CHAPTER 5

VALUES, ETHICS, AND ADVOCACY

LEARNING OUTCOME 1
Explain how values, moral frameworks, and codes of ethics affect moral de-
cisions.
Concepts for Lecture
1. Ethical and moral decisions require individuals to think and reason.
Reasoning is a cognitive function; therefore, it develops over the life
span.
2. Values are enduring beliefs or attitudes about the worth of a person,
object, idea, or action that may be unspoken or even unconscious.
Values underlie all moral dilemmas and influence decisions and
actions, including nurses’ ethical decision making.
3. Moral development is the process of learning to tell the difference
between right and wrong and of learning what should and should not
be done. This process begins in childhood and continues throughout
life. Moral development theories address this development.
Moral theories provide different frameworks through which
nurses can view and clarify moral and ethical dilemmas. Nurses can
use moral theories in developing explanations for their ethical deci-
sions and actions.
4. A code of ethics is a formal statement of a group’s ideals and values. It
serves as a standard for professional actions. One of the purposes of nursing
codes of ethics is to provide ethical standards for professional behavior.
SUGGESTIONS FOR CLASSROOM ACTIVITIES
• Ask the students to complete the Questionnaire
for Values Clarification in Table 5–2 and identi-
fy their top five essential values. Have the stu-
dents write a short paper on how these values
would affect moral decision making.
• Divide the students into three groups. Provide
the students with an ethical dilemma. Ask one
group to respond to the situation using the tel-
eological model, another using the deontolog-
ical model, and the third using the caring
model. Report results to the class.
SUGGESTIONS FOR CLINICAL ACTIVITIES
• Have the students discuss how beliefs and
attitudes about client characteristics—age,
gender, socioeconomic status, citizenship,
previous and expected future contributions to
society, health behaviors, and compliance—
affect providers’ actions.

LEARNING OUTCOME 2
Explain how nurses use knowledge of values to make ethical decisions and to SUGGESTIONS FOR CLASSROOM ACTIVITIES
assist clients in clarifying their values. • Develop several moral or ethical dilemmas
related to clients. Have the students use the
steps in values clarification to assist the clients
Concepts for Lecture to make an ethical decision.
1. Nurses need to identify clients’ values as they influence and relate to
a particular health problem.
When clients hold unclear or conflicting values that are detri-
mental to their health, the nurse should use values clarification as an SUGGESTIONS FOR CLINICAL ACTIVITIES
intervention. • Have the students describe situations where
Values clarification assists individuals to identify values, permit- the clients’ unclear or conflicting values were
detrimental to their health.
ting them to change values and act based on freely chosen values.
This is an important step in understanding ethical problems and mak-
ing ethical decisions.
The following steps can help clarify values: list alternatives, ex-
amine possible consequences of choices, choose freely, feel good
about the choice, affirm the choice, act on the choice, and act with a
pattern.
When implementing these seven steps to clarify values, the
nurse does not impose personal values because what the nurse would
choose in his or her own life may not be relevant to the client’s cir-
cumstances.

© 2016, Pearson Education Inc. 23

24 CHAPTER 5 / Values, Ethics, and Advocacy

LEARNING OUTCOME 3
When presented with an ethical situation, identify the moral issues and prin-
SUGGESTIONS FOR CLASSROOM ACTIVITIES
ciples involved.
• Have the students bring a newspaper or maga-
zine article about ethical and moral dilemmas
Concepts for Lecture to class. Divide the students into groups and
ask each group to determine which moral
1. Moral issues are those that arouse conscience, are concerned with principle would best apply as a basis for a so-
important values and norms, and evoke words such as good, bad, lution.
wrong, should, and ought.
2. Moral principles are statements about broad, general, philosophic
concepts that provide the foundation for moral rules, which are spe- SUGGESTIONS FOR CLINICAL ACTIVITIES
cific prescriptions for actions. • Assign several students to interview an RN
Principles are useful in ethical discussions. Even if a disagree- about ethical and moral dilemmas encountered
in clinical practice. Discuss these dilemmas in
ment is about which action is right in a situation, individuals may be
a clinical conference.
able to agree on the principles that apply, and this agreement may
serve as a basis for the solution to the problem.
3. The six major moral principles are autonomy, nonmaleficence, benefi-
cence, justice, fidelity, and veracity. Autonomy refers to the right to
make one’s own decisions. Inward autonomy exists if individuals have
the ability to make choices, and outward autonomy exists if their choices
are not limited or imposed by others. Nonmaleficence is the duty to do
no harm. Beneficence means doing good. Justice is often referred to as
fairness. Fidelity means to be faithful to agreements and promises, and
veracity refers to telling the truth.

LEARNING OUTCOME 4
Discuss common ethical issues currently facing health care professionals. SUGGESTIONS FOR CLASSROOM ACTIVITIES
• Have the students bring newspaper or magazine
Concepts for Lecture articles about controversial bioethical and moral
dilemmas to class for discussion.
1. Common ethical problems nurses encounter are issues in the care of • Have each student select an ethical problem
HIV/AIDS clients, abortions, organ transplantation, end-of-life and write a paper about the controversy and
issues surrounding the problem.
decisions, cost-containment issues (resource allocation), and man-
agement of personal health information.
The ANA (1994) states that the moral obligation to care for an
HIV-infected client cannot be set aside unless the risk exceeds the SUGGESTIONS FOR CLINICAL ACTIVITIES
responsibility. Other ethical issues center on HIV testing of all pro- • Discuss a clinical situation in which one of the
ethical issues was related to end-of-life deci-
viders and patients, and releasing test results to insurance companies, sions. Discuss how the issue was resolved.
sexual partners, or caregivers. • Ask a member of the institution’s ethics com-
The debate over abortion pits the principle of sanctity of life mittee, preferably a nurse representative, to
against the principle of autonomy and the woman’s right to control discuss the types of issues brought to the
committee and the process used by the com-
her own body. Conscience clauses in some state laws permit indi- mittee to assist with these issues.
viduals and agencies to refuse to assist with abortions; however,
nurses have no right to impose their values on others.
Ethical issues related to organ transplantation include allocation
of organs, selling of body parts, involvement of children as potential
donors, consent, clear definition of death, conflicts of interest be-
tween potential donors and recipients, and conflict with some reli-
gious beliefs.
Many moral problems surrounding end-of-life decisions can be
resolved if clients complete advance directives. Advance directives
guide caregivers as to the client’s wishes about treatment and pro-
vide a voice for clients when they have lost the capacity to make or
communicate decisions.
Active euthanasia is forbidden by law, but assisted suicide is le-
gal in some states. However, the ANA (1995) states that active and

© 2016, Pearson Education Inc.

 CHAPTER 5 / Values, Ethics, and Advocacy 25

assisted suicide are in violation of the Code for Nurses. Passive eu-
thanasia, commonly referred to as withdrawing or withholding life-
sustaining therapy (WWLST), involves the withdrawal of extraordi-
nary means of life support. WWLST is legally and ethically more
acceptable to many people.
Some treatments help to prolong life but do not necessarily re-
store health. Individuals often have misunderstandings about which
treatments are life-sustaining. Individuals need help to fully under-
stand treatments and need to know that decisions can be changed, if
desired. A nurse is morally obligated to withhold food and fluids if
administering is more harmful than withholding and must honor the
wishes of a competent and informed client’s refusal of food and flu-
ids. The ANA Code of Ethics for Nurses (2001) supports this posi-
tion through the nurse’s role as advocate and the moral principle of
autonomy.
Allocation of scarce health resources is an urgent issue as medi-
cal costs continue to rise and more stringent cost-containment
measures are implemented. The moral principle of autonomy cannot
be applied if it is not possible to give each client what he or she
chooses. Therefore, the principle of justice, attempting to choose
what is most fair to all, may be applied by health care providers.
Nursing care is also a health resource. Some nurses are con-
cerned that staff is not adequate to give the level of care they value.
Some states have enacted a nurse-to-client ratio. With a shortage of
nursing, an ethical dilemma arises when, in order to provide ade-
quate staffing, facilities may turn away needy clients.
Privacy is both a legal and ethical mandate. Clients must be able
to trust that nurses will reveal details of their situation only as appro-
priate and will communicate only the information necessary to pro-
vide health care.

LEARNING OUTCOME 5
Discuss the advocacy role of the nurse.
Concepts for Lecture
1. An advocate is one who expresses and defends the cause of another.
Nurses function as client advocates as well as advocates for the pro-
fession and the public.
2. The overall goal of the client advocate is to protect clients’ rights by
informing clients about their rights, providing them with information
to make informed decisions, supporting clients in their decisions,
and mediating directly on the client’s behalf.
When people are ill and enter the complex health care system,
they may be unable to assert their rights and may need an advocate
to help them assert these rights.
3. Values basic to client advocacy include the belief that the client is a
holistic, autonomous being who has the right to make choices and
decisions; the client has the right to expect a nurse–client relation-
ship based on shared respect, trust, and collaboration in solving
problems; and that it is the nurse’s responsibility to ensure that the
client has access to health care services.
4. In other societies, health care decisions may be made by the head of
the family or another member of the community. Therefore, the nurse
must be aware of the client’s and family’s views and traditions.
Advocacy requires accepting and supporting the client’s right to
decide even if the nurse believes the decision to be wrong.
SUGGESTIONS FOR CLASSROOM ACTIVITIES
• Invite a nurse active in the political arena to
discuss the role of professional and public advo-
cate.
• Present the students with a situation in which
it appears as if the client had made an unwise
decision and ask students to discuss how the
nurse should respond to this situation.
SUGGESTIONS FOR CLINICAL ACTIVITIES
• Have the students describe a situation they have
observed in which they thought the nurse acted
as a client advocate. Discuss the effects of this
nurse’s action on the client.
• Have the students describe a situation in
which they thought the nurse could or should
have acted as the client advocate. What were
the effects of the nurse’s action on the client?
Did the student take any action at this time?
What might the student have done?

© 2016, Pearson Education Inc.

26 CHAPTER 5 / Values, Ethics, and Advocacy

5. To act as professional and public advocates, nurses need an understand-

ing of ethical issues in nursing and health care as well as knowledge of
the laws and regulations that affect nursing and the health of society.

© 2016, Pearson Education Inc.