Health Care Ethics

Level II (First Semester)

ACADEMIC YEAR 2020-2021

Module 1
PREPARED BY:
FERKIYA A. ABDUWA, R.N
Instructor

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Introduction

Understanding the basis of ethical professional conduct in

nursing requires nurses to have at least a working
knowledge and understanding of the language,
concepts and theories of ethics. One reason for this, as
explained by the English philosopher, Richard Hare
(1964: 1–2), is that: first glance it might seem cumbersome spending time on clarifying and
developing an understanding of the language, concepts and underpinning theories used in
discussions and debates on ethics. Upon closer examination, however, it soon becomes
clear that such an undertaking is crucial if nurses and their associates are to engage in a
meaningful inquiry into what ethics is, what constitutes ‘nursing ethics’ and how, if at all,
nursing ethics differs from other fields of ethics, what it means to be an ‘ethical
practitioner’, why nurses have an obligation to practice their profession in an ethical
manner and how to be an ethical professional.
Furthermore, and not least, is the question of how best to proceed with the difficult task of
identifying and resolving the many moral problems that nurses (like others in the health
care team) will inevitably encounter during the course of their everyday practice.
The importance of understanding ethics terms and concepts The terms ‘ethics’, ‘morality’,
‘rights’, ‘duties’, ‘obligations’, ‘moral principles’, ‘moral rules’, ‘morally right’,
‘morally wrong’ and ‘moral theory’, to name some, are all commonly used in discussions
about ethics. Nurses, like others, may use some of these terms when discussing life events
and practice situations that are perceived as
having a moral / ethical dimension. These terms are not always used correctly, however,
with the unfortunate consequence of communication and discussions about ethical issues
sometimes becoming distorted and, as a consequence, giving rise to problems and
perplexities that did not exist previously or which could otherwise have been avoided had
they been dealt with more competently. One notable example of the incorrect use of ethical
terms can be found in the tendency by some nurses (scholars included) to treat the terms
‘rights’ and ‘responsibilities’ or ‘duties’ as being synonymous, and thus able to be used
interchangeably. Examples of this are found in the view that nurses have the ‘right’ to
practice within their codes of ethics and laws governing their practice, and the ‘right’ to
act as patient advocates. When the nature of rights and duties is
examined later, it will become clear that the term ‘right’ in these examples should, in fact,
read ‘duty’. The implications of confusing the meanings of the terms ‘rights’ and ‘duties’
and treating these two terms as being synonymous will be explored more fully in the
chapters to follow.
Another common mistake is the tendency by some nurses to draw a distinction between the
terms ‘ethics’ and ‘morality’. They draw a distinction on the grounds that, in their view,
morality involves more a personal or private set of values (i.e. ‘personal morality’)
whereas ethics is more concerned with a formalized, public and universal set of values (i.e.
‘professional ethics’). Thompson and colleagues (2006: 42), for example, acknowledge
that the terms ‘ethics’ and ‘morals / morality’ mean the same thing and ‘can be used more or
less interchangeably’. Yet they perpetuate confusion about whether this is in fact correct by
going on to argue:
What is ethics?

It is appropriate to begin the task of defining commonly used ethical terms and concepts by
first examining the terms ‘ethics’ and ‘morality’, and clarifying from the outset that there is
no philosophically significant difference between the terms ‘ethics’ and ‘morality’. As an
examination of the etymology (the study of the origin of the words) of both these terms
shows, ‘ethics comes from the ancient Greek ethikos (originally meaning ‘pertaining to

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custom or habit’) and ‘morality’ comes from the Latin moralitas (also originally meaning
‘custom’ or ‘habit’). This means that the terms may be used interchangeably, as they are in
the philosophical literature and in this book. With respect to deciding which terms should be
used in ethics discourse (i.e. whether to use the term ‘ethics’ or the term ‘morality’), this is
very much a matter of personal preference rather than of philosophical debate – noting,
however, that the terms ethics and morality have come to refer to something far more
sophisticated than ‘custom’ or ‘habit’, as will soon be shown.

Having clarified that there is no philosophically significant difference between the terms
‘ethics’ and ‘morality’, it now remains the task here to define what ‘ethics’ is.
For the purposes of this discussion, ethics is defined as a generic term that is used for
referring to various ways of thinking about, understanding and examining how best to live a
‘moral life’ (Beauchamp & Childress 2013). More specifically, ethics involves a critically
reflective activity that is concerned with a systematic examination of living and behaving
morally and ‘is designed to illuminate what we ought to do by asking us to consider and
reconsider our ordinary actions, judgments and justifications’ (Beauchamp & Childress
1983: xii).
For example, a nurse may make an ‘ordinary’ moral judgment that abortion is wrong and
conscientiously object to assisting with an abortion procedure. Whether her conscientious
objection ought to be respected, however, requires a critical examination of the bases upon
which the nurse has made that judgment and a consideration of the justifications (moral
reasons) she has put forward to support the position she has taken.

Ethics, as it is referred to and used today, can be traced back to the influential works of the
Ancient Greek philosophers Socrates (born 469 bc ), Plato (born c. 428 bc ) and
Aristotle (born 384 bc ). The works of these ancient Greek philosophers were especially
influential in seeing ethics established as a branch of philosophical inquiry which sought
dispassionate and ‘rational’ clarification and justification of the basic assumptions and
beliefs that people hold about what is to be considered morally acceptable and morally
unacceptable behavior. Ethics thus evolved as a mode of philosophical inquiry (known as
moral philosophy) that asked people to question why they considered a particular act right
or wrong, what the reasons (justifications) were for their judgments and whether their
judgments were correct. This view of ethics remains an influential one and, although the
subject of increasing controversy over the past several decades, retains considerable
currency in the mainstream ethics literature.

It is important to clarify that ethics has three distinct ‘sub-fields’, namely: descriptive
ethics, metaethics and normative ethics. Descriptive ethics is concerned with the
empirical investigation and description of people’s moral values and beliefs (i.e. values
and beliefs concerning what constitutes ‘right’ and ‘wrong’ or ‘good’ and ‘bad’
conduct). Metaethics, in contrast, is concerned with analyzing the nature, logical form,
language and methods of reasoning in ethics (e.g. it
gives consideration to meanings of ethical terms such as ‘rights’, ‘duties’ and so on).
Normative ethics, in turn, is concerned with establishing standards of correctness by
identifying and prescribing certain rules and principles of conduct and developing theories
to justify the norms established. Unlike descriptive ethics and metaethics, normative ethics
is evaluative and prescriptive (hortatory) in nature. In the case of the latter, ethics inquiry is
not so much concerned with how the world is, but with how it ought to be. In other words, it
is not concerned with merely describing the world (although, of course, a description of the
world is necessary as a starting point for an evaluative inquiry), but rather with prescribing
how it should be and providing sound justification for this prescription. Just what is to count
as a ‘sound justification’, however, is an open question and one that will be considered in
the following chapter. In this book, all three sub-fields
are drawn upon in varying degrees to advance knowledge and understanding of ethical

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issues in nursing and health care.

Biology is the study of life. A branch of the natural sciences which studies living organism
and how they interact with each other and environment. The term was first used by the
French naturalist Jean-Baptise Lamarck. It examines the structure, function, growth, origin,
evolution, and distribution of living things. also it classifies and describes organisms, their
functions, and how species come into non-existence.

What is bioethics?

Bioethics may be defined as ‘the systematic study of the moral dimensions – including
moral vision, decisions, conduct and policies – of the life sciences and health care,
employing a variety of ethical methodologies in an interdisciplinary setting’ ( Reich
1995a : xxi). The term ‘bioethics’ (from the Greek bios meaning ‘life’, and ethikos , ithiki
meaning ‘ethics’) is a neologism that first found its way into public usage in 1970–71 in
the United States of America ( Reich 1994 ; see also Jecker et al 2007 ). Although
originally the subject of only cautious acceptance by a few influential North American
academics, the new term quickly symbolized and influenced the rise and shaping of the
field itself’ ( Reich 1994 : 320). Significantly, within 3 years of its emergence, the new
term was accepted and used widely at a public level ( Reich 1994 : 328). Interestingly, it
is believed that the term ‘bioethics’ caught on because it was ‘simple’ and because it
was amenable to exploitation by the media, which had placed a great premium ‘on
having a simple term that could readily be used for public consumption’ ( Reich 1994 :
331).

It is worth noting that initially the term ‘bioethics’ was used in two different ways, reflecting
both the concerns and ambitions of two respective academics each of whom, it is
suggested, quite possibly created the word independently of the other. The first (and later
marginalized) sense in which the word was used had an ‘environmental and evolutionary
significance’ (Reich 1994: 320). Specifically, it was intended to advocate attention to ‘the
problem of survival: the questionable

Health ethics: this course deals with the study of concepts and principles of Health Ethics
and their implications to the individual, schools, hospitals, community and society. It
presents issues in the health care system that will require the practitioner a commitment to
excellence in clinical practice and commitment r=to a set of appropriate moral, ethical and
social behavior. It aims to develop in students an understanding of these important
concepts and principles as well as to proved guidelines in dealing with ethical issues with
emphasis on the role of the health care practitioner as a patient advocate.

Professional ethics: this concern one conduct of behavior and practice

when carrying out professional work. Such work may include consulting,
researching teaching and writing. The institutionalization of Codes of
Conduct and Codes of Practice is common with many professional
bodies for their members to observe. Any code may be considered to be
a formalization of experience into a set of rules. A code is adopted by a
community because its members accept the adherence to these rules,
including the restrictions that apply. It must be noted that there is
distinction between a profession such as information Systems and
Controlled professions such as Medicine and Law, where the loss of
membership may also imply the loss of the right practice.

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 What is nursing ethics?

Nursing ethics can be defined broadly as the examination of all kinds of ethical and
bioethical issues from the perspective of nursing theory and practice which, in turn,
rest on the agreed core concepts of nursing, namely: person, culture, care, health,
healing, environment and nursing itself (or, more to the point, its ultimate purpose) –
all of which have been comprehensively articulated in the nursing literature (too vast
to list here). In this regard, then, contrary to popular belief, nursing ethics is not
synonymous with (and indeed is much greater than) an ethic of care, although an
ethic of care has an important place in the overall
moral scheme of nursing and nursing ethics. Unlike
other approaches to ethics, nursing ethics
recognizes the ‘distinctive voices’ that are
nurses and emphasizes the importance of
collecting and recording nursing narratives and
‘stories from the field’ ( Benner, 1991 , Benner,
1994 ; Bishop & Scudder 1990 ; Parker 1990 ).
Collecting and collating stories from the field are
regarded as important since issues invariably
emerge from these stories that extend far beyond
the ‘paramount’ issues otherwise espoused by
mainstream bioethics. Analyses of these stories
tend to reveal not only a range of issues that are
nurses’ ‘own’, as it were, but also a whole different configuration of language,
concepts and metaphors for expressing them. As well, these stories often reveal
issues otherwise overlooked in mainstream bioethics discourses. Given this, nursing
ethics can also be described as, methodologically and substantively, inquiry
from the point of view of nurses’ experiences, with nurses’ experiences being
taken as a more reliable starting point than other locations from which to
advance a rich, meaningful and reliable system and practice of nursing ethics.
Like other approaches to ethics, however, nursing ethics recognizes the
importance of providing practical guidance on how to decide and act morally.

Drawing on a variety of ethical theoretical considerations, nursing ethics at its most

basic could thus also be described as a practice discipline which aims to provide
guidance to nurses on how to decide and act morally in the contexts in which they
work (Johnstone, 2015a , Johnstone, 2015b , Johnstone, 2015c ).

The project of nursing ethics has many aspects to its nature and approach. Among
other things, it involves nurses engaging in ‘a positive project of constructing and
developing alternative models, methods, procedures [and] discourses’ of nursing and
health care ethics that are more responsive to the lived realities and experiences of
nurses and the people for whose care they share responsibility (adapted from Gross
1986: 195). In completing this project, nursing ethics has had – and continues to
have – the positive consequence of allowing other ‘weaker’ viewpoints (including
those of patients and nurses themselves) to emerge and be heard. In this respect,
nursing ethics is also intensely political – although, it should be added, no more
political than other role-differentiated ethics.
As in the case of moral philosophy, nursing ethics inquiry can be pursued by
focusing on one or all of the following:

 descriptive nursing ethics (describing the moral values and beliefs that
nurses hold and the various moral practices in which nurses engage across
and within different contexts)

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F.A. ABDUWA, RN
  meta (nursing) ethics (undertaking a critical examination of the nature,
logical form, language and methods of reasoning in nursing ethics)

 normative nursing ethics (establishing standards of correctness and

prescribing the rules of conduct with which nurses are expected to comply).
It is important to remember (as discussed in the 3rd edition of this work (Johnstone
1999a )) that nursing ethics has not always enjoyed the status that it has today. Its
development, legitimation and recognition as a distinctive field of inquiry is testimony
to the reality that nursing ethics is both necessary and inevitable. It is necessary
because ‘a profession without its own distinctive moral convictions has nothing to
profess’ and will be left vulnerable to the corrupting influences of whatever forces are
most powerful (be they religious, legal, social, political or other in nature) (Churchill
1989: 30). Furthermore, as Churchill (1989: 31) writes, ‘Professionals without an
ethic are merely technicians, who know how to perform work, but who have no
capacity to say why their work has any larger meaning.’ Without meaning, there is
little or no motivation to perform ‘well’. In regard to the inevitability of nursing ethics,
as Churchill (1989: 31) points out, the ‘practice of a profession makes those who
exercise it privy to a set of experiences that those who do not practice lack’. By this
view, those who practice nursing are prove to a set of experiences (moral
experiences included) that others who do not practice nursing lack. So long as
nurses interact with and enter into professional caring relationships with other
people, they will not be able to avoid or sidestep the ‘distinctively nursing’ experience
of deciding and acting morally while in these relationships. It is in this respect, then,
that nursing ethics can be said to be inevitable.

ANYEEEONG!!!! TIRED READING? OK LETS TEST A LITLLE

KNOWLEDGE ABOUT THIS COURSE

1. ACTIVITY: MULTIPLE CHOICE: ENCIRCLE YOUR ANSWER

1.Ethical principles for professional nursing practice in a clinical setting are guided by the
principles of conduct that are written as the:

a. American Nurses Association’s (ANA’s) Code of Ethics

b. Nurse Practice Act (NPA) written by state legislation

c.Standards of care from experts in the practice field

d.Good Samaritan laws for civil guidelines

2.Which statement about an institutional ethics committee is correct?

a. The ethics committee is an additional resource for clients and healthcare professionals

b. The ethics committee relieves health care professionals from dealing with ethical issues

c. The ethics committee would be the first option in addressing an ethical dilemma

d. The ethics committee replaces decision making by the client and health care providers

3.The nurse is obligated to follow a physician’s order unless:

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F.A. ABDUWA, RN
a. The order is a verbal order

b. The physicians order is illegible

c. The order has not been transcribed

d. The order is an error, violates hospital policy, or would be detrimental to the client

4.Nurses are bound by a variety of laws. Which description of a type of law is correct?

a. Statutory law is created by elected legislature, such as the state legislature that defines
the Nurse Practice Act (NPA).

b. Regulatory law includes prevention of harm for the public and punishment for those laws
that are broken.

c. Common law protects the rights of the individual within society for fair and equal
treatment.

d. Criminal law creates boards that pass rules and regulations to control society.

5.The code of ethics for nurses is composed and published by:

a. The national league for Nursing

b. The American Nurses Association

c. The Medical American Association

d. The National Institutes of Health, Nursing division

6.In most ethical dilemmas, the solution to the dilemma requires negotiation among
members of the health care team. The nurse’s point of view is valuable because:

a. Nurses have a legal license that encourages their presence during ethical discussions.

b. The principle of autonomy guides all participants to respect their own self-worth

c Nurses develop a relationship to the client that is unique among all professional health
care providers

d. The nurse’s code of ethics recommends that a nurse be present at any ethical discussion
about client care.

7.The scope of Nursing practice is legally defined by:

a. State nurses practice acts

b. Professional nursing organizations

c. Hospital policy and procedure manuals

d. Physicians in the employing institutions

8.Successful ethical discussion depends on people who have a clear sense of personal
values. When many people share the same values it may be possible to identify a
philosophy of utilitarianism, with proposes that:

a. The value of people is determined solely by leaders in the Unitarian church

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b. The decision to perform a liver transplant depends on a measure of the moral life that the
client has led so far

c. The best way to determine the solution to an ethical dilemma is to refer the case to the
attending physician

d. The value of something is determined by its usefulness to society

9.A bioethical issue should be described as:

a. The physician’s making all decisions of client management without getting input from the
client

b. A research project that included treating all the white men and not treating all the black
men to compare the outcomes of a specific drug therapy.

c. The withholding of food and treatment at the request of the client in a written advance
directive given before a client acquired permanent brain damage from an accident.

d. After the client gives permission, the physician’s disclosing all information to the family
for their support in the management of the client.

10.The distribution of nurses to areas of “most need” in the time of a nursing shortage is an
example of:

a. Utilitarianism theory

b. Deontological theory

c. Justice

d. Beneficence

2.In mention about example of abortion? what is your opinion about abortion it is right or
wrong? (300 words)

3. what is the difference of right and responsibility?

 State an example of your own understanding of right as you refer to your self being
in the right and being responsible one. (300 words)

4. Nursing ethics recognizes the importance of providing practical guidance on how to

decide and act morally.

 As you been expose to hospital last semester can you identify at least two events in
your practicum that you consider to have been occasions for acting in an ethical way.
(300 words)

5. What is the best practice for nurse to avoid law suites?

End of 1st week

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Worksheet:

Name____________________ Date: ______________

Course: _________________ Time: ____________

ANYEEEONG!!!! TIRED READING? OK LETS TEST A LITLLE

KNOWLEDGE ABOUT THIS COURSE

1. ACTIVITY: MULTIPLE CHOICE: ENCIRCLE YOUR ANSWER

1.Ethical principles for professional nursing practice in a clinical setting are guided by the principles
of conduct that are written as the:

a. American Nurses Association’s (ANA’s) Code of Ethics

b. Nurse Practice Act (NPA) written by state legislation

c.Standards of care from experts in the practice field

d.Good Samaritan laws for civil guidelines

2.Which statement about an institutional ethics committee is correct?

a. The ethics committee is an additional resource for clients and healthcare professionals

b. The ethics committee relieves health care professionals from dealing with ethical issues

c. The ethics committee would be the first option in addressing an ethical dilemma

d. The ethics committee replaces decision making by the client and health care providers

3.The nurse is obligated to follow a physician’s order unless:

a. The order is a verbal order

b. The physicians order is illegible

c. The order has not been transcribed

d. The order is an error, violates hospital policy, or would be detrimental to the client

4.Nurses are bound by a variety of laws. Which description of a type of law is correct?

a. Statutory law is created by elected legislature, such as the state legislature that defines the Nurse
Practice Act (NPA).

b. Regulatory law includes prevention of harm for the public and punishment for those laws that are
broken.

c. Common law protects the rights of the individual within society for fair and equal treatment.

d. Criminal law creates boards that pass rules and regulations to control society.

5.The code of ethics for nurses is composed and published by:

a. The national league for Nursing

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F.A. ABDUWA, RN
b. The American Nurses Association

c. The Medical American Association

d. The National Institutes of Health, Nursing division

6.In most ethical dilemmas, the solution to the dilemma requires negotiation among members of the
health care team. The nurse’s point of view is valuable because:

a. Nurses have a legal license that encourages their presence during ethical discussions.

b. The principle of autonomy guides all participants to respect their own self-worth

c Nurses develop a relationship to the client that is unique among all professional health care
providers

d. The nurse’s code of ethics recommends that a nurse be present at any ethical discussion about
client care.

7.The scope of Nursing practice is legally defined by:

a. State nurses practice acts

b. Professional nursing organizations

c. Hospital policy and procedure manuals

d. Physicians in the employing institutions

8.Successful ethical discussion depends on people who have a clear sense of personal values.
When many people share the same values it may be possible to identify a philosophy of
utilitarianism, with proposes that:

a. The value of people is determined solely by leaders in the Unitarian church

b. The decision to perform a liver transplant depends on a measure of the moral life that the client
has led so far

c. The best way to determine the solution to an ethical dilemma is to refer the case to the attending
physician

d. The value of something is determined by its usefulness to society

9.A bioethical issue should be described as:

a. The physician’s making all decisions of client management without getting input from the client

b. A research project that included treating all the white men and not treating all the black men to
compare the outcomes of a specific drug therapy.

c. The withholding of food and treatment at the request of the client in a written advance directive
given before a client acquired permanent brain damage from an accident.

d. After the client gives permission, the physician’s disclosing all information to the family for their
support in the management of the client.

10.The distribution of nurses to areas of “most need” in the time of a nursing shortage is an example
of:

a. Utilitarianism theory

b. Deontological theory

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F.A. ABDUWA, RN
c. Justice d. Beneficence

Name____________________ Date: ______________

Course: _________________ Time: ____________

2.In mention about example of abortion? what is your opinion about abortion it is right or wrong?
(300 words)

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3. what is the difference of right and responsibility?

 State an example of your own understanding of right as you refer to your self being in the
right and being responsible one. (300 words)

_______________________________________________________________________________
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F.A. ABDUWA, RN
Name____________________ Date: ______________

Course: _________________ Time: ____________

4. Nursing ethics recognizes the importance of providing practical guidance on how to decide and
act morally.

 As you been expose to hospital last semester can you identify at least two events in your
practicum that you consider to have been occasions for acting in an ethical way. (300 words)

_______________________________________________________________________________
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_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
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5. What is the best practice for nurse to avoid law suites?

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End of 1st week

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