Principles of ethics

 History: after the ww II a lot of problems arose that

gave birth to bioethics to addressed the moral issues
in the field of health care, due to the increased
confusion over the invention of morden advance
equipments for health, which increase responsibility
and distress among health care professionals.
 So in 1950s, scientists and medical professionals began
to meet to address these confusing problem.
 So a health care policies and laws were enacted to
address questions of who lives? Who dies? And who
decides?. (Jonsen,1998, 2000, 2005)

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  In 1976, another commission was charged to look into
how humans were been used for research as subjects,
so in 1978 the commission released its report called
‘The Belmont Report’
 The report outline three basic principles for all human
subjects in research.
 Respect for persons, beneficence, and justice.
(National Institution of Health, 1979)

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  So in 1979, the first edition of a book was published by
Beauchamp and Childress ‘Principles of Bioemedical
Ethics’ which featured four bioethical principles:
Autonomy, nonmaleficence, beneficence and justice.
 Doing ethics based on the use of principle is termed
‘ethical principlism’ and this provides guidelines
that can be used to make justified moral decisions and
to evaluate the morality of the actions.
 When using this approach no one principle should
automatically be assumed to be superior to the other
principles.

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  The basic definitions of each of the four principles of
health care ethics are commonly known and used
often in the English language, but they take on special
meaning when being utilized in a medical setting.
 All of these principles play a key role in ensuring
optimal patient safety and care.

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Principle of Autonomy
 Autonomy ( self-respect): is the freedom and ability to
act in a self-determined manner.
 It denotes the right of a rational person to generate
personal decisions independent of outside
interference.
 This presumes that individuals are always capable of
making independent choices for themselves.
 The nurse must ensure that respect for an individual’s
autonomy is not regarded in favor of what another person
may view as best for the patient.
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  In medicine, autonomy refers to the right of the patient to
retain control over his or her body.
 A health care professional can suggest or advise, but any
actions that attempt to persuade or coerce the patient into
making a choice are violations of this principle.
 In the end, the patient must be allowed to make his or her
own decisions – whether or not the nurse believes these
choices, are in that patient’s best interests – independently
and according to his or her personal values and beliefs.

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  The patients have the right to decide for themselves in
regard to the treatment plan, provided that they
receive complete, accurate and comprehensive
information.
 Respect of patient’s autonomy include:
 Obtaining informed consent for treatment,
facilitating and supporting patient’s choice regarding
treatment options, allowing patient to refuse
treatment, etc.

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 Limitations:
 Restriction of individual’s autonomy may occur in cases
where a person presents a potential for harm to others such
as:
 Exposing other people to communicable disease
 Act of violence.
 It gives us a negative duty not to interfere with the
decisions of competent adults,
 A positive duty to empower others for whom we’re
responsible.
 Supine before law court

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Principle of Beneficence
 Beneficence consist of deeds of ‘mercy, kindness, and
charity’( Beauchamp & Childress, 2001).
 Beneficence means that people take actions to benefit
and to promote the welfare of other people.
 To ensure beneficence, nurses must develop and
maintain a high level of skill and knowledge, make
sure that they are trained in the most current and best
medical practices, and must consider their patients’
individual circumstances, ‘what is good for one
patient will not necessary benefit another.’

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  Sometimes there are limits to the good that nurses can
do, but nurses are directed in the code of ethics to
always place their patient’s interest and well-being as
their primary concern
 So nurses have the obligation to act according to the
principle of beneficence
 Doing good toward and facilitating the well-being of
one’s patient is an integral part of being a moral nurse.

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Principle of Nonmaleficence
 Nonmalficence is the principle used to communicate
the obligation to “ do no harm.”
 Health care professionals have historically been
encouraged to do ‘good’ (beneficence), but if for so
reason they can not be good, they generally are
required to at least do no harm.
 These two principle are like ‘two side of the same coin’

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  Nonmalficence is the norm that ‘one ought not to
inflict evil or harm’
 Best practice and due care standards are adapted to
minimize harm to patients
 This is done through oversight procedures to ensure
that health care providers maintain the competency
and skills needed to properly care for patients.

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  The need to be mindful of its implications;
 The need to avoid negligent care,
 The need to avoid harm when deciding to withhold or
withdraw a patient’s treatment
 Where harm cannot be avoided, we are obligated to
minimize the harm we do.
 It is wrong to waste resources that could be used for
good.

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Principle of justice
 Justice in health care ethics refers to fairness, treating
people equally and the equitable distribution of
benefits and burden.
 It’s sometimes referred to as distributive justice and its
basic premise lies in the right of individuals to be treated
equally regardless of race, gender, marital status, medical
diagnoses, social standing, economic level, or religious
belief.
 The concept reflects a duty to treat all individuals equally,
fairly and impartially

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  Impose no unfair burdens
 Eg: ‘who has a right to health care, who will pay for health
care cost, etc.’ these are questions that are asked when it
time for resource allocation.
 Social justice: this is thought in terms of how benefits and
burdens should be distributed fairly among members of
the society
 How all people in the society should have same rights,
benefits, and opportunities.
 This seeks the common good of the community instead of
individual freedom.

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  The rights based justice: deals with respect to people’s
rights rather than the law. It is believed that and
especially in healthcare industry that all individuals
have equal rights in terms of seeking healthcare and to
participate in their plan of care.
 Nurses must be fair when they distribute care, for
example, among the patients in the group of patients
that they are taking care of.
 Care must be fairly, justly, and equitably distributed
among a group of patients.

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Principle of veracity
 The principle of veracity refers to ones duty always to be
truthful.
 Veracity requires that the healthcare provider tell the truth and
not intentionally deceive or mislead clients.
 There are times when limitations must be placed on this
principle such as when the truth would knowingly produce
harm or interfere with recovery process.
 Truths maybе told in many ways, and the manner of telling the
truth to а patient is perhaps as important as the truth itself.
Within ophthalmology, this fact is most deeply felt when there
has been acute visual loss which mау or mау not bе reversible.
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  nurses must not withhold the whole truth from
clients even when it may lead to patient distress.

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6 specific principles nurses should
adhered to in every situation.
NONMALFICENCE: Remain
competent in the field and
report suspected abuse

BENEFICENCE: Have
compassion, take positive
JUSTICE, Treat all patients
actions to help others and
fairly and equally
follow through the desire to
do good

PRINCIPLE OF TOTALITY &

INTEGRITY, Consider the
FIDELITY, Keep
entire person when deciding
commitments base on virtue
which therapy, medication
of caring
or procedure a patient
should receive.

AUTONOMY, Respect
patient’s wishes, even when
you do not agree with them

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6 specific principles nurses should
adhered to in every situation.
AUTONOMY :
 Respect patient’s wishes even when you don’t agree
with them
BENEFICENCE:
 Have compassion, take positive actions and help
others and follow through the desire to do good
NONMALFICENCE:
 Remain competent in the field and report suspected
above.

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 FIDELITY :
 Keep commitment base on virtue of caring.
 The nurse must be faithful and true to their
professional promises and responsibilities by
providing high quality, safe care in a competent
manner.
TOTALITY AND INTEGRITY:
 Consider the entire person when deciding on which
therapy, medication, or procedure a patient should
receive.
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  Accountability: is accepting responsibility for one's
own actions.
 Nurses are accountable for their nursing care and
other actions.
 They must accept all of the professional and personal
consequences that can occur as the result of their
actions.

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ETHICAL ISSUES
 Nurses have the responsibility to identify ethical issues that
affect staff members and patients;
 they also have the responsibility to inform staff members
and affected clients of ethical issues that can and do
affected client care.
 Eg: providing nursing care for clients undergoing an
abortion may raise ethical and moral concerns and issues
for some nurses;
 and some patients may be affected with a liver transplant
rejection because donor livers are not abundant enough to
meet the needs of all patients who request it.
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  Although a rare occasions, a patient may, at times, ask you to do
something that is not ethical.
 For example, a patient may ask a nurse to assist in their suicide
at the end their life
 they may inquire about another patient in terms of their
diagnosis. When something like this occurs, the nurse must
inform the client that they cannot do it for ethical and legal
reasons.
 Clients may also need information about how ethics can affect
the care that they choose or reject.
 For example, a client may ask the nurse about whether or not it is
permissible ethically and legally to reject CPR at the end of life or
to take pain medications even if it hastens their death.


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  hypothetical case study:
 This involves a patient who has an ovarian cyst, that if left
untreated, will result in kidney failure.
 An operation to remove the cyst is the best treatment, but
the patient is frightened of needles and is against the
surgery that would require a needle to give her anesthesia.
 The doctor must work with the patient to respect the fact
that she dislikes needles and doesn’t want the operation
(her autonomy)
 and the needs to find a solution that would prevent her
from going into kidney failure, which is in her best interest
(beneficence).
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  Although the surgery is the best choice, forcing the patient
to accept the needle would be harmful to her
(non-maleficence).
 Finally, the doctor needs to consider the impact that the
patient’s choices might have on others if she starts to go
into preventable kidney failure,
 she’ll need dialysis, which affects other people who need
the same treatment (justice).
 So before making the final decision the doctor must
consider all four principles of health care ethics, which will
help the physician make the choice that will have the best
possible benefits for both the patient and society.


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