THEORIES AND PRINCIPLES OF

HEALTH ETHICS
 Objectives

At the end of this Lecture, you will be able to:

1.  Explain terms such as ethics, morals, beliefs, values, principles, manners,
conscience, virtues and philosophy.
2. Discuss why ethics is important in nursing practice.
3. Differentiate Deontology, Teleology (Consequentialism, Utilitarianism)
4. Discuss how duties affect all of us in everyday life.
5. Identify how these theories relate to nursing.
 Definition of Terms
Ethics
• is the branch of philosophical study that investigates moral duties, values, and ideal
human character. It involved explanation into the nature of right and wrong, good
and evil, promises, and moral duties.
• Motives and attitudes and their relationship to the good of the individual are the
interest focus of ethics (Yoder-Wise, 1999).
• Ethics is the free, rational assessment of courses of actions in relation to precepts,
rules and conduct.
 MORAL

Beauchamp and Childress (2009: 2) state:

• ‘The term morality refers to norms about right and wrong human conduct that
are so widely shared that they form a stable....social agreement’.
• Perhaps, it is the community or group who agrees the standard of acceptable
behaviour and not necessarily the leaders of the society.
 Principles

• a fundamental truth or proposition that serves as the foundation for a system of

belief or behavior or for a chain of reasoning.
• ‘Principles’ are a notion that varies from person to person
• Some people have one set of principles and other people will have different
ones.
 Values

• a person's principles or standards of behavior; one's judgment of what is

important in life.
• Putting words to values can be difficult and you may consider them the same as
principles. We are often unaware what our values are until asked
• Omery (1989: 500) states that values include: ‘...subjective, strongly
motivational preference or disposition toward a person, object, or idea that is
more likely to be manifest in an affective situation...’.
 Beliefs
• an acceptance that a statement is true or that something exists.
• trust, faith, or confidence in someone or something.
• A belief is a statement that a person holds to be true. There are no facts about its truth
otherwise it would be knowledge.
Example, a widely held belief is that there is life after death but there is no evidence to support
this notion. Usually beliefs are shared in a community such as the belief that stealing is bad.
• At times it is hard to appreciate a person’s beliefs. An example of this is the refusal to receive
a blood transfusion when it is necessary to save that person’s life. According to Griffin and
Tengnah (2008) this is concerned with differing beliefs about the sanctity of life and the
needless loss of life.
 Virtues
• behavior showing high moral standards.
• According to fry and johnstone (2002: 26), moral virtue is: ‘considered a character trait that is
morally valued and that stems from the motivation to do right or good’.
• Examples of moral virtues:
courage,
generosity,
compassion,
faithfulness and
sincerity.

• ‘pride comes before a fall’

• ‘patience is a virtue’.
 Conscience
• Conscience is another word associated with good and bad, right and wrong.
• An ability to feel what is right and wrong in a given situation. It often elicits
itself as a ‘voice’ in our head telling us not to do something as it is wrong.
• We feel that our first instinct is usually right. This seems to equate to
conscience being innate and instinctive but, ‘con’ means in Latin ‘with’ and
so conscience is ‘with science’.
• The word science indicates knowledge, discipline, art and skill so perhaps
conscience is also concerned with logical thinking, experience and
understanding of a situation and not just this inner sense.
 Nursing and ethics

• NURSING- to help people, sick or well, in the performance of those

activities contributing to health or its recovery (or a peaceful death) that
they would perform unaided if they had the neces- sary strength, will or
knowledge. It is likewise the function of nursing to help people gain
independence as rapidly as possible. (Henderson 1996: 4)
 Qualities and characteristics of caring as:

• ‘compassion,
• competence,
• confidence,
• conscience and
• commitment’
• Scenario: supporting a patient with eating and drinking
An in-patient, george blake, has an infection in his stump wound, following an amputation of his
right leg for gangrene. He has had two operations in a month, which have seriously impaired his self-
confidence. Over this time the nurses have come to recognize and admire his determination to
overcome his problems and to return home. His pain has been severe but he will only take pain
killers as a ‘last resort’. The pain and fever are now affecting his mood and he is grumpy and fed up.
He is also reluctant to eat and drink.
The nurses give him his dinner, leaving it on his table so that he can feed himself. He is reluctant
to do this. The nurses believe that it is their duty to promote his independence and improve his self-
esteem. Some relatives are at his bedside and they say that it is the duty of the nurse to feed mr blake.
 Ethical theories
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 theories

• duties are actions that we feel that we ought to do or should do.

• duties are obligations that we need to carry out and they generate rules that we
feel we need to obey (Tschudin 2003; Thompson et al. 2006; Beauchamp and
Childress 2009).
 An example from health care

• In the 1990s, there was public uproar at the retention of organs for the purpose of
research after post mortems without asking permission from the relatives. There
was no legal necessity, at the time, to ask for permission to retain these organs. The
doctors felt that they had moral justification for the removal and retention of organs
as their research would benefit others in the future and to ask for permission to
remove the organs, at the time of acute grief, would cause more harm. The affront
was particularly felt by the parents of very young infants. One comment from a
parent at the time was that the surgeons and pathologist may have been acting
legally but they were not acting morally (Wilson 1999).
 ETHICAL theory
• Consequentialism and utilitarianism
Scenario: consequentialism and utilitarianism
Mrs Zenab Begum is admitted to hospital, having suffered paralysis of her right side
following a stroke. She is obese and has difficulty in explaining herself in English
even though she has lived in England for 30 years.
The nurses attempt to get her out of bed using the hoist but she becomes agitated,
frightened and distressed. She refuses to get out of bed. The nurses explain that it is
necessary for her recovery to get out of bed and to try to walk a few steps every day.
• Can you write down the consequences if Mrs Begum does not get out of bed?
• Does making a list of these consequences help you make a decision about
whether to get her out of bed or not?
• Is it better to do what Mrs Begum thinks is best for her?
 You may have written that consequences are:

• results;
• outcomes;
• what happens if you act in a certain way;
• repercussions;
• penalties;
• costs.
 Utilitarianism

• Utilitarianism was developed to try and solve some of the problems of balancing
good and bad consequences.
• Jeremy Bentham (1748–1832) and John Stuart Mill (1806–1873) are noted for
developing this theory. Utility is concerned with the usefulness of an item.
• Bentham originally suggested that usefulness in morality terms was in
promoting pleasure and avoiding pain. Pleasure being the good consequence and
pain the bad, and the best action would be to maximize the pleasures and
minimize the pains.
• Ian Thompson and colleagues (2006: 397) suggest that in utilitarianism
‘the guiding principle for all conduct should be to achieve the greatest happiness
for the greatest number and that the criterion of the rightness or wrongness of an
action is whether it is useful in furthering this goal’.
Whereas, Mel Thompson (2006: 99) states that utilitarianism is ‘a theory that
evaluates morality according to its aim of achieving “the greatest good for the
greatest number”’.
 Does consequentialism or utilitarianism help to make a decision about the best course of action, rather than referring
to ‘duties’.

Could you calculate the greatest good to the greatest number?

• Scenario: supporting a patient with eating and drinking

An in-patient, george blake, has an infection in his stump wound, following an amputation of his
right leg for gangrene. He has had two operations in a month, which have seriously impaired his self-
confidence. Over this time the nurses have come to recognize and admire his determination to
overcome his problems and to return home. His pain has been severe but he will only take pain
killers as a ‘last resort’. The pain and fever are now affecting his mood and he is grumpy and fed up.
He is also reluctant to eat and drink.
The nurses give him his dinner, leaving it on his table so that he can feed himself. He is reluctant
to do this. The nurses believe that it is their duty to promote his independence and improve his self-
esteem. Some relatives are at his bedside and they say that it is the duty of the nurse to feed mr blake.
• Immunization protects a child from getting a disease and so prevents suffering,
the risk of severe complications and even death from the disease.
• However, the issue of whether to immunize their children or not is a dilemma
for some parents. They may still be hesitant due to the possible side effects of
the immunization itself such as fever, convulsions and allergic reactions.
• How could you help parents to reach a decision using consequentialism?
 Would you you let him out so that he can recover mentally?

• A patient has been confined to one room for a period of 2 weeks after
contracting an infection caused by clostridium difficile. This infection spreads
very rapidly in hospital and causes severe diar- rhoea, vomiting and dehydration.
• The patient becomes very depressed and confused. He says it feels like he is in
prison and that he has committed a crime. He pleads with you to let him out of
the room. However, his pathology reports confirm that he still has the
microorganism in his faeces.
 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.
• Virtue ethics is implied in much of the language used by nursing’s regulatory
and professional bodies
• Virtue ethics requires individuals to develop their character for the good.
 Core Values of professional nurse
• Profession and Professionals
• Webster defines a profession as a “calling requiring specialized
knowledge...” and “a principle calling, vocation, or employment”.
• A professional is “characterized by or conforming to the technical or
ethical standards of a profession” (Webster’s 1991).
• nursing is a service profession, dedicated primarily to helping patients
or clients. (Chitty (2001)
• Society also defines a profession. Once a profession is recognized by society,
certain obligations follow. A social contract exists between the public and the
profession. With every right given to the profession by society because of that
social contract, there exists a corresponding responsibility. The members of the
profession must meet recognized criteria or standards. These include
competence; continuing education; adherence to ethical principles and
professional values; commitment, and accountability.
A code of ethics is a criterion for a profession. The American Nurses Association’s
(ANA) Code of Ethics
• stresses the nurse’s obligation to the patient, and the responsibility to be
accountable to self and to the profession.
 American Nurses Association (ANA) Code of Ethics

• Professional nursing values are also found in the ANA Code of Ethics. The nursing code
of ethics provides a framework for ethical decision-making by members of the profession.
• The ANA’s Code of Ethics includes statements on the responsibility of the professional
nurse regarding respect for human dignity, confidentiality, incompetent and unethical
practice of peers, accountability for personal nursing judgments and decisions, and
maintenance of personal competence.
• During the process of making clinical judgments and nursing decisions, professional
nurses must be aware of personal values, values of the profession, the Code of Ethics and
the ethical principles inherent in the practice of nursing.
 Personal and Professional Values

• Personal values are concepts and ideals that provide meaning to a person’s life.
Personal values come from the family, school, religion and the norms of community
and society. Examples are honesty, integrity, and respect for others.
• Professional values are those espoused by a profession.
Two basic values of the nursing profession are competence and compassion (Creasia & Parker 1996).
1. Competency described as the integration of the attitudes, knowledge, skills
required for performance in a specific setting. The concept of competency embraces
the first rule of health care professionals of doing no harm, know as non-maleficence.
Professional incompetence
1. One or more instances involving failure to adhere to the applicable standard of care
to a degree which constitutes gross negligence, as determined by the board;
2. repeated instances involving failure to adhere to the applicable standard of care a
degree which constitutes ordinary negligence, as determined by the board;
3. a pattern of practice or other behavior which demonstrates a manifest incapacity or
incompetence to practice nursing” (Kansas Nurse Practice Act, July 2003).
2. Compassion described as being conscious of the feelings and concerns of
others with the desire to listen and alleviate the distress. Compassion in nursing
implies beneficence and the willingness to carry out professional responsibilities.
• A registered nurse demonstrates competency because of the value of
compassion. Compassion implies that competency is in place in respect to all
nursing actions and behaviors.
 Ethical Principles
• Autonomy – Self-directing freedom. Self-determination
• derived from the Greek auto meaning self nomos meaning law.
• It seems to suggest that you can choose to make decisions on your own by
thinking about the alternatives.
• It also implies that a person has principles or morals to guide the decision-
making.
 Motivation or
intention

Able to
communicat Understanding
e decision

Autunomy
Self awareness

Freedom or
independence

Responsibility

Decision
making skills

Autonomy and its components

Proxy Consent / Legally Acceptable Representative
Proxy Consent / Legally Acceptable Representative
Privacy