Ethics

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Bioethics
Prepared by:
Agnes V. Raymundo, PhD, RN
Professional Codes of Ethics
in Nursing
 Professional Nursing EducaBon
•  Began in the 1800s in England at Florence
Nigh6ngale’s school
•  Focused on profession-shaping ethical
precepts and values
•  By the end of the 1800s modern nursing had
been established
– ethics was becoming a discussion topic in
nursing
 NighBngale Pledge of 1893
•  Was wriBen under the chairmanship
of a Detroit nursing school principal,
Lystra GreIer
– to establish nursing as an art and a
science
 InternaBonal Council of Nurses (ICN)

•  Established its own organiza6on

•  Was later a pioneer in developing a
code of ethics for nurses
•  Isabel Hampton Robb
– an American nurse leader, wrote the
first book on nursing ethics, 6tled

Nursing Ethics: For Hospital and
Private Use
Nursing Ethics: For Hospital and Private
Use

•  Addressed nurse–physician, nurse–nurse, and

nurse–public rela6onships
•  Emphasis in the code was ini6ally on
physicians because male physicians usually
trained nurses in the Nigh6ngale era
–  Nurses’ technical training and obedience to
physicians remained at the forefront of nursing
responsibili6es into the 1960s
 ICN Code of Ethics for Nurses
•  Reflected technical training and
obedience to physicians as late as 1965
•  By 1973 the ICN code shiTed from a
focus on obedience to physicians to a
focus on paBent needs, where it remains
to this day
 ANA Code of Ethics for Nurses
•  In 1926 the American Journal of Nursing (AJN)
published “A Suggested Code” by the ANA,
but the code was never adopted
•  In 1940 AJN published “A Tenta6ve Code,” but
again it was never adopted
•  The ANA adopted its first official code in 1950
 ANA Code of Ethics for Nurses
•  Three more code revisions occurred before
the crea6on of the interpreta6ve statements
in 1976
•  The ANA added the word ethics to the
publica6on of the 2001 code.
•  The seventh edi6on, published in 2015, is the
latest revision
 ANA Code of Ethics for Nurses
•  Deontology and NormaBve ethics
largely serve as the basis for the code
•  They are detailed enough to guide
decision making on a wide range of
topics
 ANA Code of Ethics for Nurses
•  The interpre6ve statements are not
inclusive enough to predict every single
ethical decision or ac6on in the process
of nurses carrying out their roles
•  The interpreta6ve statements illustrate
many moral situa6ons
 Deontology
Immanuel Kant

•  Duty-based ethics
•  It is the right course of ac6on is that
which is consistent with one’s moral
du6es.
•  One of these du6es is to never use
another person as a means to one’s
own ends

 UBlitarism
•  Using a u6litarian approach to an ethical dilemma, one
would choose the course of acBon that will produce
the greatest happiness for the greatest number of
people.
•  However, cri6cs of u6litarianism highlight the difficulty
of measuring happiness and accurately predicBng the
consequences of one’s acBons.
•  They also point out that one could potenBally sacrifice
the happiness of the minority for the happiness of the
majority
•  Defines the greatest good as happiness

ConsequenBalism

•  The right course of ac6on is determined by
–  examining the consequences or outcome of an
ac6on
–  selec6ng the one that produces the greatest good
•  Thus, no ac6on is in itself right or wrong - it is
the acBon’s consequences that determine
whether it is right or wrong
 ANA Code of Ethics for Nurses
•  A clear pa6ent focus in the code obliges
nurses to remain aBen6ve and loyal to
all pa6ents in their care
– but nurses must also be watchful for ethical
issues and conflicts of interest that could
lead to poten6ally nega6ve decisions in
care and rela6onships with pa6ents.
 ANA Code of Ethics for Nurses
•  Poli6cs in ins6tu6ons
•  Cost-cueng strategic plans

– are among other nega6ve forces in

today’s environment
 ANA Code of Ethics for Nurses:
Topics Explored
•  respect for autonomy •  accountability and delega6on
•  rela6onships •  self-preserva6on
•  pa6ents’ interests •  environment and moral obliga6on
•  collabora6on •  contribu6ons to the nursing
•  privacy, profession
•  competent prac6ce •  human rights
•  ar6cula6on of professional
organiza6on
 Competent PracBce
•  Illustrates:
–  wisdom
–  honesty
–  courage as essen6al virtues to produce an image
of a morally good nurse
•  When these virtues are habitually prac6ced,
they promote the values of:
–  human dignity
–  well-being
–  respect,
–  health,
 Competent PracBce

•  Illustrates:
–  Wisdom
– Honesty
– Courage
•  as essen6al virtues to produce an
image of a morally good nurse
 Competent PracBce
•  When these virtues are habitually
prac6ced, they promote the values of
–  human dignity
–  well-being
–  respect
–  health
–  independence
•  These values reflect what is important
for the nurse personally and for pa6ents
 Professional Codes of Ethics in
Nursing

•  Notable in the code is the reference

to:
–  moral respect for all human beings
– respect of nurses for themselves.
 Professional Codes of Ethics in
Nursing

•  Another feature of the code is

the emphasis on
– wholeness of character and
– preserva6on of self-integrity
 Wholeness of Character
•  Relates to
– nurses’ professional rela6onships with
pa6ents
– recogni6on of the values within the nursing
profession
– one’s own authen6c moral values
– integra6on of these belief systems
– expressing them appropriately
 Personal Integrity
•  Involves nurses extending aBen6on and
care to their own requisite needs
•  Many 6mes nurses who do not regard
themselves as worthy of care cannot
give comprehensive care to others
•  Recognizing the dignity of oneself and of
each pa6ent is essen6al to providing a
morally enhanced level of care
 ICN Code of Ethics for Nurses
•  In 1953 the ICN adopted its first code of ethics
for nurses
•  The mul6ple revisions illustrate the code is a
globally accepted document for ethical
prac6ce in nursing
•  Since 1953 nurses in many countries have
adapted the ICN code
 ICN Code of Ethics for Nurses
•  The fundamental responsibili6es of:
– promo6ng health
– preven6ng illness
– restoring health
– allevia6ng suffering
•  emanates from the role of nursing
 ICN Code of Ethics for Nurses
•  The code serves as an ac6on-based standard
of conduct related to four key elements:
– nurses and people
– nurses and prac6ce
– nurses and the profession
– nurses and coworkers
 ICN Code of Ethics for Nurses
•  Similar to the ANA code, the elements in
the ICN code form a deontological,
normaBve ethics framework
– for nurses to internalize before using it
as a guide for nursing conduct in:
•  prac6ce
•  educa6on
•  research
•  leadership
 ANA and ICN Codes
•  Common threads exist between the nine
provisions of the ANA code (2015) and the
four elements of the ICN code (2012)
 ANA and ICN Codes
•  The codes, which apply to all nurses in all seengs
and roles, are nonnego6able ethical nursing
standards with a focus on:
–  social values
–  people
–  rela6onships
–  Professional
•  Both codes share values such as:
–  respect, privacy, equality, and advocacy
 ANA and ICN Codes
•  Nurses should protect the moral space in
which pa6ents receive care
•  They should uphold the agreement with
pa6ents on an individual and collec6ve basis.
•  Protec6ng the moral space of pa6ents
necessitates nurses provide compassionate
care by endorsing the principles of:
–  autonomy, beneficence, nonmaleficence, and
jus6ce
 ANA and ICN Codes
•  Within the codes, nursing responsibili6es
include:
–  promo6ng health
– restoring health
– preven6ng illness
– but a significant emphasisallevia6ng
suffering of pa6ents who experience
varying degrees of physical, psychological,
and spiritual suffering
 ANA and ICN Codes

•  Apply to all nurses regardless of their

roles, although no code can provide
a complete and absolute set of rules
free of conflict and ambiguity, which
is a ra6onale oTen cited in favor of
the use of virtue ethics as a beBer
approach to ethics
 Professional Ethical Codes
•  Serve as useful, systema6c, norma6ve
guidelines for direcBng and shaping behavior
•  They s6ll serve as mandates for
accountability in all roles of nursing, whether
in prac6ce or not.