Nursing Health Ethics Handout 2 2
• Morals and Ethics
• Morals: is similar to ethics and many
people use the two wards
interchangeably (closely associated with
the concept of ethics)
• Derived from the Latin “moralis”,
means custom or habit or social
consensus; specific ways of
accomplishing ethical principles
• Morality: usually refers to an
individual’s personal standards of what
is right and wrong in conduct,
character, and attitude.
• Morals: are based on religious beliefs
and social influence and group norms
• Morals and Ethics (continue)
• Ethics is a branch of philosophy (the
study of beliefs and assumptions)
referred to as moral philosophy.
• Derived from the Greek word “ethos”
which means customs, habitual usage,
conduct and character.
• Ethics: usually refers to the practices,
beliefs, and standards of behavior of a
particular group such as nurses. It also
refers to the method of inquiry that
assists people to understood the
morality of human behavior (study of
morality); moral duty
• Morals and Ethics (continue)
• In both, we describe the behavior we
observe as good, right, desirable,
honorable, fitting or proper or we might
describe the behavior as bad, wrong,
improper, irresponsible, or evil.
[Such perceptions are based on values]
• There are times when a differences in
values and decisions can be accepted
• Differences in values and decisions put
people into direct conflict.
What to do in such
situation?
• Morals and Ethics (resolving conflicts)
• Be constructive (rather than
destructive) in the methods you choose
to work toward resolving the
differences
• Listen carefully without
interruptions
• Seek clarification using gentle
questioning
• Respect cultural differences
• Be attentive to body language
• Explain the context of your
point of view and try to picture
the other person’s expective of
what you are saying
• Comparison of morals and ethics
Morals
• Principles and rules of right conduct
• Private, and personal
• Commitment to principles and values is
usually defended in daily life
• Pertain to an individual‘s character
Ethics
• Formal responding process used to
determine right conduct
• Professionally and publicly stated
• Inquiry or study of principles and values
• Process of questioning, and perhaps
changing, one’s morals

• Speaks to relationships between human
beings
• Moral development
• Moral development is a complex
process that is not fully understood
• It is the process of learning what ought
to be done and what ought not to be
done
• Different approaches to moral
development exists:
• Kohlberg’s theory
• Gilligan
• Moral distress
• When the nurses are unable to follow
their moral beliefs because of
institutional or other restriction.
• The distress occurs when the nurse
violates a personal moral value and fails
to fulfill perceived responsibility.
• Moral distress represent practical,
rather than ethical dilemmas.
• Moral outrage
- Occurs when someone else in the health care
setting performs an act the nurse believes to be
immoral.
- Nurses do not participate in the act.
- Nurses not responsible for wrong but perceive
that they are powerless to prevent.
• Kohlberg Approach
• Directly affected by Piaget’s theory of
cognitive development
• Focuses on the structure of though
about moral issues rather than the
specific content of moral values.
Nursing Health Ethics Handout 2 2
• Emphasizes fairness, rights and
autonomy in a justice framework
• Moral development progresses through
three levels:
• Level I: premoral or
preconventional level
• Level II: conventional level
• Level III: post conventional,
autonomous or principled level
• Gilligan’s Theory
• Focuses on a care perspectives
• Organized around the notions of
responsibility, compassion (care),
relationships
• The ethics of justice (fairness) is based
of the idea of equality “everyone should
receive the same treatment”. By
contrast, the ethics of care is based on a
premise of nonviolence: that no one
should be harmed or abandoned
• Gilligan’s theory (continue)
• Process of developing an “ethics of
care”
• Stage I: caring for oneself
• Stage II: caring for others
• Stage III: caring for oneself and
others
• Each stage ends with a transitional
period (a time when the individual
recognizes a conflict or discomfort with
some present behavior and considers
new approaches)
• Moral/ethical principles (concepts)

• Are statements about broad, general
philosophic concepts such as autonomy
and justice
• They provide the foundation for moral
values, which are specific prescriptions
for actions (e.g. “people should not lie”
(rule) is based on the moral principle of
respect of autonomy for people.
• Basic ethical concepts
1. Rights
2. Autonomy
3. Beneficence and Nonmaleficence
4. Justice
5. Fidelity
6. Veracity
7. The standard of best interest
• Basic ethical concepts
Rights
• Rights form the basis of most
professional codes and legal judgments
• Self-determination rights
• Rights and cultural relativism
• Rights of the unborn
• Rights of privacy and
confidentiality
• Basic ethical concepts : Autonomy
• Involves the right of self-determination,
independence, and freedom.
• It refers to the right to make one’s own
decisions
• Respect for autonomy means that
nurses recognize the individual’s
uniqueness, the right to be what that
Nursing Health Ethics Handout 2 2
person is, and the right to choose
personal goals
• Nurses who follow the principle of
autonomy respect a client's right to
make decisions even when those
choices seem not to be in the client’s
best interest
• Basic ethical concepts
Autonomy….. (continue)
• Respect for people also means treating
others with consideration
• In the clinical setting, this principle is
violated when a nurse disregards
client's subjective accounts of their
symptoms (e.g. pain)
• Patients should give informed consent
before tests and procedures are carried
out
• Basic ethical concepts :Beneficence
and Nonmaleficence
Beneficence: means “doing good”
• Nurses should implement actions that
benefit clients and their support
persons. However, in an increasing
technologic health care system, doing
good can also pose a risk of doing harm
(e.g. intensive exercise program).
Nonmaleficence: means the duty to do no
harm.
• This is the basic of most codes of
nursing ethics.
• Harm can mean deliberate harm, risk of
harm, and unintentional harm.
• In nursing, intentional harm is always
unacceptable.
• The risk of harm is not always clear

• A client may be at risk of harm during a
nursing intervention that is intended to
be helpful (e.g. medication)
• Basic ethical concepts : Justice
• Is often referred to as fairness
• Nurses frequently face decisions in
which a sense of justice should prevail
(succeed)
• E.g. busy unit, new admission
• Basic ethical concepts
Fidelity
• Means to be faithful to agreements and
responsibilities one has undertaken
• Nurses have responsibilities to clients,
employers, government, society, the
profession, and themselves
• Circumstances often affect which
responsibilities take precedence at a
particular time
• Basic ethical concepts
Veracity
• Refers to telling the truth
• As a nurse should I tell the truth when it
is known that doing so will cause harm?
• Does tell a lie when it is known that the
lie will relieve anxiety and fear?
• Should I lie to dying people?
• The Types of Ethical Thoughts
1. Cantian or Kantian
2. Rawl’s Ethics
3. St. Thomas Aquinas
4. Ross ethics
(Actual prima facie duty, duty of fidelity, duty of
reparation, duty of gratitude, duty of justice,
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duty of beneficence, duty of improvement, duty
of nonmaleficence.
• Basic ethical concepts
The standard of best interest
• Applied when a decision must be made
about a patient’s health care and the
patient is unable to make an informed
decision
Ppt 2
 Ethical Principles
Conflict is inevitable. Ethical principles provide
the framework/ tools which may facilitate
individuals and society to resolve conflict in a
fair, just and moral manner.
 Ethical Principles
 Autonomy/Freedom
 Veracity
 Privacy/Confidentiality
 Beneficence/Nonmaleficence
 Fidelity
 Justice
 Autonomy
 The right to participate in and decide on
a course of action without undue
influence.
 Self-Determination: which is the
freedom to act independently.
Individual actions are directed toward
goals that are exclusively one’s own.
 Veracity
 The duty to tell the truth.
Truth-telling, honesty.
 Privacy/Confidentiality

 Respecting privileged knowledge.
 Respecting the “self” of others.
 Beneficence/Nonmaleficence
 The principle and obligation of doing
good and avoiding harm.
 This principle counsels a provider to
relate to clients in a way that will
always be in the best interest of the
client, rather than the provider.
 Fidelity
 Strict observance of promises or duties.
 This principle, as well as other
principles, should be honored by both
provider and client.
 Justice
 The principle that deals with fairness,
equity and equality and provides for an
individual to claim that to which they
are entitled.
 Comparative Justice: Making a
decision based on criteria and
outcomes. ie: How to
determine who qualifies for one
available kidney. 55 year old
male with three children versus
a 13 old girl.
 Noncomparative Justice: ie: a
method of distributing needed
kidneys using a lottery system.
 Why Employ Ethical Principles?
 Respect for the Individual
 In our pluralistic society individuals
often misunderstand each other.
 Even when they do understand each
other, it is possible for them to
disagree.
Nursing Health Ethics Handout 2 2
 The Healthcare arena, in common with
every other segment of society has
found it necessary to find ways to
create understanding and agreement.
 How to Create Understanding
and Agreement?
 Common ground must be created or
found.
 A function of Ethics, in our society, is to
make agreement possible.
 As healthcare professionals and
patients meet, they meet as strangers
from diverse backgrounds therefore,
their ways of looking at and
approaching the world are usually quite
different.
Creating Harmony is Difficult
In The Healthcare Arena.
 Power
 Self esteem
 Communication
 Personality/Attitude
 Education Level
 Socioeconomic Class
 Culture (which constitutes the most
profound difference).
 Values
Changing Healthcare
Environment
 Managed Care
 Increased Healthcare Costs
 Technology
 Baby Boomers
 Young and Old Life Spans

 Decrease in Healthy Lifestyles
 Lack of Healthcare Access/Insurance
 Feelings of Entitlements for
Healthcare at a minimal personal cost
 External Forces
 Political Influences/Forces
 Immigration/Migration of the
elderly
 Medicare/Prescription drugs –
life
style driven
 Decrease in extended families
 Decrease in resources
 Work force
 Family Caretakers
 Support/Finances
Services in the
Community
 Socio-economic Disparities –
healthcare right or privilege?
 person on a team may be responsible
How May Harmony Be Achieved?
 Through ethical principles/behaviors,
because they:
 Provide a unique opportunity
for personal fulfillment and self
respect.
 Serve to make it possible for
professionals to deal with each
other on a human level with
respect across all disciplines.
 Serve to make it possible for
professionals and clients to deal
with each other on a human
Nursing Health Ethics Handout 2 2
level with respect across all
cultures and communities.
 Make it possible for strangers
to achieve understanding (if
agreement is not reached,
toleration may be achieved).
 May make it possible for
professional and clients to
agree on and respect each
others rights.
 May make it possible for this
agreement to carry over into
other aspects of life outside the
healthcare setting where the
idea of Ethics may be first
introduced to the professional.
 May make it possible for
provider and patient to interact
on the basis of shared goals.
Difference between RESPONSIBILITY versus
ACCOUNTABILITY:
 Responsibility is task-oriented. Every
for a given task that is required to
complete a massive project.
 Accountability is what happens after a
situation has occurred. It is how you
respond and take ownership over the
results.