-are basic and obvious moral truths that guide deliberation and action RESPECT FOR PERSONS -implies that one considers others to be worthy of high regard. Certainly, genuine regard and respect for others serves as the cornerstone of any caring profession. There are following ethical principles: Autonomy, beneficence, nonmaleficience, veracity, confidentiality, justice, and fidelity.

Literally means self governing. It is frequently used, yet poorly understood. Aveyard (2000)-denotes autonomy as having the freedom to make uses about issues that affect one’s life. Is closely linked to the notion of respect for persons. An important principle in cultures where all individuals are considered to be unique and valuable members of the society. Implies that each person has the freedom to make decisions about personal goals. It is a state in which each of us is free to choose and implement our own decisions, free from lies, restraint or coercion. FOUR BASIC ELEMENTS of an autonomous person: 1. Autonomous person is respected. It is logical that those choosing the nursing the nursing profession would inherently value and respect the unique humanness of others. This element is essential to assuring autonomy. 2. Autonomous person must be able to determine personal goals. These goals maybe explicit and of a global nature, or maybe less well defined. 3. Autonomous person has the capacity to decide on a plan of action. The person must be able to understand the meaning of the choice to be made and deliberate on the various options, while understanding the implications of the possible outcomes. 4. Autonomous person has the freedom to act upon choices. In situations were persons are capable of formulating goals, understanding various options, and making decisions, yet are not free to implement their plans, autonomy is either limited or absent. Autonomy maybe limited in situations where the means to accomplish autonomously devised plans do not exists.

is one of power. 1. Consequently. 2. eventhough to others she seems to be incapable of caring for herself. This power is based upon knowledge and authority and is inherent in the role. Lies in our assumptions about patient’s knowledge base. 3. The complementary relationship. The patient’s role is a dependent one.flowing. It is easy for us to forget that we have gained a specialized body of knowledge through our programs of basic nursing education and extensive work experience that is easy to presume everyone has at least some of the same type of knowledge. as a result. A least four factors are related to this failure. the choice might be viewed as unreasonable and might become grounds to believe the patient is incompetent to make decisions. others think in ways that are creative and free. rather than the appropriateness of decisions. This especially occurs when nurses perceive choices to be selfevident. can lead to violations of patient autonomy. Discounting a particular decision as incorrect may not take into consideration the fact that people process information in different ways. can be thought of as being dependent upon the health care provider. maintain dignity. The role of a health care professional on the other hand. while a necessary one.A number of intrinsic factors may threaten the patient autonomy. nurses and other health care workers fail to recognize subtle violations of patient autonomy. In truth. we may discount or criticize patients’ decisions. Example: If an elderly person chooses to stay in her own home. This leads to faulty conclusion. eventhough flaws lie in the patients’ level of knowledge. RECOGNIZING VIOLATIONS OF PATIENT AUTONOMY Often. Nurses may falsely assume that patients have the same values and goals as themselves. The patient seeks health care assistance because of the real or perceived need and. . Lies in our failure to recognize that individuals thought processes are different. This state of mind compels some nurses to believe that the only reasonable course of action is the one that is consistent with their own values. the elderly person may recognize that life is drawing to a close and might want to remain in familiar surroundings. remain dependent and prevent needless depletion of her life savings. It is important to recognize these types of differences when several people are working together to come up to a common decision. Example: There are those whose thought processes are very logical and methodical.

Example: Taking medications as scheduled. . exercising regularly and quitting smoking. It assures the legal protection of a patient’s right to personal autonomy in regards to specific treatment and procedures. It lays the groundwork for the trust that society places in the nursing profession. maintaining a therapeutic or weight loss diet. writing care plans and trying to keep up a frantic pace-attentiveness to assuring patients’ autonomy is sometimes neglected. INFORMED CONSENT -Relates to a process by which patients are informed of the possible outcomes. Use of the term is just as likely to represent failure of the nurse as that of the patient. As we go about our work-doing procedures. The objective of the beneficence provides nursing context and justification. Noncompliance Is generally thought of as denoting an unwillingness of the patient to participate in health activities. giving medications. This produces a climate of industrious habit. PRINCIPLE OF BENEFICENCE -is one that requires nurses’ to act in ways that benefit patients.4. alternatives. Lies in the unfortunate fact that in some instances the “work” of nursing becomes the major focus. Paternalism is appropriate when a patient is judged to be incompetent or to have diminished decision making capacity. Paternalism/Parentalism Is a gender biased term that literally means acting in a fatherly manner. and the trust that individuals place in particular nurses or health care agencies. The concept of informed consent is one that has come to mean the patients are given the opportunity to autonomously choose a course of action in regard to plans for medical care. and risk of treatments and are required to give their consent freely.

The ethical principle of beneficence has 3 major components: 1. Included in this principle are deliberate harm. All codes of nursing ethics requires us to prevent or remove harm. 2. 3. Example: Consider the case of a patient who is in the process of lingering. Nonmaleficience also means avoiding harm as a consequence of doing good. Some believe that doing no harm and preventing or removing harm. The definition of good in any particular case will determine. risk of harm. PRINCIPLE OF NONMALEFICENCE -Is related to beneficence. and if not corrected reporting the problem to other appropriate authorities like professional organizations or licensing boards. This principle requires us to act in such a manner as to avoid causing harm to patients. Hippocratic tradition says: first do no harm-principle of nonmaleficience. terminal illness. We ought to remove evil or harm. Questions arise when. Others believe that death is preferable to a life of pain and dependence. We ought to prevent evil or harm. .beneficent acts are morally and legally demanded by our professional role. in particular situations. the action that is to be taken. those involve cannot decide what is good.Beauchamp and Walters. It seems safe to assume that the intention of nurses is to promote good.There is no controversy as to whether nurses are obligated to act beneficently. at least in part. and harm that occurs during the performance of beneficial acts. There are those who believe that life is sacred and should be preserve at all costs. In such more Imperative than doing good. painful. We ought to do or promote good.1999. Example: The nurse takes appropriate action to safeguard individuals when their care is endangered by a co-worker or any other person. reporting the practice to the appropriate authority within the institution. which places this principle among others. the harm must be weighed against expected benefit. Steps includes the following: expressing concern to the person carrying out the questionable practice.

PRINCIPLE OF VERACITY Relates to the practice of telling the truth. Joseph Ellin (1991) discusses special considerations that have been posed by the medical profession in relation to truth telling. He suggest that it does not seem beneficent to adopt an ethic of absolute veracity in which it is obligated to cause avoidable anguish to someone who is already ill. Example: Consider analgesia for patients with painful terminal illness . Giving an immunization. while causing similar pain. results in the benefit of protecting the child from serious disease. and maybe overridden only in gravest cases. He writes “one could hope to avoid this dilemma by holding that the duty of veracity. suggest that the true communication between people can take place only when there are no barriers between them. though not absolute. Truthfulness is widely accepted as a universal virtue. or as a result of conflicting beliefs and values. may result in dependence and can hasten death when given in amounts required to relieve pain.Example: Sticking a child with a needle for the purpose of causing pain is always bad-there is no benefit. The harm caused by pain of the injection is easily outweighed by the benefit of the vaccine. the autonomy of the patient. on the other. we encounter many situations in which the distinction is less clear. Narcotic analgesia maybe the only type of medication that will relieve very severe pain. This medication however. Violating the principle of veracity shows lack of respect. is to be given very great weight.or at the very least. or avoiding disclosure. implies that the specific function of the nurse or other person involved assumes prominence over the patient . Martin Buber (1965). In a day to day practice. because the outcome of a particular therapy cannot be assured. especially when hope and positive outlook may promote healing and help prolonged life. . Lying or deception creates a barrier between people and prohibits both meaningful communication and the building of relationships. Telling lies. either because the harm caused may appear to be equal to the benefit gained.

and subsequently discourage others from seeking care. On another level. On one level. Individual’s right to control personal information and protect privacy. Example: Diagnoses of mental illness. 2. Utility If patients suspect that health care providers reveal sensitive and personal information.PRINCIPLE OF CONFIDENTIALITY Is the ethical principle that requires nondisclosures of private or secret information with which one is entrusted. The capacity to choose what others know about us.” The ability to maintain privacy in one’s life is an expression of autonomy. nurses must keep in mind the number of people who have legitimate access to patient’s records. patients have the right to expect that personal and private information will not be shared unnecessarily among health care providers. maintaining confidentiality of patients is an expression of respect of persons and in many ways essential to the nurse-patient relationship. . Information of a sensitive and private nature. and drug addiction that. This oath has been recited for decades by graduating nurses: “I will do all in my power to elevate the standard of my profession and will hold in confidence all personal matter committed to my keeping and all family affairs coming to my knowledge in the practice of my profession. if revealed. Confidentiality is the only facet of nursing care mentioned in the nightingale pledge. alcoholism. care must be taken to avoid inadvertent breaches of confidentiality. There are at least two basic ethical arguments of maintaining confidentiality: 1. is important because it enables us to maintain dignity and preserve a measure of control over our own lives. particularly intimate personal details. Support for this principle is found in codes and oaths of nursing and medicine dated back many centuries. Thus. they maybe reluctant to seek care. could lead to public scorn.

PRINCIPLE OF JUSTICE Is the ethical principle that relates to fair. The process of licensure is one that ensures no other group can practice within the domain of nursing as defined by society and the . On the surface. Within the context of health care ethics. it is impossible for all people to have everything they might want or need . the relevant application of the principle focuses on distribution of goods and services. nationalized health care systems would seem to meet this criterion. This application is called DISTRIBUTIVE JUSTICE. ad appropriate treatment in light of what is due or owed to persons. Example: Society has granted nurses the right to practice nursing through the processes of licensure and certification. recognizing that giving to some will deny receipt to others who might otherwise have received these things. PRINCIPLE OF FIDELITY Often related to the concept of faithfulness and the practice of keeping promises.So a governing system formulate policies that deal with fair and equitable distribution of scarce resources. DISTRIBUTIVE JUSTICE To each equally To each according to need To each according to merit To each according to social contribution To each according to the persons rights To each according to individual effort To each as you would be done by To each according to the greatest good to the greatest number There are those who believe that all should receive equally regardless of need. equitable. Due to finite supply of goods and services. since all citizens are legible for the same services.

Example: A terminally ill patient. in every case. exist to support a course of action. to remain competent in practice. We decide matters related to management of care. while most would think it is morally right to preserve practice within the established scope of practice and definition of nursing.profession. a conflict can be experienced when there is evidence to indicate that a certain act is morally right and evidence to indicate that the act is morally wrong. A dilemma may occur when the agent believes that one or more moral norms. to abide by the policies of employing institutions. but no evidence is conclusive. Problems sometimes arise when there is a conflict between promises that have been made and the potential consequences of those promises in cases in which carrying them out will cause harm in other ways. many would believe it is morally wrong to prolonged suffering. Thus. Moral/ Ethical Dilemmas Occurs when there are conflicting moral claims. harmful consequences of the promised action should be weighed against the benefits of keeping the promise. Beauchamp and Childress (1984). and is a basic premise of the nurse-patient relationship. The following presents a guide for ethical decision making. Members are called to be faithful to the society that grants the right to practice –to keep the promise of upholding the professions code of ethics. or when to collaborate or initiate referrals. Often we make decisions without conscious awareness of the process but have an innate sense of knowing what to do. institutional policy. Though fidelity is the cornerstone of trusting nurse-patient relationship. It gives rise to an independent duty to keep promises or contracts. and one or more moral norms exist to support another . to accept licensure and become legitimate members of the profession mandates that nurses uphold the responsibilities inherent in the contract with society. ETHICAL DECISION MAKING Nurses constantly make decisions. Principle of fidelity relates to loyalty within nurse-patient relationship. and to keep promises to individual patients.

or who has the best chance of survival? Conflicting moral claims can be said to occur. and so forth. of the morally correct action. Example: When they must decide who gets the critical care bed.which occurs when the nurse identifies a moral problem but is unsure. Moral dilemma. 3. Example: A nurse caring for an older patient who is somewhat neglected .when we are unsure what the moral principles or values apply. . who can pay.but institutional or other restraints make it nearly impossible to follow through the appropriate action.which arises when the nurse knows the morally correct action and feels a responsibility to the patient. Moral uncertainty.course of action. Health care providers face this type of dilemma. who arrives first. and in two actions are mutually exclusive. With little attention being given to the patient’s problem.which occurs when two or more mutually exclusive moral claims clearly apply and both seem to have equal weight. Wilkinson (1987-88) added another category to Jameton’s typology: MORAL outrage.which occurs when someone else in the health care setting performs an act the nurse believes to be immoral. loyalties. rights. Moral / Ethical problems Jametom (1984) describes three different types of moral problems: 1. principles. for example. duties. Should they make the decision relative to who is most deserving. Moral distress. between obligations. 2.or when we are unable to define the moral problems.

Though the nurse might say that her duty to the children conflicts with her duty to care for the patient. Example: Moral dilemma could arise if one is contemplating a deduction that is not quite legitimate to save money owed to taxes. The nurse might perceive a dilemma because she made a promise to take her children to the circus. The nurse who must work overtime. The ethnically correct course of action is in doubt. Examples: Practical dilemma could involve the decision to file an extension for the payment of one’s income taxes in order to use the money for another purpose. As a result. it can be argued that the duties are not of equal moral weight. NONMORAL claims-often identified as claims of self-interest. in order to pay for child’s medical expenses. Moral Distress A painful feelings and or psychological disequilibrium that occurs in situations in which the ethnically right course of action is known but cannot be acted upon. . persons in moral distress act in manner contrary to their personal and professional values.Practical Dilemma Requires that choice be made between two alternatives that probably have no ramifications or consequences involving right or wrong. an ambiguous proposition having to set solution. caring for a gravely ill patient. Moral dilemma Any situation that requires a right or wrong decision about an action. Practical dilemma: The duty to keep the promise to her children is a practical duty that is grounded in self-interest.

Job satisfaction .Some nurses leave their positions and even the profession.When moral distress occurs. According to Cynda Hylton Rushton of John Hopkin’s University School of Nursing.Departure from the work environment and or nursing . yet institutional or other restraints make it nearly impossible to pursue this course of action.frequently ignored problem in healthcare work environments unaddressed.” Example: Nurses in the hurried atmosphere of a particular hospital’s same day surgery report that they are expected to have sedated patients sign consent forms. and therefore believe themselves to be powerless to make the necessary changes. The right action is clear. .Fail to give good physical contact According to Hamri 2000 Moral Distress.Stress . yet they have neither personal authority nor access to decision-making channels. Ethical decision making assures that moral claims hold greater weight than nonmoral claims. The nurses know that this practice is one that does not respect patient’s rights to informed consent.Avoid patient contact .it can be personally risky for staff to criticize a practice that helps the hospital make end meet.Nurses loose their capacity for caring .Burnout . Important consequences includes: .it restricts nurses ability to provide optimum patient case and to find job satisfaction.“A powerful impediment to nursing practice. recognizing that the physicians have often neglected to explain the scheduled procedures fully. Jameton 1984-points out that in situations of this sort. Unrelieved moral distress over a period of time can erode the nurse’s values and affect confidence and self-esteem. Moral distress is a critical. When moral distress arises everyone should take steps to have it addressed. there are no conflicting moral claims.

The charge nurse has no involvement in the situation.Janie and Karen Rich (2006). Massachussetts: Jones and Barlett Publishers.Moral Outrage Occurs when someone else in the health care setting performs an act the nurse believe to be immoral (Wilkinson.Alvita (2002).Margaret and Nathaniel.Ethics and Issues in Contemporary Nursing-Second edition. and therefore do not believe they are responsible for wrong. . Reference: Butts.Nursing ethics across the curriculum and into practice. The surgeon was in a hurry and felt the patient would be safe. Nurses do not participate in the act. but perceive that they are powerless to prevent it. but recognizes a grave moral problem. The nurse is more likely to be on the fringe of the immoral situation rather than directly involved. Example: The charge nurse in a medical surgical floor on the evening shift is working at the desk when the nursing supervisor comes to the floor to use the telephone to call a hospital administrator. even though there were violations of patient privacy.Whistleblowing may be a response to moral outrage. informed consent and safety.1987-88). Burkhardt. The charge nurse overhears the supervisor describing a situation in which a patient was endangered when a physician insisted on performing a surgical procedure in a patient’s room.Delmar Thompson learning.


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