CONTENTS

I. Nursing Theorists
A. Hildegard Peplau’s Interpersonal Relations Model
B. Imogene King’s Goal Attainment Theory
C. Jean Watson’s Human Caring Theory
D. Maslow’s Hierarchy of Needs

II. Ethical Theories

1. Deontology
2. Teleology
3. Utilitarianism

III. Virtue Ethics

1. Virtues Ethics in Nursing
2. Core Values of a Professional

IV. Ethical Principles

1. Autonomy
a) Patient’s Rights
b) Patient’s Bill of Rights
c) Informed Consent
d) Proxy Consent/Legally Acceptable Representative
e) Confidentiality
f) Privacy
2. Confidentiality
3. Veracity
a) Truth Telling and Right to Information
4. Fidelity
5. Justice
6. Beneficence
7. Non-maleficence
 I. Nursing Theorists

A. Hildegard Peplau’s Interpersonal Relations Model

Hildegard Peplau, a psychiatric nurse, introduced her interpersonal concepts in 1952. Central to
Peplau’s theory is the existence of a therapeutic relationship between the nurse and the client.
Nurses enter into a personal relationship with an individual when a need is present. The nurse–
client relationship evolves in four phases:
1. Orientation. The client seeks help and the nurse assists the client to understand the
problem and the extent of the need for help.
2. Identification. The client assumes a posture of dependence, interdependence, or
independence in relation to the nurse (relatedness). The nurse’s focus is on ensuring the
individual that the nurse understands the interpersonal meaning of the client’s situation.
3. Exploitation. The client derives full value from what the nurse offers through the
relationship. The client uses available services based on self-interest and needs. Power
shifts from the nurse to the client.
4. Resolution. In the final phase, old needs and goals are put aside and new ones adopted.
Once older needs are resolved, newer and more mature ones emerge.

B. Imogene King’s Goal Attainment Theory

Imogene King’s theory of goal attainment (1981) was derived from her conceptual framework
(below). King’s framework shows the relationship of personal systems (individuals), interpersonal
systems (groups such as nurse–client), and social systems (such as educational system, health
care system). She selected 15 concepts from the nursing literature (self, role, perception,
communication, interaction, transaction, growth and development, stress, time, personal space,
organization, status, power, authority, and decision making) as essential knowledge for use by
nurses.
King’s theory offers insight into nurses’ interactions with individuals and groups within the
environment. It highlights the importance of a client’s participation in decisions that influence
care and focuses on both the process of nurse–client interaction and the outcomes of care. King
believes that her theory, used in evidence theory-based practice, blends the art and the science
of nursing.

C. Jean Watson’s Human Caring Theory

Jean Watson believes the practice of caring is central to nursing; it is the unifying focus for
practice. Nursing interventions related to human care originally referred to as carative factors
have now been translated into 10 clinical caritas processes (Watson, 2013):
1. Embrace altruistic values and practice loving kindness with self and others.
2. Instill faith and hope and honor others.
3. Be sensitive to self and others by nurturing individual beliefs and practices.
4. Develop helping–trusting, human caring relationships.
5. Promote and accept positive and negative feelings as you authentically listen to
another’s story.
6. Use creative scientific problem-solving methods for caring decision making.
7. Share teaching and learning that addresses the individual needs and comprehension
styles.
8. Create a healing environment for the physical and spiritual self which respects human
dignity.
9. Assist with basic physical, emotional, and spiritual human needs.
10. Open to mystery and allow miracles to enter.

A survey has been created and tested that measures these processes used by nurses in caring for
clients (DiNapoli, Nelson, Turkel, & Watson, 2010).

D. Maslow’s Hierarchy of Needs

U.S. Psychologist Abraham Maslow was a practitioner of humanistic psychology. He is known for
his theory of “self-actualization.” In the books Motivation and Personality and Toward a
Psychology of Being, Maslow argued that each person has a hierarchy of needs that must be
satisfied.

Our most basic need is for physical survival, and this will be the first thing that motivates our
behavior. Once that level is fulfilled the next level up is what motivates us, and so on.

1. Physiological needs - these are biological requirements for human survival, e.g. air, food,
drink, shelter, clothing, warmth, sex, sleep.

If these needs are not satisfied the human body cannot function optimally. Maslow considered
physiological needs the most important as all the other needs become secondary until these
needs are met.
2. Safety needs - protection from elements, security, order, law, stability, freedom from fear.

3. Love and belongingness needs - after physiological and safety needs have been fulfilled, the
third level of human needs is social and involves feelings of belongingness. The need for
interpersonal relationships motivates behavior

Examples include friendship, intimacy, trust, and acceptance, receiving and giving affection and
love. Affiliating, being part of a group (family, friends, work).

4. Esteem needs - which Maslow classified into two categories: (i) esteem for oneself (dignity,
achievement, mastery, independence) and (ii) the desire for reputation or respect from
others (e.g., status, prestige).

Maslow indicated that the need for respect or reputation is most important for children and
adolescents and precedes real self-esteem or dignity.

5. Self-actualization needs - realizing personal potential, self-fulfillment, seeking personal

growth and peak experiences. A desire “to become everything one is capable of becoming
II. Ethical Theories

1. Deontology
 Its foundations come from the work of an eighteenth-century philosopher,
Immanuel Kant (1724-1804).
 It defines actions as right or wrong based on their “right-making characteristics”
such as fidelity to promises, truthfulness, and justice.
 It does not look to consequences of actions to determine right or wrong; instead,
it examines a situation for the existence of essential right or wrong
 If an act is just, respects autonomy, and provides good, it will be right, and it will
be ethical according to this philosophy.
 Also called Principles-Based Theories, involve logical and formal processes and
emphasize individual rights, duties, and obligations.

Application to Bioethics:
For example, if you try to make a decision about the ethics of a controversial medical
procedure, deontology guides you to focus on how the procedure ensures fidelity to the
patient, truthfulness, justice, and beneficence. You focus less on the consequences
(ethically speaking).

2. Teleology
 from the Greek word telos, meaning “end,” or the study of ends or final causes
 John Stuart Mill (1806-1873), a British philosopher, first proposed its
philosophical foundations.
 looks to the presence of principle regardless of outcome.
 Also called Consequence-Based Theories, look to the outcomes (consequences)
of an action in judging whether that action is right or wrong.
 Teleological theories focus on issues of fairness.

3. Utilitarianism
 A one form of consequentialist theory, it views a good act as one that is the most
useful—that is, one that brings the most good and the least harm to the greatest
number of people. This is called the principle of utility.
 The Principle of Utility says: a person should choose that action which produce
the greatest good for the greatest number of people affected by the alternatives
open to him.
 This approach is often used in making decisions about the funding and delivery
of health care.
 Utilitarianism measures the effect that an act will have.

Application to Bioethics:
In August 2000, conjoined twins, named Mary and Jodie were born in a hospital in
Manchester England. Their spines were fused, and they had one heart and one pair of
lungs between them. Jodie, the stronger one, was providing blood for her sister. The
prognosis was that without intervention, both girls would die within six months. The only
hope was an operation to separate them. This would save Jodie, but Mary would die
immediately. Thus, there were two options:
(a) Not intervene and see both babies die, or
(b) Intervene and save one life, Jodie.

What is the acceptable course of action?

According to utilitarian, we need to decide which course of action will produce the
greatest good for the greatest number of people affected by the action. It is plausible to
interpret utilitarianism as supporting alternative (b). Surely it is better to save one life
rather than not.
III. Virtue Ethics

1. Virtue Ethics in Nursing

 Virtue ethics is ethics based on character. Its fundamental idea is that a person who
has acquired the proper set of dispositions will do what is right when faced with a
situation involving a moral choice.
 Thus, virtue ethics doesn’t involve invoking principles or rules to guide actions.
 The virtuous person is both the basic concept and the goal of virtue ethics. The
virtuous person is one who acts right, because she is just that sort of person.
 Right actions flow out of character, and the virtuous person has a disposition to do
the right thing. Rules need not be consulted, calculations need not be performed,
abstract duties need not be considered.
 In medical contexts, virtue ethics calls attention to the central role which such virtues
as courage, loyalty, integrity, compassion, and benevolence, along with determination
and intelligence, should play in the practices of medical providers.

2. Core Values of a Professional

 Core values are a set of fundamental beliefs, ideals or practices that inform how you
conduct your life, both personally and professionally.
 Values are learned through observation and experience. As a result, they are heavily
influenced by a person’s sociocultural environment— that is, by societal traditions; by
cultural, ethnic, and religious groups; and by family and peer groups.
 Nurses should keep in mind the influence of values on health. For example, some
cultures value treatment by a folk healer over that by a physician.
 People derive values from society and their individual subgroups, they internalize
some or all of these values as personal values. People need societal values to feel
accepted, and they need personal values to have a sense of individuality.
 Nurses’ professional values are acquired during socialization into nursing from codes
of ethics, nursing experiences, teachers, and peers.
 The American Association of Colleges of Nursing (2008) identified five values essential
for the professional nurse: altruism, autonomy, human dignity, integrity, and social
justice.
IV. Ethical Principles
1. Autonomy
 Autonomy refers to the right to make one’s own decisions.
 Honoring the principle of autonomy means that the nurse respects a client’s right
to make decisions even when those choices seem to the nurse not to be in the
client’s best interest.

A. Patient's Rights
1. The patient has the right to consider and respectful care.
2. The patient has the right to obtain from his physician complete current
information concerning his diagnosis, treatment and progress in terms the patient
can be reasonably expected to understand.
3. The patient has the right to receive from his physician information necessary to
give informed consent prior to the start of any procedure and /or treatment.
Where medically significant alternatives for care treatment exist, or when the
patient requests information concerning medical alternatives, the patient has the
right to such information and to know the name of the person responsible for the
procedures and/or treatment.
4. The patient has the right to refuse treatment to the extent permitted by law, and
to be informed of the medical consequences of his action.
5. The patient has the right to every consideration of his privacy concerning his own
medical care program.
6. The patient has the right to expect that all communication and records pertaining
to his care should be treated confidential.
7. The patient has the right to expect that within its capacity a lying – in must make
reasonable response to the request of a patient for services.
8. The patient has the right to obtain information as to any relationship of his lying –
into other health care and educational institutions in so far as his care is concerned
and any professional relationship among individuals, by name, who are treating
them.
9. The patient has the right to expect continuity of care.
10. The patient has the right to examine and receive an explanation of his bill
regardless of source of payment.
11. The patient has right to know what lying-in rules and regulations apply to his/her
contract as patient.

B. Patient's Bill of Rights (Philippines)

A. The following rights of the patient shall be respected by all those involved in
his care:

1. Right to Appropriate Medical Care and Humane Treatment.

 Every person has a right to health and medical care corresponding to his state
of health, without any discrimination and within the limits of the resources,
 manpower and competence available for health and medical care at the
relevant time.
 The patient has the right to appropriate health and medical care of good
quality.
 In the course of such care, his human dignity, convictions, integrity, individual
needs and culture shall be respected.
 If any person cannot immediately be given treatment that is medically
necessary, he shall, depending on his state of health, either be directed to wait
for care, or be referred or sent for treatment elsewhere, where the
appropriate care can be provided. If the patient has to wait for care, he shall
be informed of the reason for the delay.
 Patients in emergency shall be extended immediate medical care and
treatment
 without any deposit, pledge, mortgage or any form of advance payment for
treatment.

2. Right to Informed Consent.

 The patient has a right to a clear, truthful and substantial explanation, in a
manner and language understandable to the patient, of all proposed
procedures, whether diagnostic, preventive, curative, rehabilitative or
therapeutic, wherein the person who will perform the said procedure shall
provide his name and credentials to the patient, possibilities of any risk of
mortality or serious side effects, problems related to recuperation, and
probability of success and reasonable risks involved: Provided, That, the
patient will not be subjected to any procedure without his written informed
consent, except in the following cases:
a. In emergency cases, when the patient is at imminent risk of physical
injury, decline or death if treatment is withheld or postponed. In such
cases, the physician can perform any diagnostic or treatment procedure as
good practice of medicine dictates without such consent;
b. When the health of the population is dependent on the adoption of a
mass health program to control epidemic;
c. When the law makes it compulsory for everyone to submit to a
procedure;
d. When the patient is either a minor, or legally incompetent, in which
case, a third-party consent is required;
e. when disclosure of material information to patient will jeopardize the
success of treatment, in which case, third party disclosure and consent
shall be in order;
f. When the patient waives his right in writing.
 Informed consent shall be obtained from a patient concerned if he is of legal
age and of sound mind. In case the patient is incapable of giving consent and
 a third-party consent is required, the following persons, in the order of priority
stated hereunder, may give consent:
a. spouse;
b. son or daughter of legal age;
c. either parent;
d. brother or sister of legal age, or
e. guardian
 If a patient is a minor, consent shall be obtained from his parents or legal
guardian.
 If next of kin, parents or legal guardians refuse to give consent to a medical or
surgical procedure necessary to save the life or limb of a minor or a patient
incapable of giving consent, courts, upon the petition of the physician or any
person interested in the welfare of the patient, in a summary proceeding, may
issue an order giving consent.

3. Right to Privacy and Confidentiality.

 The privacy of the patients must be assured at all stages of his treatment. The
patient has the right to be free from unwarranted public exposure, except in
the following cases:
a) when his mental or physical condition is in controversy and the
appropriate court, in its discretion, orders him to submit to a physical or
mental examination by a physician;
b) when the public health and safety so demand; and
c)when the patient waives this right.
 The patient has the right to demand that all information, communication and
records pertaining to his care be treated as confidential. Any health care
provider or practitioner involved in the treatment of a patient and all those
who have legitimate access to the patient's record is not authorized to divulge
any information to a third party who has no concern with the care and welfare
of the patient without his consent, except:
a) when such disclosure will benefit public health and safety;
b) when it is in the interest of justice and upon the order of a competent
court; and
c) when the patients waives in writing the confidential nature of such
information;
d) when it is needed for continued medical treatment or advancement of
medical science subject to de-identification of patient and shared medical
confidentiality for those who have access to the information.
 Informing the spouse or the family to the first degree of the patient’s medical
condition may be allowed; Provided, That the patient of legal age shall have
the right to choose on whom to inform. In case the patient is not of legal age
or is mentally incapacitated, such information shall be given to the parents,
legal guardian or his next of kin.
4. Right to Information.
 In the course of his/her treatment and hospital care, the patient or his/her
legal guardian has a right to be informed of the result of the evaluation of the
nature and extent of his/her disease, any other additional or further
contemplated medical treatment on surgical procedure or procedures,
including any other additional medicines to be administered and their generic
counterpart including the possible complications and other pertinent facts,
statistics or studies, regarding his/her illness, any change in the plan of care
before the change is made, the person’s participation in the plan of care and
necessary changes before its implementation, the extent to which payment
maybe expected from Philhealth or any payor and any charges for which the
patient maybe liable, the disciplines of health care practitioners who will
furnish the care and the frequency of services that are proposed to be
furnished.
 The patient or his legal guardian has the right to examine and be given an
itemized bill of the hospital and medical services rendered in the facility or by
his/her physician and other health care providers, regardless of the manner
and source of payment. He is entitled to a thorough explanation of such bill.
 The patient or his/her legal guardian has the right to be informed by the
physician or his/her delegate of his/her continuing health care requirements
following discharge, including instructions about home medications, diet,
physical activity and all other pertinent information to promote health and
well-being.
 At the end of his/her confinement, the patient is entitled to a brief, written
summary of the course of his/her illness which shall include at least the
history, physical examination, diagnosis, medications, surgical procedure,
ancillary and laboratory procedures, and the plan of further treatment, and
which shall be provided by the attending physician. He/she is likewise entitled
to the explanation of, and to view, the contents of the medical record of
his/her confinement but with the presence of his/her attending physician or
in the absence of the attending physician, the hospital’s representative.
 Notwithstanding that he/she may not be able to settle his accounts by reason
of financial incapacity, he/she is entitled to reproduction, at his/her expense,
the pertinent part or parts of the medical record the purpose or purposes of
which he shall indicate in his/her written request for reproduction. The patient
shall likewise be entitled to medical certificate, free of charge, with respect to
his/her previous confinement.
 The patient has likewise the right not to be informed, at his/her explicit
request.

5. The Right to Choose Health Care Provider and Facility.

 The patient is free to choose the health care provider to serve him as well as
the facility except when he is under the care of a service facility or when public
 health and safety so demands or when the patient expressly or impliedly
waives this right.
 The patient has the right to discuss his condition with a consultant specialist,
at the patient’s request and expense. He also has the right to seek for a second
opinion and subsequent opinions, if appropriate, from another health care
provider/practitioner.

6. Right to Self-Determination.
 The patient has the right to avail himself/herself of any recommended
diagnostic and treatment procedures. Any person of legal age and of sound
mind may make an advance written directive for physicians to administer
terminal care when he/she suffers from the terminal phase of a terminal
illness: Provided, that
a) he is informed of the medical consequences of his choice;
b) he releases those involved in his care from any obligation relative to the
consequences of his decision;
c) his decision will not prejudice public health and safety.

7. Right to Religious Belief.

 The patient has the right to refuse medical treatment or procedures which
may be contrary to his religious beliefs, subject to the limitations described in
the preceding subsection: Provided, That such a right shall not be imposed by
parents upon their children who have not reached the legal age in a life
threatening situation as determined by the attending physician or the medical
director of the facility.

8. Right to Medical Records.

 The patient is entitled to a summary of his medical history and condition, He
has the right to view the contents of his medical records, except psychiatric
notes and other incriminatory information obtained about third parties, with
the attending physician explaining contents thereof. At his expense and upon
discharge of the patient, he may obtain from the health care institution a
reproduction of the same record whether or not he has fully settled his
financial obligation with the physician or institution concerned.
 The health care institution shall safeguard the confidentiality of the medical
records and to likewise ensure the integrity and authenticity of the medical
records and shall keep the same within a reasonable time as may be
determined by the Department of Health.
 The health care institution shall issue a medical certificate to the patient upon
request. Any other document that the patient may require for insurance
claims shall also be made available to him within a reasonable period of time.
9. Right to Leave.
 The patient has the right to leave a hospital or any other health care institution
regardless of his physical condition: Provided, That
a) he/she is informed of the medical consequences of his/her decision;
b) he/she releases those involved in his/her care from any obligation
relative to the consequences of his decision;
c) his/her decision will not prejudice public health and safety.
 No patient shall be detained against his/her will in any health care institution
on the sole basis of his failure to fully settle is financial obligations. However,
he/she shall only be allowed to leave the hospital provided appropriate
arrangements have been made to settle the unpaid bills: Provided, farther,
that unpaid bills of patients shall be considered as lost income by the hospital
and health care provider/practitioner and shall be deducted from gross
income as income loss for that particular year.

10. Right to Refuse Participation in Medical Research.

 The patient has the right to be advised if the health care provider plans to
involve him in medical research, including but not limited to human
experimentation which may be performed only with the written informed
consent of the patient. Provided, further, That, an institutional review board
or ethical review board in accordance with the guidelines set in the Declaration
of Helsinki be established for research involving human experimentation:
Provided, finally, That the Department of Health shall safeguard the
continuing training and education of future health care
provider/practitioner to ensure the development of the health care
delivery in the country.

11. Right to Correspondence and to Receive Visitors.

 The patient has the right to communicate with relatives and other persons and
to receive visitors subject to reasonable limits prescribed by the rules and
regulations of the health care institution.

12. Right to Express Grievances.

 The patient has the right to express complaints and grievances about the care
and services received without fear of discrimination or reprisal and to know
about the disposition of such complaints. The Secretary of Health, in
consultation with health care providers, consumer groups and other
concerned agencies shall establish a grievance system wherein patients may
seek redress of their grievances. Such a system shall afford all parties
concerned with the opportunity to settle amicably all grievances.
13. Right to be Informed of His Rights and Obligations as a Patient.
 Every person has the right to be informed of his rights and obligations as a
patient. The Department of Health, in coordination with health care providers,
professional and civic groups, the media, health insurance corporations,
people’s organizations, local government organizations, shall launch and
sustain a nationwide information and education campaign to make known to
people their rights as patients, as declared in this Act. Such rights &d
obligations of patients shall be posted in a bulletin board conspicuously placed
in a health care institution.
 It shall be the duty of health care institutions to inform patients of their rights
as well as the institution's rules and regulations that apply to the conduct of
the patient while in the care of such institution.

C. Informed Consent
 "Consent given by a competent individual who:
- Has received the necessary information (verbally and in writing).
- Has adequately understood the information.
- After considering the information, has arrived at a voluntary decision
without having been subjected to undue influence or inducement, or
intimidation."
 Creation of Informed Consent Documents
o Use local language
o Write to appropriate reading level
o Illustrate with appropriate concepts, drawings, images or videos
o In cases of emergency, interventions to save the life of the patient can be
done without the patient’s consent.

 Essential Elements of Informed Consent

o Procedure Description
 The procedure to be done
 Objectives of the procedure
 Expected responsibilities
 Steps involved
o Alternatives
 Alternative procedures
 Advantages and disadvantages of each
 Availability
o Benefits
 Reasonably expected
 Not exaggerated
 Duration
o Risks
 Anticipated
 Physical, social, psychological
  Likelihood, severity, duration
o Confidentiality
 Degree of confidentiality
 Indicate persons or organizations which will have access to the
information
 Anticipated future use of data or samples
o Voluntary approval or refusal
 Absolutely voluntary
 Has the right to refuse at any time
 No penalty for refusal
o Documentation
 Part of the informed consent process
 Signatures: Person, Guardian, Legal representative, Witness
 Ethics committee review and approval
o Contact Persons
 Member of the medical or surgical team
 Special groups

What should occur if the patient cannot give informed consent?

 If the patient is incapacitated/incompetent, a surrogate decision maker must
speak for him.
 There is a specific hierarchy of appropriate decision makers defined by law.
 If no appropriate surrogate decision maker is available, the physicians are
expected to act in the best interest of the patient until a surrogate is found or
appointed.

These include a ranking order and act in a person’s best interests:

1. Personal care guardian
2. Attorney for personal care
3. Representative appointed by Consent and Capacity Board
4. Spouse or partner
5. Child or parent or individual/agency entitled to give or refuse consent instead of
parent
6. Parent with right of access only
7. Brother or sister
8. Any other relative
9. Public guardian and Trustee

What is the scope of consent? Generally, limited to specific procedure.

Extending. Caution advised when treatment exceeds the scope of consent.
1. General Consent. When a patient consent to treatment of a CONDITION rather
than a specific procedure, the scope of treatment involves all measures
reasonably necessary to treat the condition.
 2. Unexpected Circumstances. When an unexpected condition arises while
performing a consented procedure and the patient is unable to grant consent, the
doctor must use medical JUDGEMENT to decide on the appropriate action. If time
allows the doctor should consult the FAMILY or other LEGAL representative.

Limiting
1. Limited to a particular procedure or prohibit a particular procedure.
2. Except in emergency, the doctor is bound by these limits.
3. The doctor should try to convince the patient to forgo such limitations
when in his medical judgment such procedure might be necessary.

Who may consent?

 The law presumes that patients 18 and over are competent to give consent to
treatment.
 For minors the doctor must look to the parents or legal guardian for consent.
 Substituted consent must also be sought for incompetent adults and for those
whose judgment is impaired by their condition or medication.

D. Proxy Consent/Legally Acceptable Representative

 Proxy consent is the process by which people with the legal right to consent to
medical treatment for themselves or for a minor or a ward delegate that right to
another person. There are three fundamental constraints on this delegation:
1. The person making the delegation must have the right to consent.
2. The person must be legally and medically competent to delegate the right to
consent.
3. 3. The right to consent must be delegated to a legally and medically competent
adult.
 There are two types of proxy consent for adults. The first, the power of attorney
to consent to medical care, is usually used by patients who want medical care but
are concerned about who will consent if they are rendered temporarily
incompetent by the medical care. A power of attorney to consent to medical care
delegates the right to consent to a specific person. The second type is the living
will.

E. Confidentiality
o The concept of confidentiality in health care is widely respected. Federal
legislation known as the Health Insurance Portability and Accountability Act of
1996 (HIPAA) mandates the protection of patients’ personal health information.
The legislation defines the rights and privileges of patients for protection of
privacy. It establishes fines for violations.
o Confidentiality protects private patient information once it has been disclosed in
health care settings. Patient confidentiality is a sacred trust. Nurses help
organizations protect patients’ rights to confidentiality.
 F. Privacy
o The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
represents one of the more recent federal statutory acts affecting nursing
care. This law provides rights to patients and protects employees.
o In the privacy section of the HIPAA, there are standards regarding
accountability in the health care setting. These rules create patient rights to
consent to the use and disclosure of their protected health information, to
inspect and copy one’s medical record, and to amend mistaken or incomplete
information. It limits who is able to access a patient’s record. It establishes the
basis for privacy and confidentiality concerns, viewed as two basic rights
within the U.S. health care setting.
o Privacy is the right of patients to keep personal information from being
disclosed.

2. Confidentiality
 Confidentiality means that any information a participant relates will not be made
public or available to others without the participant’s consent.

3. Veracity
a. Truth Telling and Right to Information
 Veracity refers to telling the truth. Although this seems straight- forward, in
practice, choices are not always clear. Should a nurse tell the truth when it is
known that it will cause harm? Does a nurse tell a lie when it is known that the
lie will relieve anxiety and fear? Lying to sick or dying people is rarely justified.
The loss of trust in the nurse and the anxiety caused by not knowing the truth,
for example, usually outweigh any benefits derived from lying.
 For example, clients may not value truth-telling for life-threatening conditions,
because this may eliminate hope and, therefore, hasten death. Family
members may request that the client not be told of his or her diagnosis.
(Ethic/cultural variation)

4. Fidelity
 It means to be faithful to agreements and promises.
 By virtue of their standing as professional caregivers, nurses have responsibilities to
clients, employers, government, and society, as well as to themselves.
 Nurses often make promises such as “I’ll be right back with your pain medication” or
“I’ll find out for you.”
 Clients take such promises seriously, and so should nurses.

5. Justice
 It is frequently referred to as fairness. Nurses often face decisions in which a sense of
justice should prevail.
  For example, a nurse making home visits finds one client tearful and depressed and
knows she could help by staying for 30 more minutes to talk. However, that would
take time from her next client, who has diabetes and needs a great deal of teaching
and observation. The nurse will need to weigh the facts carefully in order to divide her
time justly among her clients.

6. Beneficence
 It means “doing good.”
 Nurses are obligated to do good, that is, to implement actions that benefit clients and
their support persons. However, doing good can also pose a risk of doing harm.
 For example, a nurse may advise a client about a strenuous exercise program to
improve general health but should not do so if the client is at risk of a heart attack.
7. Non-maleficence
 It is the duty to “do no harm”.
 Harm can mean intentionally causing harm, placing someone at risk of harm, and
unintentionally causing harm. In nursing, intentional harm is never acceptable.
However, placing a person at risk of harm has many facets. A client may be at risk of
harm as a known consequence of a nursing intervention that is intended to be helpful.
 For example, a client may react adversely to a medication. Unintentional harm occurs
when the risk could not have been anticipated.
 For example, while catching a client who is falling, the nurse grips the client tightly
enough to cause bruises to the client’s arm. Caregivers do not always agree on the
degree of risk that is morally permissible in order to attempt the beneficial result.
Sources:
https://slideplayer.com/slide/4717036/
https://www.indeed.com/career-advice/career-development/core-values
www.scribd.com
https://biotech.law.lsu.edu/Books/lbb/x302.htm

Kozier and Erb’s Fundamental of Nursing, 10th Edition

Fundamentals of Nursing by Potter, Perry, Stockert, Hall 8th Edition