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Ethical Principles
Autonomy

Beneficence

Nonmaleficence

Justice

Veracity

Fidelity

Sanctity of Life
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 Principles Ethical Reasoning
1. Autonomy: “autos” = self, “nomos” = rule
– Individual rights
– Privacy
– Freedom of choice
– Pt has the right to make decisions for themselves. May
see this come up with consent for treatment issues,
informed consent. Pt has right to know procedure,
complications, other options, that they can opt to not
have the procedure/treatment. Framework is rights
based

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 Principles Ethical Reasoning
Autonomous behavior includes the provision of
information so patients can make informed choices.
Nurse autonomy reflects a moral obligation to provide
competent care to clients and to protect clients from
unsafe practice
• Examples of promoting autonomous behavior:
Presenting all treatment options to a patient, explaining
risks in terms that a patient understands, ensuring that a
patient understands the risks and agrees to all
procedures before going into surgery.
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• Duty to do good- goodness, kindness, charity
• Centerpiece “focus” for caring
• Duty: PREVENT\ REMOVE harm
• Nurses should implement actions that benefit clients
and their support persons. However, in an increasing
technologic health care system, doing good can also
pose a risk of doing harm (e.g. intensive exercise
program).

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 Beneficence
• Our actions must aim to ‘benefit’ people – health,
welfare, comfort, well-being, improve a person’s
potential, improve quality of life
• ‘Benefit’ should be defined by the person themselves.
It’s not what we think that is important.
• Act on behalf of ‘vulnerable’ people to protect their
rights
• Create a safe and supportive environment
• Help people in crises
– Because you’re going beyond just trying to do good to that pt,
you’re trying to prevent harm
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• Examples of beneficent actions: resuscitating a
drowning victim, providing vaccinations for the
general population, encouraging a patient to
quit smoking and start an exercise program

• Balancing Autonomy and Beneficence

• For example, a patient who has had bypass surgery
may want to continue to smoke or a patient with
pneumonia may refuse antibiotics.
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Non – maleficence (to do no harm)

• Don’t to inflict harm on people

• do not cause pain or suffering This is the basic
• do not incapacitate- injury- of most code
• do not cause offence-crime- of nursing
ethics.
• do not deprive people
• do not kill

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 Example of non-maleficence
• Psychiatrist makes an exception to the duty to
keep patient’s secrets, in order to report to
police that a patient has said she has an
immediate plan to harm someone. In such an
instance, the psychiatrist would be acting out of
nonmaleficence — a desire to prevent harm to
her patient’s intended victim.

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 Confidentiality
• Keep privileged information private
• Exceptions
– Protecting one person’s privacy harms another or
threatens social good (direct threat to another
person)
– Drug abuse in employees, elder and child abuse

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 Examples of maintaining confidentiality include:
Individual files are locked and secured
Support workers do not tell other people what is in a client’s
file unless they have permission from the client
Information about clients is not told to people who do not
need to know
Clients’ medical details are not discussed without their
consent
Adult clients have the right to keep any information about
themselves confidential, which includes that information
being kept from family and friends.

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 Double Effect
• Some actions can be morally justified even though consequences
may be a mixture of good and evil
• Must meet 4 criteria:
– The action itself is morally good or neutral
– The agent intends the good effect and not the evil (the evil
may be foreseen but not intended)
– The good is not achieved by the evil
– There is no favorable balance of good over evil
The principle of double effect is an essential ethical construct
for nurses to understand if they are going to adequately control
complex symptoms at the end of life...Giving a patient who is
dying, hypotensive, and in pain sufficient opioid dosages to
control the pain is good palliative care
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 Fidelity-Loyalty
• Duty to be faithful to one’s commitments
– includes implicit –‫ضمني‬- & explicit promises- ‫صريح‬
– Make a promise, follow thru
• Implicit – those promises that are implied, not
verbally communicated
– Like when pt comes into the hospital, they expect
to be cared for
• Explicit – those that we verbally communicate
– Like if you tell them you’ll be back with pain meds,
you’d better come back
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• Example: A patient asks the nurse not to reveal the fact that she
is dying or give her diagnosis to his family. The nurse asks why
she does not want her family advised. The patient explains
that her family is very emotional and has stated they would do
everything to keep her alive, even if it required long-term
mechanical ventilation.

• The patient has explained multiple times that she does not
want mechanical ventilation. The nurse recognizes that
keeping of this information in confidence, while supporting
the family

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 Justice
• Seeks fairness
• More specifically, distributive justice refers to
distribution of benefits and burdens
• Treating people fairly
• Not favouring some individuals/groups over others
• Acting in a non–discriminatory / non-prejudicial
way
• Respect for people rights
• Respect for the law

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 Distributive Justice Concepts
– Equally disbursed according to
•Need
•Effort
•Societal contribution
•Merit “value”
•Legal entitlement “power”

• Distributive Justice – sharing the scarce

resources in society in a fair and just manner
(e.g. health services, professional time)
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 Paternalism
• When one individual assumes the right to make
decisions for another
• Limits freedom of choice
• Think about parents making decisions for children
• Ex. Withholding pertinent information from a pt.
Like elderly Dx with terminal cancer, and family
asks to not tell them that it’s terminal so they will
still be motivated to fight

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• Closely tied to autonomy
• Promotes ability of individuals to make autonomous
choices and should be treated accordingly

• Autonomy is preserved thru advanced directives.

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•Life is the highest good
– All forms of life, including mere biologic existence,
should take precedence over external criteria for
judging quality of life

– If life is the highest good, is it ethical to keep a brain

dead person alive?

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 Veracity
• Veracity: The obligation to tell the truth and not to lie or deceive others
• Truthfulness, translated to truth-telling in the healthcare environment,
means nurses are usually ethically obligated to tell the truth & aren’t
intentionally to deceive or mislead patients, which relates to the authentic,
not fake

• The first relates to patient care and such issues as informed consent.
• The second application relates more generally to professional ethics and
the basic expectation that we are honest in our professional
interactions. This particular application of veracity is apparent in a
broad range of issues including professional relationships,
documentation standards, billing practices, risk management, peer
review, community relations, and regulatory reporting, and compliance.

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• Nurses have a difficult decision to make, especially
when a patient wants to know the full truth and
physicians have decided to disclose only part of the
truth—or none of it—to the patient.

• No matter how disappointing the news will be to

patients and families, nurses must evaluate each
situation carefully with wisdom and contemplation
before making any decision on the degree of
disclosure.
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 Honesty
• A virtue – ‫فضائل‬-of moral integrity is the ethical
competency of honesty. Nurses have earned this
trust because of their commitment and loyalty to
their patients.
Nurses identify honesty as important for three
reasons:
(1) Honesty is a prerequisite for good care
(2) Dishonesty is always exposed in the end
(3) Nurses are expected to be honest.
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• In a phenomenological study of nurses on honesty in
palliative care, nurses sometimes had difficulty
defining honesty. In an attempt to clarify nurses’
perceptions of honesty, they often defined lying or
dishonesty as sharp contrasts to honesty.

• Nurses perceived honesty as a virtue related to facts,

images, ethics, and communication, and they
perceived truth-telling as a palpable feature in trusting
relationships.

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• Honesty is also about being honest with one’s self.
Nurses need to establish a routine checkpoint system of
ongoing self-evaluation to retain & improve honesty in
actions and relationships with patients and others.

• For example, if a nurse is in the process of

administering medications and a pill falls on the hospital
floor, would the nurse be justified in wiping it off and
placing it back in the cup if no one was there to see the
action?

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