Ethico-Moral Considerations CANVAS

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Almighty God, we glorify you for giving us the

Angelite Charism. We thank you for the gift of your
Son, Jesus Christ, who is the Way, Truth and Life.
We bless you for the continuous guidance of the
Holy Spirit.
Grant us, we pray, courage and strength that we
may give perpetual praise to you in whatever we do.
We ask this through Christ our Lord. Amen.
Oh, Holy Guardian Angels, guide us and protect us!

Laus Deo Semper!
Ethico-moral
Considerations in
Nursing
Introduction
• Nurses’ decisions
• Advocacy for client decisions
• Need for:
– Sensitivity to ethical dimensions
– Awareness of nurse and client values
– Understand how values influence decisions
– Think about approaching moral problems/issues
Copyright © 2016, 2012, 2008 Pearson Education, Inc. All Rights Reserved
Values
• Enduring beliefs or attitudes about the worth of a person,
object, idea, or action
• May be unspoken or even unconsciously held
• Underlie all moral dilemmas
• Not all values are moral values.
• Values are often taken for granted.
Values
• Value system
– Basic to a way of life
▪ Organize and prioritize values
▪ Give direction to life
▪ Form the basis of behavior
• Beliefs
– Interpretations or conclusions people accept as true
– Based more on faith than facts
Values
• Attitudes
– Mental positions or feelings toward a person, object,
or idea
▪ Acceptance
▪ Compassion
▪ Openness
– Last over time
Values
• Attitudes
– Judged as bad or good, positive or negative
▪ Beliefs are judged as correct or incorrect.
– Vary among individuals
Box 5-1 Essential Nursing Values
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 care.
Human dignity is respect for the inherent worth and
uniqueness of individuals and populations. In professional
practice, human dignity is reflected when the nurse values
and respects all patients and colleagues.
Box 5-1 Essential Nursing Values
Integrity is acting in accordance with an appropriate code
of ethics and accepted standards of practice. Integrity is
reflected in professional practice when the nurse is honest
and provides care based on an ethical framework that is
accepted within the profession.
Social justice is acting in accordance with fair treatment
regardless of economic status, race, ethnicity, age,
citizenship, disability, or sexual orientation.
From The Essentials of Baccalaureate Education for Professional Nursing Practice

(p p. 27-28), American Association of Colleges of Nursing, 2008, Washington, D C:
Author. Reprinted with permission.
Table 5-1 Behaviors That May Indicate
Unclear Values
Behavior Example
Ignoring a health professional’s advice A client with heart disease who values hard work
ignores advice to exercise regularly.
Inconsistent communication or behavior A pregnant woman says she wants a healthy
baby, but continues to drink alcohol and smoke
tobacco.
Numerous admissions to a health agency for A middle-aged obese woman repeatedly seeks
the same problem help for back pain but does not lose weight.
Confusion or uncertainty about which course A woman wants to obtain a job to meet financial
of action to take obligations, but also wants to stay at home to care
for an ailing husband.
Morality and Ethics
• Ethics has several meanings.
– A method of inquiry that helps people to understand
the morality of human behavior
– The practice or beliefs of a certain group
– Expected standards of moral behavior of a particular
group as described in the group’s formal code of
professional ethics
Morality and Ethics
• Bioethics
• Nursing ethics
• Morality
– Refers to private, personal standards of what is right
and wrong in conduct, character, and attitude
– Concerned with important values and norms evoke
words such as good, bad, wrong, should, and ought
Morality and Ethics
• Nurse must be able to distinguish morality from:
– Law
– Religion
Moral Development
• Process of learning to tell right from wrong
– Begins in childhood and continues throughout life
• Theorists
– Lawrence Kohlberg
– Carol Gilligan
Moral Frameworks
• Consequence-based (teleological) theories
– Utilitarianism
– Utility
• Principles-based (deontological) theories
• Relationships-based (caring) theories
Moral Principles
• Statements about broad, general, philosophic concepts
• Provide the foundation for moral rules, which are specific
prescriptions for actions
• Useful in ethical discussions
• May be able to agree on principles that apply
Moral Principles
• May serve as a basis for the solution that is acceptable to
all parties
• Moral rules
– Specific prescriptions for actions
• Autonomy
– Right to make one’s own decisions
Moral Principles
• Autonomy
– Right to make one’s own decisions
– Inward autonomy if individuals have the ability to
make choices
– Outward autonomy if choices are not limited or
imposed by others
Moral Principles
• Nonmaleficence
– Duty to do no harm
– Harm can mean intentionally causing harm, placing
someone at risk for harm, or unintentionally causing
harm.
Moral Principles
• Beneficence
– Means doing good
• Justice
– Often referred to as fairness
• Fidelity
– Being faithful to agreements and promises
• Veracity
– Telling the truth
Moral Principles
• Accountability
– Being answerable to oneself and others for one's own
actions
• Responsibility
– Specific accountability or liability associated with the
performance of duties of a particular role
Nursing Ethics
• No one profession responsible for ethical decisions
• The Joint Commission
– Mandatory ethics committees or similar
• Purpose of ethics committees
– Relevant facts of case brought out
– Forum to express diverse views, provide support for
caregivers, reduce institution’s legal risks
Figure 5-1
An ethics committee contemplates all aspects of the case being considered. Ghislain &
Marie David De Lossy/Alamy
Nursing Code of Ethics
• Code of ethics
– Formal statement of ideals and values shared by
members of a group
• Reflects common moral judgment over time
• Serves as a standard for professional actions
• Usually higher standard than legal standard
Nursing Code of Ethics
• Purposes
– Inform the public about the minimum standards of the
profession
– Provide a sign of the profession’s commitment to the
public
Nursing Code of Ethics (3 of 3)
• Purposes
– Help the public understand ethical considerations of
professional nursing
– Aid self-regulation among nurses
– Remind nurses of their special responsibilities in
caring for the sick
Figure 5-2
When there is a need for ethical decisions or client advocacy, many different individuals
contribute to the final outcome. Photo Network/Alamy.
Advocacy
• Advocates
– Express and defend another’s cause
– Support clients in their decision
– Remain objective
– Accept and respect the client’s right to decide, even if
the nurse believes the decision to be wrong
The Advocate’s Role
• Inform clients about rights and provide information to
make informed decisions
• Give full or mutual responsibility of decision making to
client when they are capable
• Directly intervene on client’s behalf by influencing others
• Advocacy in home care
– Client may revert to old habits, things that are
detrimental to health when in home setting
▪ May be seen as noncompliance
▪ Client autonomy must be respected.
– Limited resources
– Lack of client care services
– Financial considerations
• Professional and public advocacy
– Are assertive
– Recognize that the rights and values of clients and
families must take precedence when they conflict with
those of health care providers
– Are aware that conflicts may arise over issues
– Work with community agencies and lay practitioners
– Know that advocacy may require political action

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Angelite Prayer

Almighty God, we glorify you for giving us the

Oh, Holy Guardian Angels, guide us and protect us!

From The Essentials of Baccalaureate Education for Professional Nursing Practice

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