− Ethics is a very personal concept and personal
INTRODUCTION TO HEALTHCARE
ETHICS
INTRODUCTION
− At one time, health care ethics was the domain
of health care professionals
− Doctors, nurses, and the other care givers in the
allied health care professions made most of the
decisions that pertained to the ethics of their
occupations
− While patients were often consulted about some
of the medical decisions which affected them,
they were usually passive, insofar as ethical
decisions were concerned
− Today, however, the situation has changed
considerably
− Because of the technical revolution in both
information and in the provision of health care,
patients are now an integral part of the medical
decision-making process
− Moreover, and perhaps more significantly, the
ethical questions to which science, medicine,
and health care give rise, affect the present and
future well-being of people, whether they are
sick or not
− For example, the manner in which health care is
financed and provided now concern everyone
− The escalation of health care costs is
fundamentally an ethical issue, as is the need to
provide health care based upon human need
rather than upon consumer ability to pay
− Many situations arise in the practice of medicine
and in medical research that present problems
requiring moral decisions
A few of these can be illustrated by the following
questions
✓ Should everyone receive equal treatment in
medical care?
✓ Should people suffering from a genetic disease
be allowed to have children?
✓ Should individuals be allowed to die without
measures being taken to prolong life?
✓ Note of these questions has an easy answer, and
one hope never to have to deal with them
The decisions for these issues is subjective, hence need
to refer legal and ethical standards
decision
− Blanchard and Peale developed three questions
to serve as an “ethics check” that is a useful tool
for persons facing an ethical dilemma
✓ Is it illegal or in accordance with
institutional or company policy?
✓ Does it promote a win win situation with
as many individuals as possible?
✓ How would I feel about myself were I to
read about my decisions or action in the
daily newspaper? How would my family
feel? Can I look myself in the mirror?
If the answer to any one of the three questions is no, the
action is unethical
If the answer to all three questions is yes, the actions is
ethical
− Coach thee suggest that leaders, managers,
health services providers and students ask and
answer the following eight questions to test the
rightness or wrongness of their actions
✓ Is it legal?
✓ Does it comply with my/our rules and
guidelines?
✓ Is it in synch with my personal and
organizational values?
✓ Will I be comfortable and guilt free if I do
it?
✓ Does it match my commitments and
promised guarantees?
✓ Would I do it to my family or friends?
✓ Would I be perfectly okay with someone
doing it for me?
✓ Would the most ethical person I know do
it?
ETHICS AND MORALITY
− No matter what our social, cultural, economic or
professional backgrounds are, we are all in the
business of practicing ethics on a daily basis
− We have certain values (things we think are
important for their own sake) and beliefs (views
about the nature of existence and the way we
understand the world to be)
− For example, we hold values such as charity and
generosity
− Ethics is about carefully studying the values that
actually do guide our attitudes and behaviors in
 given contexts, and it is about exploring what
values will guide our attitudes and behaviors.
Ethics- laws and guidelines, standards
Morality- own ethics, self-perception, self-belief values
Not all legal are moral and not all moral are legal.
− ETHICS refers to the standards of behavior that
tell us how human being ought to act in the many
situations in which they find themselves as
friends, parents, business peoples,
professionals…
Ethics is
• A moral principle
• What is good and bad
• What is right and wrong
• Based on value system
− Ethical norms are not universal – depends on the
sub culture of the society
− Ethics Is not following the law
− Ethics is not following culturally accepted norms
− Ethics is not science
− MORALITY is conformity to ideals of right human
conduct
- Morality is the quality of being in accord with
standards of right or good conduct
- Morality is looking at how good or bad our
conduct is, and out standards about conduct
− Ethics is used to refer to the formal study of
those standards or conduct
− Morals are the concepts of what is “good” and
what is “bad” and how one should behave
− Ethics is primarily a matter of knowing whereas
morality is a matter of doing
WHAT IS HEALTH CARE ETHICS?
− Is a branch of ethics that deals with ethical issues
in health, health care, medicine and science
− It involves discussions about treatment choices
and care options that individuals, families, and
health care providers must face
− It requires critical reflection upon the
relationships between health care professionals
and those they serve, as well as the programs,
systems, and structure developed to improve the
health of a population
− Few specific examples of health ethics issues
include:
o Making decisions about end-of-life care
o Determining whether to allocate funds
to the treatment of disease or the
promotions of health
o Critically examining the discrepancies in
our health status between populations
and our ethical obligations to ensure
equitable access to health services
o Ensuring ethical conducts in health
research
HEALTH ETHICS AND THE LAW
− Laws are societal rules or regulations that are
advisable or obligatory to observe
− Ethics is a set of moral standards and a code for
behavior that govern an individual’s interactions
with other individuals and within society
− Laws are mandatory rules to which all citizens
must adhere or risk criminal liability
− Ethics often relate to morals and set forth
universal goals that we try to meet, however,
there is not temporal penalty for failing to meet
the goals as there is apt to be in law
− Both ethics and law are normative frameworks,
i.e. they define how people ought to act Ethics
and law are often complementary; for example,
a legal decree might require a person to do what
is ethically required
− However, something can be legal and yet conflict
with ethical standards and vis-versa
− For instance, there are no laws prohibiting
countries from investing vast public resources in
the development of medical interventions of
minor public health significance, such as cure for
male pattern baldness It is not ethical to devote
their resources to minor public health
significance rather than reducing the burden of
life-threatening disease
− Disrespectfully to one’s parents may be
considered unethical, even though it is not
against the law
− It is also possible that individual laws may
themselves violate important ethical principles
− Ethical analysis of the law can stimulate
important reform efforts or acts of civil
disobedience
− While ethics and law are different, ethics
remains a foundation for law, and often provides
a justificatory basis for legal norms
RATINALE OF HEALTH ETHICS
− Nowadays, conflicts of interests between the
government and medical institutions, between
medical institutions and medical personnel,
between physicians and patients are getting
more and more serious and complex
− High technologies not only brought us hopes of
cure but have also created a heavy economic
burden
− The ethical dilemmas of high technology
medicine-brains death, organ-transplantations,
and concerns about quality of life-have become
increasingly prominent
− The attainment of highest possible level of
health is highly dependent, among other things,
on the regulations of health service delivery and
the application of suitable ethical principles
− Ethics is and always has been an essential
component of medical practice
− Ethical principles such as respect for persons,
informed consent and confidentiality are basic to
the physician-patient relationship
− The study of ethics prepares public health
professionals, health and medical practitioners
and students to recognize difficult situations and
to deal with them in a rational and principled
manner
− Ethics is also important in professionals’
interaction with society and their colleagues and
for the conducts of medical research
− It provides standards of behavior for health
workers
DISCUSSION
− According to the World Health Organization,
health professionals play a central and critical
role in improving access and quality health care
for the population. They provide essential
services that promote health, prevent diseases,
and deliver health care services to individuals,
families and communities based on the primary
health care approach.
ESSENTIAL CHARACTERISTICS OF A PROFESSION
− Competence in a specialized body of knowledge
and skill
− The provision of a particular service to society
− Standards of education and practice
− Self-regulation—an acknowledgement of
specific duties and responsibilities toward our
patients, colleagues, and society.
− Health care professional groups generally
operate under a legal practice act that outlines
the activities the providers perform in the
delivery of patient care and develop a code of
ethics to assist in self-regulation.
− To enter the practice of health care is to enter
into a social compact not only with the patients
you serve but with all other practitioners and the
community at large. This require commitment to
excellence in clinical practice and commitment
to a set of appropriate legal, ethical, and
professional etiquette behaviors.
− Most often we think of professional competence
in terms of clinical skills. In this program, you are
expected to develop other professional
attributes beyond clinical skills such as
professional and ethical behavior.
GENERAL PRINCIPLE OF PROFESSIONAL CONDUCT
− Professionals are required not only to have an
ethical commitment, a personal resolve to act
ethically, but also have both ethical awareness
and ethical competency. Ethical awareness
refers to the ability to discern between right and
wrong, while ethical competency pertains to the
ability to engage in sound moral reasoning and
consider carefully the implications of alternative
actions.
SPECIFIC PRINCIPLE OF PROFESSIONAL CONDUCT
• Service to Others
- Professionals are committed to a life of
service to others. They protect life, property,
and public welfare. To serve others, they
shall be prepared for heroic sacrifice and
genuine selflessness in carrying out their
professional duties even at the expense of
personal gain.
• Integrity and Objectivity
- To maintain and broaden public confidence,
professionals shall perform their
responsibilities with the highest sense of
integrity and imbued with nationalism and
spiritual values. In the performance of any
professional service, they shall at all times,
 main objectivity, be free of conflicts of professional practices fully aligned with
interest, and refrain from engaging in any global best practices.
activity that would prejudice their abilities to • Equality of All Professions
carry out their duties ethically. - All professionals shall treat their colleagues
- They shall avoid making any representation with respect and shall strive to be fair in their
that would likely cause a reasonable person dealings with one another. No one group of
to misunderstand or to be deceived. professionals is superior or above others. All
• Professional Competence professionals perform an equally important,
- In providing professional services, a certain yet distinct, service to society. In the eyes of
level of competence is necessary, i.e., the PRC, all professions are equal and,
knowledge, technical skills, attitudes, and therefore, every one shall treat one other
experience. Professionals shall, therefore, professionals with respect and fairness.
undertake only those professional services
HEALTH CARE ETHICS
that they can reasonably deliver with
− Health care ethics are designed to promote
professional competence. Corollary to this, it
order and maintain civility. With ethics, you are
is their express obligation to keep up with
not dealing with something that can be
new knowledge and techniques in their field,
considered bad manners; you are dealing with
continually improve their skills and upgrade
the rights and welfare of other people. In a
their level of competence and take part in a
normal person, when an action or behavior is
lifelong continuing education program.
considered boorish or rude, others will avoid
• Solidarity and Teamwork
them. But when a health care practitioner fails to
- Each profession shall nurture and support
maintain an appropriate standard of legal or
one organization for all its members. Though
ethical conduct, the consequences can be career
a deep spirit of solidarity, each member
ending.
should put the broader interest of the
− Some people talk about their personal ethics,
profession above one’s personal ambition
others talk about a set of morals, and everyone
and preference. Through teamwork within a
in a society is governed by the same set of laws.
cohesive professional organization, each
Knowing the difference and relationship
member shall effectively observe ethical
between them is important though, because
practices and pursue continuing professional
they can conflict with one another. If the law
development as well as deepen one’s social
conflicts with our personal values or a moral
and civic responsibility.
system, we have to act – but to do so we need to
• Social and Civic Responsibility
be able to tell the difference between them.
- Professionals shall always carry out their
− Ethics is a branch of philosophy that aims to
professional duties with due consideration
answer the basic question, “What should I do?”
of the broader interest of the public. They
It’s a process of reflection in which people’s
shall, therefore, serve their
decisions are shaped by their values, principles,
clients/employers and the publics with
and purpose rather than unthinking habits, social
professional concern and in a manner
conventions, or self-interest.
consistent with their responsibilities to
society. As responsible Filipino citizens, they − If one uses “morality” in its descriptive sense,
shall actively contribute to the attainment of and therefore uses it to refer to codes of conduct
the country’s national objectives. actually put forward by distinct groups or
societies, one will almost certainly deny that
• Global Competitiveness
there is a universal morality that applies to all
- Every professional shall remain open to
human beings. A person who knows the
challenges of a more dynamic
difference between right and wrong and chooses
interconnected world. He or she shall rise up
right is moral. A person whose morality is
to global standards and maintain levels of
 reflected in his willingness to do the right thing –
even if it is hard or dangerous – is ethical. Ethics
are moral values in action.
− The law is different. It’s not a morality in the
strict sense of the word because, at least in
democratic nations, it tries to create a private
space where individuals can live according to
their own ethical beliefs or morality. Instead, the
law tries to create a basic, enforceable standard
of behavior necessary in order for a community
to succeed and in which all people are treated
equally.
− You are entering a profession where there is an
abundance of value questions that must be dealt
with daily. As professionals, even in our
opposition and standing up for our position – it
is important that we remain appropriate and
constructive in our actions.
FOUNDATIONS OF LAW
Basic source of modern law:
• Common Law – emanates from judicial
decisions, unwritten laws
• Statutory Law – arises from legislative bodies
• Administrative Law – flows from rules and
regulations and decisions of administrative
agencies
FUNDAMENTAL PRINCIPLES OF LAW
✓ A concern for justice and fairness
✓ Plasticity and change
✓ Acts are judged on the universal standard of the
reasonable person
✓ Doctrine of Individual Rights and Responsibilities
– every person is liable for his or her own actions.
LAWSUIT
− A lawsuit is a civil legal action by one person or
entity against another person or entity, to be
decided in a court. As a practitioner, it is hoped
that you will never be involved in a lawsuit, but
it is useful to understand the process.
− A lawsuit begins when a plaintiff (a person who
brings an action in a court of law) files a
complaint or petition with the court that
addresses the elements of the prima facie case (
prima facie means legally sufficient to establish a
case) against a defendant (a person against
whom an action us brought).
HIPPROCATIC OATH
− It is a code written well over 2,000 years ago.
− I will apply dietetic measures for the benefit of
the sick according to my ability and judgment; I
will keep them from harm and injustice.
− I will neither give a deadly drug to anybody who
asked for it, nor will I make a suggestion to this
effect. Similarly, I will not give to a woman an
abortive remedy. In purity and holiness, I will
guard my life and my art.
− I will not use the knife, not even on sufferers
from stone, but will withdraw in favor of such
men as are engaged in this work.
− Whatever houses I may visit, I will come for the
benefit of the sick, remaining free of all
intentional injustice, of all mischief and in
particular of sexual relations with both female
and male persons, be they free or slaves.
− What I may see or hear in the course of the
treatment or even outside of the treatment in
regard to the life of men, which on no account
one must spread abroad, I will keep to myself,
holding such things shameful to be spoken
about.
− If I fulfill this oath and do not violate it, may it be
granted to me to enjoy life and art, being
honored with fame among all men for all time to
come; if I transgress it and swear falsely, may the
opposite of all this be my lot.
NIGHTINGALE’S PLEDE (1953)
− I solemnly pledge myself before God and in the
presence of this assembly, to pass my life in
purity and to practice my profession faithfully. I
will abstain from whatever is deleterious and
mischievous and will not take or knowingly
administer any harmful drug. I will do all in my
power to maintain and elevate the standard of
my profession, and will hold in confidence all
personal matters committed to my keeping, and
all family affairs coming to my knowledge in the
practice of my calling. With loyalty will I
endeavor to aid the physician in his work, and as
a 'missioner of health' I will dedicate myself to
devoted service to human welfare.

DECISION MAKING IN VALUE
ISSUE AND PRIVATE LAW
DISCUSSION
− As professionals, 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. Questions regarding health
care ethics rarely have easy answers; in fact,
there are no easy answers. If answers were
easy, these problems would not be called
dilemmas.
− Ethical theories can help us to clarify our
thinking when we make ethical decisions as
they can provide a framework to guide us when
we consider what is right or wrong and good or
bad. Generally ethical theories are considered
to fall into two main groups.
1. Deontological theories that are
associated with duties and rights and
that encourage judgements on the
rightness of actions based on the duty
of those involved, irrespective of any
real or predicted consequences or
outcomes.
2. Teleological ethics are much more
concerned with the goals and
consequences of actions when making
judgements on their appropriateness.
− Examples of such theories are consequentialism
and a specific form of consequentialism called
utilitarianism.
DEONTOLOGICAL (DUTY-ORIENTED) THEORIES
− Duty-oriented ethicists feel the basic rightness
or wrongness of an act depends on its intrinsic
nature rather than on the situation or the
consequences. Edwards (1996: 46) considers
that: ‘From the perspective of a duty-based
theory . . . the rightness or wrongness of an act
is essentially independent of its consequences;
what matters is that the actor acts out of moral
duty’. Much of the current thinking in relation
to duty-based ethics is derived from the work of
the philosopher Immanuel Kant (1724–1804)
who is, generally, considered the first
proponent of duty-based ethics.
− Kant based his moral philosophy on the crucial
fact that we are rational beings, and a central
feature of this rationality was that principles
derived from reason are universal. These
universal truths applied to all people, for all
times, in all situations. Kant held that the
human mind works the same way, regardless of
who you are, where you are, or when you are.
− Kant also proposed that these ‘rational agents’
are bound by ‘supreme moral law’ or
‘categorical imperative’ which applies to all
regardless of feelings, emotions desires or
needs. A ‘categorical imperative’ is a rule or
maxim that is true and right in all
circumstances.
According to Glannon (2005) there are two parts to this
imperative.
1. The agent should act only on a principle or a
maxim that can be regarded as a universal law
and agreed by everyone.
2. No one should be treated merely as a ‘means’
but always as an end.
Duty oriented Reasoning
− Duty-oriented theorists obviously wish to
promote a good result; however, they feel that
merely serving the good is not an adequate
foundation for ethics. For these theorists, the
right action is one based on principles
regardless of results.
TEOLOGOCAL (CONSEQUENCE-ORIENTED) THEORIES
− Consequence-oriented theories judge the
rightness or wrongness of decisions based on
outcomes or predicted outcomes. Those
following a consequence-based theory would
decide that what is right also maximizes some
good. The right thing to do, then, is the good
thing to do. Those theorists argue about what
constitutes the good, but once agreed, they
would have no problem, theoretically, in
deciding on a right course of action.
Consequences are considered the results of our
actions and what may occur from these actions.
The driving force for consequentialism is that
the results are good.
− Consequentialism is the ethical theory of
looking at the consequences of an action, then
weighing up the good and bad consequences
before deciding what the best thing to do is. For
consequentialism and utilitarianism, the
problems arise from the difficulty of trying to
predict the outcomes of any actions and how to
quantify or weigh the pleasures or happiness,
goodness, and badness of these outcomes. The
problem that is most difficult in a nursing
situation is that when calculating the greatest
good then the minority will suffer. It seems
completely wrong that anyone should suffer at
all. However, this should also take into account
what is meant by the greatest good as surely
the greatest good is to save lives.
− To a utilitarian, the good resides in the
promotion of happiness or the greatest net
increase of pleasure over pain. 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. Utilitarian systems are
referred to as teleological theory, taken from
the Greek word telos, which means end.
Aristotle’s traits of a virtuous character provided:
Consequences Oriented Reasoning
− A formulation of utilitarianism that seems to
avoid the problem of exact quantification
required in act utilitarianism is rule
utilitarianism. This theory holds that an action
can be 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 whole variety of situations.
− Utilitarianist Joseph Fletcher holds that human
need determines what is or is not ethical. He
used the term agape which can be defined as
general goodwill or love for humanity. If an act
helps people, it is a good act; if it hurts, it is a
bad act.
VIRTUE ETHICS
Your beliefs become your thoughts,
Your thoughts become your words,
Your words become your actions,
Your actions become your habits,
Your habits become your values,
Your values become your destiny.
-Mahatma Gandhi
− In Nicomachean Ethics, the philosopher
Aristotle suggests a different solution than the
action-centered ethical systems of duty-
oriented and consequence-oriented reasoning
when he places the focus not on the particular
action but rather on the heart of the moral
agent.
− The primary focus of virtue ethics is the heart of
the moral agent making the decision rather
than the reasoning to a 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. This is primarily
about personal character and moral habit
development rather than a particular action.
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.

− In that practices have histories, the individual

enters into a relationship not only with
contemporary practitioners, but also with those
who preceded her in the role. This is especially
true of those who have come before and have
extended the practice to its present point. In
this way, we learn from tradition, but tradition
also learns from us. Our rapidly changing
specialties do pose some problem for virtue
ethics in that what may be considered a role-
virtue at one time may be inappropriate later.
The best example is perhaps nursing. The
perceived good practice in 1960s would have
contained ample portions of virtues like
submissiveness and respectfulness, whereas
today these practices are being replaced with
virtues such as patient advocate, navigator, and
educator. It is quite possible that on the same
shift, a patient could have several groups of
nurses with differing views of what the “good
nurse” is all about.
 − Involves a willful act that violates another’s
FOUNDATIONS OF LAW interest
PRIVATE LAW VS PUBLIC LAW − Assault and Battery
• Private Law − Defamation of Character
− Citizen vs citizen - Slander
− civil law - Libel
• Public Law − False Imprisonment
− Private vs. government − Invasion of Privacy
− criminal law ASSAULT AND BATTERY
TORT − any unlawful touching go another that is without
− A private or civil wrong or injury justification or excuse
− Contract Law Assault - committed without physical contact (verbally
− Breach of contract cursing and threatening)
Basic Objectives of Tort law Battery - requires physical contact of some sort (bodily
1. Preservation of peace between individuals injury or offensive touching)
2. Determining of fault DEFAMATION OF CHARACTER
3. Compensation for injury − occurs when one person communicates to a
Categories of Tort law second person about a third in such a manner
that the reputation of the person about whom
✓ Negligent Tort discussion was held is harmed
✓ Intentional Tort
✓ Strict Liability Libel - written defamation

Negligent Tort Slander - spoken defamation

− Unintentional commission or omission of an act FALSE IMPRISONMENT

− No intent, outcome is unexpected, injury occurs − illegal confinement of an individual against his or
her will by another individual in a manner that
Negligence takes many forms… violates the confined individual’s right to be free
from restraint of movement.
• Malfeasance – execution of an unlawful or
improper act INVASION OF PRIVACY
• Misfeasance – the improper performance of an − unjustifiable intrusion into the personal life of
act that leads to injury another without consent.
• Nonfeasance – failure to perform an act, when − In breach of contract, there is failure, without
there is a duty to act legal excuse, to perform any promise that
comprises the whole or part of the contract.
To sustain a claim of negligence…
Contractual duty can occur as the result of
• Duty signing formal documents or can arise out of
• Dereliction of Duty implication.
• Direct Cause
• Damage

Legal doctrines associated with medical malpractice…

res ipsa loquiĞor (the thing speaks for itself)

respondeaĞ superior (let the master answer)

Intentional Tort

ETHICAL THEORIES
ETHICAL ISSUES IN NURSING
• Abortion
• Management of computerized information
• End-of-life issues
• Allocation of scarce resource
Ethical theories can help us to clarify our thinking when
we make ethical decisions as they can provide a
framework to guide us when we consider what is right or
wrong and good or bad
DEONTOLOGICAL THEORY
− Comes from the greek word “DEON” which
means duty
− Judgements on the rightness of actions based on
the duty
− The right action is one based on principles
regardless of results.
− The two main non-consequentialist theories are
ethics of duties and ethics of rights and justice.
2.2.1 Article 2: The Universal Declaration of Human
Rights
'Everyone is entitled to all the rights and freedoms set
forth in this Declaration, without distinction of any kind,
such as race, colour, sex, language, religion, political or
other opinion, national or social origin, property, birth or
other status. Furthermore, no distinction shall be made
on the basis of the political, jurisdictional or international
status of the country or territory to which a person
belongs, whether it be independent, trust, non-self-
governing or under any other limitation of sovereignty.'
TEOLOGICAL THEORY
− Consequence-oriented (Consequentialism)
− Consequentialism
− Judge the rightness or wrongness of decisions
based on outcomes or predicted outcomes
− Looking at consequences of an action, then
weighing up the good and bad consequences
before deciding
− The two main consequentialist theories
considered here are egoism and utilitarianism
Egoism – one’s self is, or should be, the motivation for all
our actions
− Human nature as self-centered
− Descriptive egoism – person is really motivated
by their own self-interest
− Normative egoism – we should be acting in our
own interests, as this is the only was that overall
welfare can be improved
Utilitarianism – focuses on collective welfare and it
identifies goodness with the greatest amount of good for
the greatest number of people (the greatest happiness
principle)
Essential elements:
− Whether an action is right or worng determined
solely by its consequences (Principle of Utility)
− The value of the consequences of an action is
assessed in terms of the amount of happiness or
well-being caused. (Principle of Pleasure)
− In assessing the total happiness caused to a
number of people, equal amounts of happiness
are to have equal value, no one person's
happiness having greater value that another's.
(Principle of Maximation)
VIRTUE ETHICS
 − provides an explanation of what makes a person
good or bad
− primary focus is the heart of the moral agent
making the decision rather than the reasoning to
a right action
− primarily about personal character and moral
habit development rather than a particular
action.
Altruism - is a concern for the welfare and well-being of
others. In professional practice, altruism is reflected by
the nurse’s concern for the welfare of patients, other
nurses, and other health care providers.
Autonomy - is the right to self-determination.
Professional practice reflects autonomy when the nurse
respects patients’ rights to make decisions about their
health.

Human dignity - is respect for the inherent worth and the

uniqueness of individuals and populations. In
professional practice, human dignity is reflected when
nurse values and respects all patients and colleagues.

Integrity - is acting in accordance with an appropriate

code of ethics and accepted standards of practice. It is
Virtue Ethics Reasoning reflected in professional practice when the nurse is
honest and provides care based on an ethical framework
VIRTUE AND VICES that is accepted within the profession.
Virtue - Instances or patterns of conduct that are
ethically right, good and proper Social justice - is upholding moral, legal and humanistic
principles. This value is reflected in professional practice
Vices - those that are wrong, bad or improper when the nurse works to ensure equal treatment under
Virtue Ethics in Nursing the law and equal access to quality health care.

VIRTUE ETHICS IN NURSING

− Virtue ethics is an approach that focuses on
character with the assumption that a person of
good character will tend to behave in ways that
are consistent with their character.
− A virtue ethics for nursing is therefore concerned
with the character of individual nurses and seeks
ways to enable nurses to develop character traits
appropriate for actions that enhance wellbeing.
(Sellman, 2017)

Six Virtues of Nursing

• professional competence
• honesty and integrity
• caring and compassion
• fairness and justice
• respect and self-respect
• courage

CORE VALUES OF A PROFESSIONAL NURSE

Personal Values - are learned values from society and
perceived and internalized by an individual as his own.

− are acquired during socialization into nursing

from Code of Ethics, nursing experiences,
teachers and peers.