MORAL PRINCIPLES IN HEALTH CARE
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What is a PRINCIPLE?
• Principle is that from which something
proceeds in any manner, whatsoever.
What is a MORAL PRINCIPLE?
• Moral Principle refers to a fundamental
rule of moral law containing certain truth
from which knowledge of a definite moral
action for performance proceeds along
with the provision of solution to specific
moral problems or issues.
MORAL PRINCIPLES
These are part of a normative theory that
justifies or defends moral rules and/or moral
judgments; they are not dependent on one's
subjective viewpoints. Moral principles in
health practice refer to those general
judgments that serve as a basic justification
for the many particular ethical prescriptions
and evaluations of health activities.
Moral Principles
• Autonomy
• Nonmaleficence
• Beneficence
• Justice
• Fidelity
• Confidentiality
• Veracity
• Accountability
Autonomy
• The freedom to make decisions about
oneself
• The right to self-determination
• Healthcare providers need to respect
patient’s rights to make choices about
healthcare, even if the healthcare
providers do not agree with the patient’s
decision.
A 26-year-old male has been involved in a
high-speed collision, in which he sustained
blunt force trauma to his head as his head hit
the front windscreen of his car.
lose consciousness; he is fully responsive
and has no indications of neurological
damage. He does, however, have a
significant head wound that is bleeding
continuously. This patient has refused
treatment on the grounds that he feels “fine”
and is refusing to have sutures to close his
head wound. He would like to leave the
Department.
Even though the best interests of this patient
would be served by undergoing a CT scan
and having sutures, he is an adult with full
mental capacity, and so we must respect his
autonomy in choosing to leave the
Department. We cannot prevent him from
leaving, and if we did it would be unlawful
detainment.
Why is Autonomy Important?
 Autonomy is important because we
need to make sure that the patient
is actively involved in their diagnosis
and treatment – and not just deferring
to their Doctor.
As a nurse, you need to think about the
following things:
• Have you explained fully the patient’s
medical condition, their options for
treatment and the advantages and
disadvantages of those treatments?
• Is the patient able to retain this
information, evaluate their options and
arrive at a decision?
• Has the patient provided informed consent
for our actions?
Nonmaleficence
• Requires that no harm be caused to an
individual, either unintentionally or
deliberately
• This principle requires nurses to protect
individuals who are unable to protect
themselves
Non-maleficence has four key
components:
 1. An action must not be intrinsically
wrong
2. A good effect must be intended by the
action
3. The good outcome must not be a
byproduct of a bad effect
4. If there are negative outcomes of an
action, the good outcomes of the
action must outweigh the bad
An example of a non-maleficent action would
be stopping a medication known to be
harmful or refusing to give a medication to a
patient if it has not been proven to be
effective.
Beneficence
 This principle means “doing good” for
others
 Nurses need to assist clients in meeting
all their needs
◦ Biological
◦ Psychological
◦ Social
Beneficence is a moral principle that
addresses the idea that a nurse's actions
should promote good. Doing good is thought
of as doing what is best for the patient.
Beneficence should not be confused with the
closely related moral principle
of nonmaleficence, which states that one
should not do harm to patients. This principle
acts as an obligation for nurses to protect
their patients from harm by removing and
preventing bad situations and promoting good
ones.
 For example, if a patient has been in
the hospital for weeks, a nurse
showing beneficence might take that
patient outside for some fresh air.
Justice
• Every individual must be treated equally
• This requires nurses to be nonjudgmental
In nursing, the moral principle of justice
means to treat fairly. For example, if you were
juggling multiple patients, you would not
provide better care based on who has the
best insurance. Nurses practicing justice do
not provide care to patients differently based
on their race, gender identity, sexual
orientation, or religion. Nurses practicing in a
just manner provide care equally amongst
their patients.
Fidelity
• Loyalty
• The promise to fulfill all commitments
• The basis of accountability
• Includes the professionals faithfulness or
loyalty to agreements & responsibilities
accepted as part of the practice of the
profession
In nursing, the ethical principle of fidelity
means to be faithful or loyal, which means
that you keep promises to patients. For
example, a nurse who told their patient they
were coming back in 30 minutes to check on
their pain, would either come back, or
delegate somebody else to come back if they
got tied up.
Confidentiality
• Anything stated to nurses or health-care
providers by patients must remain
confidential
• The only times this principle may be
violated are:
◦ If patients may indicate harm to
themselves or others
◦ Legal requirements to report
certain conditions or circumstances
◦ If the patient gives permission for
the information to be shared
The obligation of confidentiality prohibits the
health care provider from disclosing
information about the patient's case to others
without permission and encourages the
providers and health care systems to take
precautions to ensure that only authorized
access occurs. Appropriate care often
requires that information about patients be
discussed among members of a health care
team; all team members have authorized
access to confidential information about the
patients they care for and assume the duty of
protecting that information from others who
do not have access.
Veracity
• This principle implies “truthfulness”
• Nurses need to be truthful to their clients
• Veracity is an important component of
building trusting relationships
Veracity means to tell the truth—to never lie
to patients or give them knowingly false
reassurance, which is also lying. For
example, if a patient was starting
chemotherapy and asked about the side
effects, a nurse practicing veracity would be
honest about the side effects they could
expect with chemotherapy.
Accountability
 Individuals need to be responsible for their
own actions
 Nurses are accountable to themselves
and to their colleagues
 Accountability is foundational to
professional nursing practice and is often
referred to as the “hallmark of
professionalism”
 Accountability is defined as
the acceptance of responsibility for honest
and ethical conduct. Accountability in
nursing practice is integral to professional
practice. It is concerned with weighing the
interest of patients with diverse health
issues while using professional judgment,
knowledge, skills, and evidence-based
practices to make decisions that promote
positive patient outcomes.
Why Accountability Is Important
Nursing Practice?
1. Accountability in nursing helps foster
trusting relationships between patients and
nurses, which can positively influence patient
outcomes.
2. Nurses who hold themselves accountable
set themselves up for success.
3. A culture of accountability in nursing
reduces the misuse of valuable healthcare
resources.
4. Nurses who practice accountability can
promote a positive reputation for the facilities
where they are employed.
HOW CAN NURSES DEMONSTRATE
ACCOUNTABILITY IN NURSING
PRACTICE?
There are endless opportunities to
demonstrate accountability in nursing
practice. The following is a list of 10 best
ways nurses can demonstrate accountability
in nursing practice.
1. Work within your Scope of Practice.
2. Accept responsibility for yourself and
your actions.
3. Follow policies and procedures as
established by your employer.
4. Accept correction or instruction from
supervisors when needed.
5. Stay up to date with professional
nursing standards.
6. Use evidence-based practices when
providing patient care.
7. Implement accountability safeguards.
8. Complete tasks assigned to you before
leaving work.
9. Set personal and professional goals.
10. Provide safe, quality care to all
patients.
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