Professional Documents
Culture Documents
Ethical Principles
Ethical Principles
Ethical Principles
Ethical principles: basic and obvious m oral truths that guide deliberation and action
Respect for persons: im plication that one considers others to be worth of high regard
- Precept which underlies ethical principles
- Basis for ethical principles discussed below
AUTONOMY
- Means self-governing
- Frequently used as contrast to undesirable states
- Dependency, coercion
- Paternalism , thoughtlessness, habit
- Freedom to m ake choices re an issue affecting ones life
Threats to autonom y
Health care industry potential to dehum anizes and erodes autonom y of consum ers
- Disrobed on entering hospital; asked questions re private m atters
- Forced to relinquish m oney and belongings
- Expected to rem ain in bed; privacy virtually im possible
- Follow hospital schedule and regim ent
- Patients expected to follow plans else labeled noncom pliant
Burkhardt, M.A & Nathaniel, A.K. (2002). Ethics and Issues in Contemporary Nursing NY: Delmar
Outlined by Lois E Brenneman NPCEU www.npceu.com 1
Potential threats to patient autonomy
Nurses m ay falsely assum e patients have sam e values and goals as provider
- Elderly person choosing to stay at hom e when viewed as incapable
- COPD patient who sm okes
Failure to recognize that patients thought processes m ay differ from provider
- Differences not in values but in thinking patterns
- Backgrounds, cultures, patterns of thinking
Incorrect assum ptions re patients knowledge base
- Providers have specialized health care knowledge
- Failure to recognize deficits in patient knowledge base
W ork of nursing becom es the m ajor focus
- Frenzied pace and unrealistic workloads, staffing reduction
- Advanced technology, bottom -line managem ent
- Profit centered health care environm ent
INFORMED CONSENT
- Patients are inform ed re the possible outcom es, alternatives and risks of treatm ent
- Required to freely give consent
- Legal protection of patients right to personal autonom y concerning treatm ents and procedures
PATERNALISM - PARENTALISM
- Can be viewed as form of advocacy when genuine concern com bined with dim inished capacity
Burkhardt, M.A & Nathaniel, A.K. (2002). Ethics and Issues in Contemporary Nursing NY: Delmar
Outlined by Lois E Brenneman NPCEU www.npceu.com 2
NONCOMPLIANCE
- Som e advocate withhold services to non-com pliant patients based on lim ited resources
- Am erican Nurses Association (ANA) does not support withholding based on noncom pliance
- Code for Nurses with Interpretative Statem ents can be interpreted to respect
noncom pliance as right of patient - m ay reflect social, cultural, religious norm s
- Refusal to participate regardless of outcom e is the prerogative of the patient
- Non-com pliance m ust not effect care - choice belongs to patient
- Frowns upon labeling of patients with term inology as non-com pliance
BENEFICENCE
Prevent Harm
Nurse acts to safeguard client and public when health care and safety are
affected by incom petent, unethical practice of any person (ANA Code for Nurses
with Interpretive Statem ent - 1985)
NONMALEFICENCE
Burkhardt, M.A & Nathaniel, A.K. (2002). Ethics and Issues in Contemporary Nursing NY: Delmar
Outlined by Lois E Brenneman NPCEU www.npceu.com 3
VERACITY
- Per Martin Buber (1965) com m unication occurs only where there are no barriers
- Lying and deception creates barrier thus prohibits m eaningful com m unication and relationships
- Nurses m ust be truthful to effective com m unicate where com m unication is considered the
cornerstone of nurse-patient relationship
- Manipulating info for purpose of controlling others is akin to coercion to control (Jam eton, 1984)
- Lying prohibits others from participating in decisions on an equal basis
Used to benefit patient - constitutes paternalism
Used against patient - fraud
- Deceiving others m ay constitute an unnecessary assum ption of responsibility
- Im plication deception: unfortunate consequences suggest that deceiver is responsible
- Im plication veracity: bad consequences which follow truth telling results in attribution of
responsibility to unfortunate nature of reality
- Truth-telling engenders trust where nurse-patient relationship felt to be based on trust
- Patients are willing to suspend som e autonom y on basis of the relationship
- W ithout trust som e patients needs m ay go unm et
- Am erican Hospital Association supports veracity in Patients Bill of Rights
- Patients have right to com plete and current info concerning dx, tx and prognosis
- Directed at physicians but nurses have responsibility as advocates
- ANA Code for Nurses with Interpretive statem ents (1985) supports veracity
- Subsequent statem ents support principle but recognize situations which are exception
- Recognize certain situations where patients right to info m ay be suspended
- Dram atic discrepancy in literature between nursing and m edical perspectives on veracity
- Perspectives drawn from m edical literature
- Physicians often claim that patients do not want bad news and truth in all settings
- Truth has potential to harm
- Lies may be appropriate in the nam e of beneficence
- Patients m ay lack sufficient knowledge re physiology to interpret m ed info accurately
- Som e patients m ay not want truth re: illness
- Physicians do not have absolute responsibility to tell truth particularly where hope and
positive outlook m ay be life-affirm ing
- Distinction m ade between lying and deception
- Absolute duty to avoid lying
- No duty to avoid deceive
- Exam ple: MVA where m om is critical and 2 of 4 children are killed
- Veracity never given m uch consideration in m edical literature
- Veracity absent from all oaths, codes and prayers even Hippocratic Oath
- Am erican Medical Association Code of Ethics (1847) endorses som e form of deception
Avoid all things which have tendency to discourage patient and depress his
spirits (Bok, 1994 p 683)
Burkhardt, M.A & Nathaniel, A.K. (2002). Ethics and Issues in Contemporary Nursing NY: Delmar
Outlined by Lois E Brenneman NPCEU www.npceu.com 4
- Nursing and m edicine have apparent different perspectives
- Recognizing differing viewpoints is essential for collaboration
CONFIDENTIALITY
LIMITS OF CONFIDENTIALITY
Burkhardt, M.A & Nathaniel, A.K. (2002). Ethics and Issues in Contemporary Nursing NY: Delmar
Outlined by Lois E Brenneman NPCEU www.npceu.com 5
JUSTICE
Ethical principle relating to fair, equitable and appropriate treatm ent via what is due to persons
Recognizes that giving to som e will deny receipt to others who m ight otherwise receive
Distributive justice when concept is applied to goods and services
- Im possible for all people to have finite supply of goods and services
- Governm ents form ulate/enforce policies dealing with fair and equitable distribution
Decisions re distributive justice on a variety of levels
- Governm ent: policy on broad public health issues: m edicare, im m unizations
- Hospitals: intensive care beds, ER services
- Nurses: decide how to allocate tim e am ong patients assigned
- To each equally
- To each according to need
- To each according to m erit
- To each according to social contribution
- To each according to persons rights
- To each according to individual effort
- To each as you would be done by
- To each according to the greatest good to the greatest num ber
OPPOSING VIEWS
Friedrich Nietzsche view: to each according to his present or future social contribution
- Superior individuals exist; society should enhance these superm en
- Not very equitable or appealing to m any in US
W ork ethic view: receive according to effort put forth - com m on in US culture
Needs view:
- Entitlem ent program s: com bo of needs and greatest goods theory
- Based on needs of individual
- Greatest good for greatest num ber of people
Burkhardt, M.A & Nathaniel, A.K. (2002). Ethics and Issues in Contemporary Nursing NY: Delmar
Outlined by Lois E Brenneman NPCEU www.npceu.com 6
FIDELITY
- Contract with society: rights and responsibilities and m echanism for accountability
- No other group can practice within dom ain of nursing as a profession
- Rights also m andate nurses uphold responsibilities inherent in contract with society
- Mem bers expected to be faithful to society that grants the right to practice
Burkhardt, M.A & Nathaniel, A.K. (2002). Ethics and Issues in Contemporary Nursing NY: Delmar
Outlined by Lois E Brenneman NPCEU www.npceu.com 7