NURSING ETHICS

Objectives
➢ At the end of this lecture, the student should be able to:
 Define nursing ethics

 State at least 2 importance of nursing ethics

 Explain at least 4 ethical theories

 Explain at least 5 ethical principles

 List the ICN code of ethics

 Apply ethical theories and principles in solving ethical
issues
Introduction
 Ethics comes from the Greek word, “ethos”
which means ‘morals’

 Ethics – the systematic consideration of morality

 Nursing ethics – the systematic consideration of

morality in nursing practice, management,
education & research
 Ethics – Relevance in Nursing
 Permits people to take a consistent position on
specific or related issues

 Provide an analytical framework by which moral

problems can be discussed & evaluated
 Ethics – Types
 Normative or Prescriptive Ethics
➢ judges morality as good or bad
➢ How should people act?

 Non-Normative or Descriptive Ethics

➢ describes existing morality
➢ What do people think is right?
 Normative ethics
 The term "normative" reflects the ordinary view that some things
are better than others.

 With this classification, a question is raised about what is right or wrong.

 For instance, a teenager who is maintaining a scholarship is pregnant. She is to

decide whether she will abort the baby to avoid issues and being kicked out of
the school or sustain the pregnancy and deliver the baby.
Descriptive ethics

 This type of ethics provides an accurate and realistic

narration of moral behaviours without producing a
moral judgment.

 Descriptive ethics tries to focus on how human beings

actually operate in the real world, rather than attempt
to theorize about how they should operate.
 Descriptive ethics gathers information and observations about what the
choices that people actually make, and if individuals make the same
. choices in different circumstances.

 This branch of ethics deals with topics of situational ethics. For example,
why does an individual steal in one situation, and does not steal in
another situation?
 Should he steal a drug to save his wife, or refrain from theft even though
that would lead to his wife's death?
 Ethical Theories

 Any philosophical attempt to classify morality into

right (good) or wrong (bad)

 Focus – actor, action or consequences

 Actor – Virtue ethical theory

 Action – Deontological ethical theory
 Consequences – Teleological ethical theory
Virtue Ethical Theory
 Judgement is based on the actor’s
character/virtues

 Criticism
 It does not consider a person's change in moral
character which may go unnoticed until a
significant amount of evidence mounts up
against him or her
Virtue Theory

 The virtue theory asks what a "good person" would do in

specific real-life situations.

 This recently revived theory stems from the character

traits discussed by Aristotle, Plato, and Thomas Aquinas.

 They discuss such timeless and cross-cultural virtues as

courage, soberness, wisdom, justice, faith, and charity.
Deontological Ethical
Theory
 Also known as duty ethical theory

 Rightness is determined by conformity to moral

rules/obligations
 Deontology holds that the most important aspects
of our lives are governed by certain unbreakable
moral rules. These rules may not be broken, even
if breaking them may improve an outcome
Deontology
 In other words, they may do the "right" thing, even though the
consequences of that action may not be "good."
 One example of a list of "unbreakable" rules is the Ten Commandments.

 Criticism
 In cases of conflicting duties, it does not provide any guidance
Teleological Ethical Theory

 The term is associated with this philosophy is teleology, from the Greek word
telos, meaning end or the study of ends or final causes.

 Utilitarianism; Proposes that the value of something is determined by its

usefulness.

 This philosophy may also be known as consequentialism, since its main

emphasis is on the outcome or consequence of action.
 Teleological Ethical Theory
 Aka Consequentialism/ Utilitarianism/ Hedonism
ethical theory
 Goodness is measured by consequences
 Based on giving the greatest happiness to the
greatest number of people
 Collective good > the good of an individual
 Certain pleasures (eg. intellectual fulfilment) are
by nature more valuable than other pleasures (eg.
physical desires)
 basically promotes good or valued ends, rather than using the right means.

 .
Simply put, this theory advocates achieving the greatest good for the greatest
number of people.

 It is often advocated as the basis for broad social policies.

 This is to say, the action is right if in the end it creates an overall beneficial
effect
Teleological Ethical
Theory
 Criticisms
➢ Flaws associated with predicting the future
eg. lighting a fire to give warmth → burning
a house

➢ Impossible to compare tangible & intangible

gains (eg., money vs. happiness)

➢ It is not always concerned with justice,

beneficence or autonomy for an individual

.The difference between utilitarianism and deontology is in the focus on
consequences or outcomes.

 Utilitarianism measures the effect that an act will have; deontology looks
to the presence of principle regardless of outcome.
 Ethical Principles
 Ethical principles are the common goals that each
theory tries to achieve in order to be successful
 These goals include
❑ autonomy,
❑ beneficence,
❑ non- maleficence/ malfeasance,
❑ justice,
❑ fidelity,
❑ veracity…
 Ethical Principles
 Autonomy – independence, self determination, self – reliance and respect for
personal choices

 Nursing Implications- Displays respect for all persons, support client’s right to
informed consent; autonomy is truly exercised when members of the
healthcare team agree to the importance of autonomy.
▪ Factors such as immaturity, physical or mental
incapacity may decrease one's autonomy

▪ The only justification for imposing medical treatment

on a patient against his will is to prevent harm to others
Beneficence

➢ Beneficence – Actively seeking benefits; promotion of

good.
▪ Obligation to do good

Nursing Implications; - Promote actions that benefit
clients; seek benefits that provide the least harm;
consider client’s best interest above self interest.
Non-maleficence

 Non-maleficence – Actively seeking to do no harm.

➢ Avoidance of harm

 Nursing Implications – Avoid deliberate harm, risk of

harm, and harm that occurs during performance of
nursing actions; seek to do least harm if benefits must
result in some harm.
Justice

 Justice – Fairness or equity.

▪ Fair, equitable & appropriate distribution of benefits &
risks regardless of gender, race, social class or religion

 Nursing Implications – Ensure fair allocation of resources

such as nursing care to all clients; determines the order
in which clients should be treated eg clients at greater
risk are treated first.
Fidelity

 Fidelity – Faithfulness; striving to keep promises

▪ Obligation to keep one’s word
▪ It holds that a person’s duties & obligations should be
faithfully fulfilled
 Nursing Implications – Keep promises made to clients,
families and other professionals; avoid abandonment of
clients even when client’s goals differ from Healthcare
providers goal.
Veracity

➢ Veracity
▪ Truth telling
 accuracy or conformity to truth. Veracity guides nurses
to practice truthfulness.

▪ This principle compels that truth be completely told, ie,

not withholding information nor giving false information
Confidentiality

 Confidentiality relates to the concept of privacy.

 Information obtained from an individual will not be
disclosed to another unless it will benefit the person or
there is a direct threat to the social good.
The Principle of Confidentiality
 Based on loyalty and trust

 Maintain the confidentiality of all personal, medical

and treatment information

 Information to be revealed with consent and for the

benefit of the patient.

 Except when ethically and legally required

 Disclosure should not be beyond what is required

 Ethical Dilemmas
 Arise when there is conflict between 2 or more ethical
principles & there is the need to decide on the most
appropriate option.

 Eg., when a patient refuses nursing care or treatments that

would benefit his/her health –autonomy vs. beneficence.

 A woman who has contracted HIV/AIDS tells you not to inform

her husband – confidentiality vs. justice.

 A patient comes to a private hospital with gunshot wounds &

tells the nurse not call the police – confidentiality vs. justice.
 Ethical Dilemmas
 Miss B was experiencing excruciating pain during an
improper lumbar puncture, she pleaded with the doctor to
stop. The doctor asked the nurse to prepare an ampoule of
injection lidocaine to continue the procedure. What should
the nurse do ?

 Inappropriate medication orders.

 Mother refuses treatment for a baby.

 Working with an incompetent colleague.

 Unsafe Patient to Nurse Ratio.

 Providing care with possible risk to your health
(eg. TB, HIV, violence).
Ethical Dilemmas

 Pastor James comes to Nurse Gifty as she is leaving the

Sunday service & tells her about a church member who is
on admission at her hospital. The pastor asks her to find
out what her diagnosis is so he can pray specifically for
the patient. Confidentiality and Beneficience

 A nurse who has worked a 12-h (night) shift was asked to

continue to work because there were new accident
casualties to be attended to. Beneficence and Autonomy
ICN Code of Ethics for Nurses
❖ Nurses have 4 fundamental responsibilities:
o Promote health
o Prevent illness
o Restore health
o Alleviate suffering

❖ The ICN Code of Ethics are standards of ethical conduct that guide
nurses’ actions & decision making, & inform the public of nurses’
values & standards

❖ The code has 4 principal sections

o Nurses & People
o Nurses & Practice
o Nurses & the Profession
o Nurses & Co-workers
 Nurses & People
 The nurse’s primary professional responsibility is to people requiring
nursing care
 In providing care, the nurse promotes an environment in which there is
respect for human rights, values, customs & spiritual beliefs of the
individual, family & community.
 The nurse ensures that the individual receives sufficient information on
which to base consent for care & related treatment
 The nurse holds in confidence personal information & uses judgment in
sharing this information
 The nurse shares with society the responsibility for initiating &
supporting action to meet the health & social needs of the public, in
particular those of vulnerable populations
 The nurse also shares responsibility to sustain & protect the natural
environment from depletion, pollution, degradation & destruction.
 Nurses & Practice
 The nurse carries personal responsibility & accountability for nursing
practice, & for maintaining competence by continual learning

 The nurse maintains a standard of personal health such that the ability to
provide care is not compromised

 The nurse uses judgement regarding individual competence when

accepting & delegating responsibility

 The nurse at all times maintains standards of personal conduct which

reflect well on the profession & enhance public confidence

 The nurse, in providing care, ensures the use of technology & scientific
advances are compatible with the safety, dignity & rights of people
Nurses & the Profession
 The nurse assumes the major role in determining &
implementing acceptable standards of clinical nursing
practice, management, research and education

 The nurse is active in developing a core of research-

based professional knowledge

 The nurse, acting through the professional organisation,

participates in creating & maintaining safe, equitable
social & economic working conditions in nursing
Nurses & Co-workers
 The nurse sustains a co-operative
relationship with co-workers in nursing &
other fields

 The nurse takes appropriate action to

safeguard individuals, families &
communities when their health is
endangered by a co-worker(s) or any other
person(s)
Conclusion
 Nurses are faced with many ethical
dilemmas in practice & make decisions that
have ethical implications
 It is recommended that the professional
codes of ethics be regarded as the
cornerstone of nurses’ ethical knowledge
base
 Also, nurses should acknowledge the ethical
standards related to the institutional setting
& cultural environment in which they
practice
 NMC CODE OF CONDUCT/ETHICS
FOR NURSES
As a registered Nurse and or Midwife, you are
expected by the council to observe the following:

❑ Accountability for Professional practice

❑ Individuality of patient, client and their relatives

❑ Protection of confidential information

❑ Consent for care or treatment rendered

❑ Maintainance of professional knowledge and

competence

❑ Identification and minimizing risks to patients, client

and their relatives

❑ Trustworthiness

❑ Collaboration with other professionals in the health

team
Accountability for Professional
practice
 You should be answerable for your action and
omissions regardless of advice or directions
from another professional

 You have a duty to care for patients, client

and their relatives who are entitled to receive
safe and competent care.
 You must adhere to the laws of Ghana as
enshrined in the constitution

 You may delegate care to others who may

or may not be registered Nurses or
Midwives but you remain accountable for
such delegation.
Individuality of patient,
client and their relative
 Acknowledge and respect the role of Patients, clients
and their families as partners in their care and the
contribution they can make to their care, speedy
recovery or peaceful death.

 Ensure that you promote and protect the interest and

dignity of Patients, clients and their relatives.
 Irrespective of gender, age race, ability, sexuality
economic status, culture, religious or political
affiliations

 Avoid any abuse of the privileged relationship which

exists with Patients, client and their relatives and
of the privileged access allowed to their property
residence or workplace.
 Report to a relevant person of authority, at the
earliest possible time, any conscientious
objection that may be relevant to your
professional practice.

 Continue to provide care to the best of your

ability until alternative arrangements are
instituted
Protection of confidential
information
 Respect confidential information obtained in
the course of professional practice and refrain
from disclosing such information without the
consent of the patient, client or relative or
legal guardian, except where such disclosure is
required by law or by order from a court of
jurisdiction or is necessary in the public
interest.
 Ensure that patients, clients and relatives
understand that some information may be
made available to other members of the health
team involved in the delivery of care.

 Seek patient's or clients wishes regarding the

sharing of information with the relatives and
others. When a Patient or client is considered
incapable of giving permission, you must
consult your immediate supervisor.
Consent for care or
treatment rendered
 Acknowledge that patients and clients have a
right to receive information about their
condition, which should be accurate, truthful
and easily understood

 Respect patients' or clients' rights to decide

whether or not to accept any care or
treatment.
 Ensure that informed consents is given
voluntarily by a legally competent person

 Note that consent may be given in writing, orally

or by cooperation , which should be accurately
documented
 Note that consent equally applies to mentally
challenged patients, in such cases; you may consult
Specialists and or relatives.

 Note that witness to given consent must be a close

relative or a legal guardian of the Patient client
 The concern here is that some health workers feel
that the end justifies the means and may not seek
consent before procedures.

 This is especially common in clinical trails { that is

research /experimentation on patients with new
medical tests, drugs or surgical procedures} where
health care personnel are unable to predict all
possible consequences of the test/procedure.
 Closely related to the above is whether clinical
trails should be performed on humans at all since
results are unknown.

 Ethical Resolution: ensure patients right to self-

determination in all care. Nurses should strive
to gain the patients trust and confidence
Maintainance of professional
knowledge and competence
 Keep your knowledge and skills up to date through
out your professional working life.

 Renew your Professional Identification Number (PIN)

within the specified period upon providing evidence
of workshop updates.

 Acknowledge limitations of your professional

competence and only accept responsibilities and
undertake practice for those in which are competent
Identification and minimizing
risks to patients, client and
their relatives
 Work with other members of the team to promote
health care environments that are conducive to
safe, therapeutic and ethical practice

 Act quickly to protect clients from risk if you have

good reasons to believe that you or a colleague,
from your own or another profession, may not be
fit to practise for reasons of conduct, health or
competence
 Ensure the availability and adequacy of basic
resources to function.
 Make known to your immediate supervisors any
circumstance which could place the patient,
client and their relatives in jeopardy or which
militates against safe standards of practice
 In an emergency, in or outside the working setting, you
have a professional duty to provide care. The Care
provided would be judged against what could
reasonably be expected from someone with your
knowledge, skills and abilities when placed in those
particular circumstances
Trustworthiness

 Uphold the reputation of your profession; your

behaviour must at all times bring credit to
profession.

 Avoid the use of professional qualification in

the promotion of the commercial products or
services in order not to compromise the
independence of professional judgements on
which Patients, Clients and relatives rely
 Refuse gift, favour or hospitality which
might be interpreted a seeking to exert
undue influence to obtain preferential
consideration

 Neither ask for nor accept loans from

Patients, Clients or their relatives and
friends
"Collaboration with other
professionals in the health team

 Work in collaboration and in co-operation with

other health professionals, recognise and
respect their particular contributions within the
health team
 Communicate effectively and share your
knowledge, skill and expertise with other
members of the health team for the benefit of
patients, clients and their relatives.
 Ensure accurate documentation of all
procedures and care rendered to patients,
clients and relatives
 VALUES
 Is a personal belief about the worth of a given idea,
attitude, custom, or object that sets standards that
influence behaviour.

 The values that an individual holds reflect cultural and

social influences, relationships and personal needs.
Values vary among people and develop and change over
time.

 Understanding one’s own value system and assessing the

value systems of others helps to facilitate decision
making while ensuring respect for client autonomy.
.
 Ethical values stem from ethical principles.

 Each of these principles consists of various moral rules, which are our
learned values.

 For example, the values of dealing honestly with patients;

 fully informing patients before procedures, therapy, or
 being involved in research; and
 respecting the patient’s personal values are all incorporated under the
principle of autonomy or respect for persons.
 Assessing Patient Values

 A key to making ethical decisions at the bedside is to know what the patient’s
values are.

 In patients too young or incompetent to express their values, it may be

necessary for physicians to make general assumptions about what the normal
person would want in a specific situation or to rely on surrogate decision
making.

 With patients who are able to communicate, however, care must be taken to
discover what their own uncoerced values really are.
.
 A typical ethically dangerous scenario is with a patient who refuses
lifesaving medical intervention "on religious grounds.“

 Typically, the spouse is at the bedside, does most of the talking, and may
be influencing the patient’s decision.

 In those cases, it is incumbent on the clinician to question the patient

alone to assess his or her real values.
VALUES CLARIFICATION
 This is a process of self discovery that helps a
person gain insight into values.

 A person clarify values by learning to make

choices when alternatives are presented and
determines whether choices are carefully
made.
THREE STEPS OF VALUES
CLARIFICATION

 Choosing one’s Beliefs and values

Choosing from alternatives, choosing freely, considering
all consequences.
 Prizing one’s beliefs and behaviours.
Pricing and cherishing the choice, publicly affirming the
choice.
 Acting on one’s beliefs
Making the choice part of one’s behaviour, acting with a
pattern of consistency and repetition.
 CULTURAL VALUES

 Those adopted as a result of the social setting in which a

person lives.
 Ethnocentrism is the belief that one’s own culture is
superior.
 The nurse who holds this belief may assess and plan
intervention for the client, as well as evaluate the
effectiveness of what was done, based on personal
perceptions and values, without taking into account the
perceptions and beliefs of the client.
• The nurse who appreciates values will
accurately identify differences between
personal opinion and the values that others
embrace.
• Through value clarification, the nurse better
serves the needs of clients especially when
values differ.
• The respect demonstrated for client’s
differences, the skill used in helping the client
clarify values, promotes a nurse’s ability to
teach and to heal.
 Bioethics consensus promises to diminish
ethnocentricity by encouraging respect for
unusual points of view while still striving to
come to agreement between all participants
(Moreno, 1995).
 Bioethics consensus proposes a methodology
for processing moral conflict with equal
regard for different points of view.
 It is a technique with a philosophical agenda
to promote respect and agreement rather
than a philosophy or moral system itself.
NURSING POINT OF VIEW
 When ethical dilemmas arise, the nurse’s point of view
plays a vital and essential role.
 The nurse will often acquire information about a client
that is not available to any of the other disciplines
involved.
 Nurses usually interact with clients over longer time
intervals than do other disciplines.
 In addition since nurses may be involved in very intimate
physical acts such as bathing, feeding and special
procedures, clients and families are revealing information
not generally solicited by physician or social workers.
 On the other hand, it is important for nurses to
remember that care of any one client has become
multidisciplinary and fragmented.
 The nursing point of view is part of a larger picture
that is best built by all members of the health care
team, including the client and family.
 Wherever the ethical issue arises, the nursing point of
view is valuable and essential.
 It is both an obligation and a privilege for the
professional nurse to accumulate information on the
issues, examine personal values, and share knowledge
with clients and colleagues in an effort to address the
difficult issues that constitute ethical dilemmas in
health care.
INSTITUTIONAL ETHICS COMMITTEES

 Most health care institutions use an

ethics committee to process ethical
dilemmas. These committees are
generally multidisciplinary.
 Functions

 To offer education in ethics to diverse

populations: clients, families, professionals
institutional staff and community members.
 To assist institutions in the development and
review of policies related to ethical
responsibilities
 To ensure that policies are implemented and
understood by ever-changing groups of
practitioners
 To serve as resource persons or consultants for
specific client situations with ethical dimensions.