.
ART.1 .- The code of ethics is constituted by a systematized set of principles, guidelines and standards that guide the financial duties of professional nurses.
1. It is based on moral principles that must be honestly applied by the professionals of nursing practice to ensure an honorable conduct, with justice, solidarity, competence and legality.
2. The holistic concept of health-disease process, they must manage, implement and nursing professionals for the protection of health and life of the population.
3. Nursing is a profession of service so highly human who has chosen this profession must assume a behavior in accordance with the ideals of: solidarity, respect for human life and to be considered in their biodiversity as part and interrelationship with peers and nature
4. The education permanent, having a system of human values and the proper handling of communication allows the nurse or reflect ethical behavior in their relationship with people in their care, with colleagues, team members health and society in general, see what their respectability and recognition assures labor and social.
5. The development scale of the human person demands respect and practice of these human values: justice, freedom, etc.., By both the nurse and the nurse both their personal and professional life should be respected and everyday practices.
6. Health is a right, therefore the nurse and the nurse must respect and work for society and the state to put it into effect.
The Professional Practice
ART.2. In practice, the nurse or nurse should be affiliated to their respective school.
ART.3. The nurse and the nurse to join the school wing acquire Federation and the responsibility to comply with the laws and ethics governing the practice agreement establishes the legal framework of practice of nurses and nursing, compliance is a serious lack against professional ethics.
ART.4. The faults and ethics violations in accordance with this code relate to ethical behavior and will be sanctioned by the respective court of honor. Misconduct is unethical not to report violations against this code, committed by a nurse.
It is the duty of any nurse or nurse know and abide by the laws on health lifetimes.
ART.5. The nurse and nurse must meet civic duties and participate together with those of more citizens in the promotion and protection of health and life in the individual, family and community
ART.6. The nurses are responsible for their performance and to maintain existing professional competence through training and education, consider working with humans and with the rapid changes occurring in science, technology and culture.
ART.7. The nurse and nurses must accept or recognize the individual responsibility that they bear in making decisions in their work.
ART.8. The nurse and nurse must respect the attitudes, knowledge, and practices of the individual, family and community where these do not harm or be a risk to health.
ART.9. In consideration of his prestige and that of the profession, nurses must observe caution when used for professional reasons the media collective.
ART.10. The nurses refuse to have their names or people being used for advertising purposes that violate the dignity and human rights.
ART.11. every nurse and nurse is free to choose the place where they can practice their profession unless they have contracts that are so determined and accepted.
ART.12. The nurse and nurse must provide the individual family and community humanized care, timely, continuous and assured.
ART.13. The nurse and nurse should respect the scale of values, ideology and religion of the individual, family and community.
ART.14. The nurse and nurse must respect and not do that discriminate by nationality, race, color, religion, etc..
ART.15. The nurse and nurse professional with critical judgment rate the competence of personnel who are required to assign responsibilities.
ART.16. The nurses decide the most appropriate for treating a patient when his life is at risk and emergency situations.
ART.17. The nurses take into consideration the participation of individuals, families and communities in meeting their needs, applying the principles of treatment and intervention advice and consent.
ART.18. The nurse and nurse, even in cases of urgent necessity, not abandon the patient without having taken measures to ensure continuity of care.
ART.19.Comenten grave lack of nurses that promote or engage in acts that threaten the quality of care and health, the person at any stage of life.
ART.20. The nurse and nurse may participate in research clinics that do not conflict with ethics and morals and also must obtain the voluntary consent of the person or persons authorized executed, after a detailed explanation of the nature and risk of the same.
ART.21. The nurses are required to report to local, national or international practice of torture, physical or mental patients refugees, political or common prisoners, and those who are victims of violence within the family
ART.22. The nurse and nurse should respect the rights of all patients, particularly the terminally ill and their families
ART.23. The nurse and nurse must be objective and truthful about their reports, statements or testimony.
ART.24. The nurse and nurse for the discharge of their functions must wear the uniform in accordance with existing institutional rules, and respect to keep their badges: caps and lamps as part of their identity professional.
ART.25. The nurses participate in collective efforts or particular requirements to preserve the human environment from harmful environmental factors and other risks society.
ART.26. The nurses are required to provide services in cases of natural disasters, social upheaval, invasions … …, presenting serious risks for public health.
Exercise of teaching and research
ART.27. The nurse and nursing students must provide standards of professional and personal morality, through word and example of their daily lives.
ART.28.The nurses must have and demonstrate a high scientific training, technical and humanistic training to ensure quality of other professionals.
ART.29. The nurse and nurse educators must have the strength to reject impositions flattery and any other action that might induce them to commit irregularities unethical.
ART.30. The nurse and nurse involved in the formation of non-professional level of nursing must ensure that educational content corresponding to that level.
ART.31. The nurse and nurse to expropriate foreign scientific work, commit a serious lack of ethics.
ART.32. The nurse and nurse should communicate and disseminate the product of their research or production science between nursing professionals and encourage the publication of their work.
ART.33. The nurse and nurse to be made related to the profession published using a pseudonym, they must communicate their identity to the College Federation.
Art.35. As a member of a multidisciplinary team of health, the nurse and the nurse must have a harmonious relationship with other health team members, based on mutual respect and cooperation to promote improved health of the population, which is their common goal.
Art.36. The nurse or health team requires close collaboration, in which the nurse should carry out its functions autonomously, ensuring confidence in the treatment that takes the health team. In cases where risk is in the patient or user, the nurse and the nurse act immediately.
Art.37. The relationships between nurses and nurses should be based on harmony and cooperation, particular emphasis should be given to the orientation of new promotions and training of future professionals.
Art.38. The nurses in teaching and service should maintain close cooperation, considering the mutual stress leads to a better quality health care to the population and the advancement of the profession.
Art.39. The relationships between colleagues will be mutual respect, identity, loyalty and solidarity.
Art.40. Have seriously breached professional ethics:
A) The nurse and the nurse they cause that libel, slander or infamous to a colleague in a professional or personal life.
B) The nurse and the nurse who does not respect lines of authority and try to move a colleague through illegal means or unfair.
C) The nurse and the nurse who distort or refuses to provide information relating to the care of patients or families in their care and alter your moral living.
Art.41. The nurse and the nurse who has trained to contribute to the professional development of colleagues.
Art.42. The nurse and the nursing staff to assess his position to promote their development and progress, acting with justice or equity.
1.4 ETHICS AND RESEARCH
This relates to the research clinic with humans, the nurse not only cares for the patient, but conducts a clinical trial patient’s plea for experimentation to practice the ethical principle of respect for individual autonomy making it different from utilitarianism and paternalism.
The patient’s participation must be voluntary and not forced, when the patient has not left your prior consent, practitioners should allow an immediate family member involved and not having close relative or friend will be the nurse who speak for patients merit provided care and patient trust.
1.5 ETHICS AND ABORTION
Is the interruption of pregnancy for any reason before the fetus is sufficiently developed to survive.
From the ethical point of view there are two types of abortion: the led, which is produced by chemical or mechanical means, and spontaneous, that have no ethical problems by their nature, in turn, the causes can be: therapeutic , is being done in order to restore health or save the mother’s life threatened by the process of gestation, and euthanasia, is what is done with the purpose of eliminating fetuses that have health problems, sparing suffering.
2.1 BIOETHICS CONCEPT
On Bioethics, Potter (1971) says that “Bioethics thus emerges as an attempt to build a bridge between experimental science and humanities”
Bioethics is the morality of life are standards that are based on ethical principles that normalize the individual and social behavior of the person.
This follows from the definition of bioethics at the “Encyclopaedia Of. Bioethics”: According to Reich, (1978) says that the “systematic study of human behavior in the field of sciences of life and health, considered in the light values and moral principles. ”
Bioethics is the ethics that want to deliver the guiding principles of human behavior in the biomedical field.
This preparation should be demanding and continuous and must meet both theoretical aspects (ethics, anthropology, history of technological development, philosophy of science) and practical (thinking critically, acquire the habit of honesty and intellectual capacity for communication and dialogue including the learning of a language and familiarity with computerized virtual communication).
But bioethics is not limited to medical field, but includes all the moral problems having to do with life in general, thus extending its scope to issues related to the environment.
Other literatures define bioethics as “the systematic study of human behavior in the field of life sciences and healthcare, as wing behavior is examined in light of the values and moral principles.” It now includes not only the traditional aspects of medical ethics, but include environmental ethics, with discussions on the rights of future generations, sustainable development, etc..
Bioethics is now part of ethics that studies the correctness and incorrectness of the actions that are carried out in the field of nursing.
His main area of study is medical ethics, as the nursing
Usually involves the technical intervention on the human body, and any intervention on the man is marked by its value maximum, this maximum value determines the purposes and actions to be pursued and made to act upon it.
Thus bioethics, is interpreted as the art of achieving a social consensus about what can and can not do in health care. In the end, that agreement, the result of social discussion ends up being often the imposition of the pecking order, in sharp contrast with the obligation of physicians to respond in a more attentive to the weakest.
This requirement must always be a limit to the performance and decisions of the nurses in the inter-action with the user and this limit implies respect the free decision of the patient, the expression of his personality in all its aspects as well as human and spiritual.
You have the right to accept or refuse any treatment he suggests, and the nurse only obligation to explain and justify the need for the procedure to practice and if the case requires notice of the risks of rejecting the procedure. But even there, the patient is the sole owner of his life and decisions.
“As nurses it is our duty to study, investigate and report on issues and ways of biomedicine, bioethics, policy and rights pertaining to the promotion and defense of human dignity, always monitor compliance with ethical principles.”
Thus the practice of medicine and nursing become a contact between two systems of values: one medical values and secondly the values of the user.
2.2 BIOETICA RESEARCH WORK
In medicine, in the field of research, there is the ethical problem of experimenting on human beings and hence the possibility of violating their rights.
Many people have lent their assistance givers for an investigation, believing her to avoid the pain of others and accept that such are the cases of Dr. Finlay, discoverer of vaccination against foot-yellow, second Dr. Salk, the discoverer of the vaccine against polio.
Research is always at pains human beings to humanity, that is why there have been several papers about it.
The Nuremberg Code (1949), concerning the trial of Nazi war crimes tribunals.
The Declaration of Helsinki (1964), which sets basic standards for medical research and clinical biomedical experimentation and non-clinical.
BIOETHICS IN TRANSPLANTS
Transplantation is the replacement of anatomical components, from a living donor is dead or therapeutic purposes.
There are some ethical problems:
The sobreherida transplant patients.
Streamlined distribution and transplant program.
In the case of transplants with organs from cadavers, certification of death.
2.4 BIOETHICS AND INSEMINATION AND FERTILIZATION ARTIFICIAL
Artificial insemination is a technique aimed at obtaining a human conception through the transfer of semen into the genital tracts of women, called homologous when the donor is the husband and heterologous when the donor is not.
Artificial fertilization aimed at a human conception through the union of egg and sperm in vitro and after embryo transfer to the uterus.
The ethical objections against artificial insemination and fertilization are of two kinds: one is related to the autonomy of human beings, the other type is referred to sociological and biological and social relations between spouses and children.