MORALS AND ETHICS TYPES OF DUTIES
Although the terms morals and ethics are often used
interchangeably, ethics usually refers to a standardized code as
a guide to behaviors, whereas morals usually refers to an
individual’s own code for acceptable behavior.
MORALS
• Morals arise from an individual’s conscience.
• They act as a guide for individual behavior and are learned
through instruction and socialization.
• You may find, for example, that you and your patients
disagree on the acceptability of certain behaviors, such as
premarital sex, drug use, or gambling.
• Even in your nursing class, you will probably encounter
some disagreements because each of you has developed
a personal code that defines acceptable behavior.
ETHICS
• Ethics – part of philosophy that deals with the rightness or
wrongness of human behavior. It is also concerned with the
motives behind behaviors.
• Bioethics – the application of ethics to issues that pertain
to life and death. The implication is that judgments can be
made about the rightness or goodness of health-care
practices.
ETHICAL THEORIES
DEONTOLOGICAL THEORIES
• Take their norms and rules from the duties that individuals
owe each other by the goodness of the commitments they
make and the roles they take upon themselves.
• The term deontological comes from the Greek word deon
(duty).
• Deontological ethics considers the intention of the action,
not the consequences of the action.
• In other words, it is the individual’s good intentions or
goodwill (Kant, 1949) that determines the worthiness or
goodness of the action.
KANT’S ETHICS (KANTIANISM)
• Ethical view is sometimes called deontologism for its
emphasis on “duty or obligation”
• Form of “intuitionism” -> internal motive or intention ->
motivist theory
• Maintains that a person acts morally, only, if he does
whatever he is obliged to do
• Act done in accord with duty and act done from a sense of
duty
o Accord with Duty – One who performs his/her
functions merely out of the desire to do so or out of fear
of being accused of negligence is acting in
o Sense of Duty – One who recognizes that there is a
special obligation to perform his/her function
CATEGORICAL IMPERATIVE
• mandates an action without any conditions lays down a
universal rule which, if followed will ensure that the person
is acting from a sense of duty
HYPOTHETICAL IMPERATIVE
• Commands with a corresponding conditions and limitations
• a directive to the effect that if you wish to achieve such an
end, you must act in such a manner. The person is acting
from a sense of prudence
• Perfect Duty – one which we must always observe
irrespective of time and place or circumstances
• Imperfect Duty – one which we must observe only on some
occasions
KANT’S ETHICAL PRINCIPLE IN THE MEDICAL CONTEXT
• It is always wrong to lie, no matter what the consequences
may be
• Always treat people as ends not only as means
• An action is right and legitimate insofar as it satisfies the
categorical imperative
• Some rights should be recognized
TELEOLOGICAL THEORIES (UTILITARIANISM)
• Contrasted with deontology, the ethical approach of
utilitarianism is to promote the greatest good that is possible
in situations (i.e., the greatest good for the greatest
number).
• Take their norms or rules for behaviors from the
consequences of the action.
• This theory is also called utilitarianism.
• According to this concept, what makes an action right or
wrong is its utility, or usefulness.
• Usefulness is considered to be the amount of happiness the
action carries.
• “Right” – Encompasses actions that have good outcomes
• “Wrong” – Composed of actions that result in bad
outcomes.
• Based on this idea, ethics depends on what people want
and desire.
• The passions determine what is right or wrong. However,
individuals who follow teleological theory disagree on how
to decide on the “rightness” or “wrongness” of an action
(Guido, 2001) because individual passions differ.
• Utilitarians place great emphasis on what is best for groups,
not individual people. In doing so, the focus is on moral acts
that produce the most good in terms of the most happiness.
• By aiming for the most happiness, this theory focuses on
good consequences, utility (usefulness), or good ends.
• Although happiness is the goal, it should be kept in mind
that utilitarianism is not based merely on subjective
preferences or judgments of happiness.
• Commonsense ethical directives agreed upon by groups of
people are usually applied
PRINCIPALISM
• This theory integrates existing ethical principles and tries to
resolve conflicts by relating one or more of these principles
to a given situation.
• Ethical principles actually influence professional decision
making more than ethical theories.
ETHICAL PRINCIPLES
• Ethical principles assist decision making because they are
a standard for measuring actions.
• Ethical principles are not confined to specific behaviors.
They act as guides for appropriate behaviors.
• They also take into account the situation in which a decision
must be made. Ethical principles speak to the essence or
fundamentals of the law rather than to the exactness of the
law (Macklin, 1987).
AUTONOMY
• Derived from the Greek words “Autos” (self) and “Nomos”
(Rule/Governance)
• Autonomy is the freedom to make decisions for oneself.
• This ethical principle requires that nurses respect patients’
rights to make their own choices about treatment. Informed
 consent before treatment, surgery, or participation in “PATIENTS SELF-DETERMINATION ACT OF 1990”
research is an example. • Enacted in 1991
• To be able to make an autonomous choice, individuals • Designed to facilitate knowledge and the use of “advance
need to be informed of the purpose, benefits, and risks of directive”
the procedures to which they are agreeing.
• Advance Directive
o Written expression of patient’s wishes about medical
SELF-GOVERNANCE care
• Making an independent choice o May be self-written instruction or prepared by
• Self determination and freedom someone else as instructed by the patient
• Independence – free of threats, force, or coercion
TYPES OF ADVANCE DIRECTIVE
FOUR BASIC ELEMENTS ➢ Living Wills
• Must be able to determine personal goals ➢ Legal documents giving directions to
• Has the capacity to decide on a plan of action health care providers related to
• Has the freedom to act upon the choices withholding or withdrawing life support if
• An autonomous person is respected certain conditions exist
o Maintaining confidentiality ➢ Durable Power of Attorney
o Facilitating patient choice regarding treatment options ➢ Allows a competent person to designate
o Allowing the patient to refuse treatment another as a surrogate or proxy to act on
her behalf in making health care
INFORMED CONSENT decisions in the event of the loss of
decision making capacity.
• Known as “enlightened consent”
• Provides legal protection of patient’s right to autonomy
• Consent forms -> Legal Documents -> “Prima Facie” (first NONMALEFICENCE
hand evidence) • The ethical principle of nonmaleficence requires that no
harm be done, either deliberately or unintentionally.
ELEMENTS • This rather complicated word comes from Latin roots:
• Competence – Capacity for decision-making o Non = not
• Disclosure – content/information o male (pronounced mah-leh) = bad
• Comprehension – information given has been understood o facere = which means to do.
• Voluntariness – consent must be voluntary • The principle of nonmaleficence also requires that nurses
protect from danger individuals who are unable to protect
TYPES themselves because of their physical or mental condition.
• Implied – verbal (ex: physical exam) • Nurses should not participate in treatments or procedures
• Expressed – written (ex: invasive procedures) that will harm the patients
• Examples:
FUNCTIONS o Do not kill
• Protective – safeguarding o Do not cause pain to others
• Participative – Involving decision-making o Do not cause offense to others
o Do not incapacitate others
INDIVIDUALS WHO CAN NOT GIVE INFORMED CONSENT o Do not deprive others of the good of life
• Minors/persons under the age of maturity • Hippocratic Oath
• Mentally incompetent o I will use treatment to help this sick according to my
• Those who speak a foreign language ability and judgement, but I will never use it to injure
or harm them
FORMS OF DEFIANCE OF PATIENT’S AUTONOMY
• Employment of intervention without the use of the patient’s STANDARD OF DUE CARE
personal capacity to make his choices & decisions • With emergency cases, attempting to save lives after a
• Employment of intervention against the patient’s choices & major accident justifies the risk created by such emergency
decisions measures
• Omission of an intervention that is in agreement with the
patient’s choice & decision
• Withdrawal of the services of a health care professional &
making a referral of the case without the informed choice of
the patient

CONDITIONS FOR INAPPLICABILITY OF THE

PRINCIPLE OF AUTONOMY
• The patient freely decides to waive his consent for health
care services and delegates authority to trusted person
• The patient’s competence to make informed decision is
absent or impaired and that the case is a matter of life and
death
• Autonomy is exercised to inflict harm upon oneself or others
 • Rescue persons from danger

COMPONENTS
• Promote good
• Prevent evil or harm
• Remove evil or harm

JUSTICE
• The principle of justice obliges nurses and other health-care
professionals to treat every person equally regardless of
gender, sexual orientation, religion, ethnicity, disease, or
social standing (Edge & Groves, 2005).
• The right and the demand to be treated justly, fairly, and
equally
• Everyone should be treated and judged by the same criteria
according to this principle.
BENEFICENCE • Giving each one his or her due
• The word “beneficence” also comes from Latin:
o Bene = well/good TYPES OF JUSTICE
o Facere = to do. • Criminal
• The principle of beneficence demands that good be done o “Just infliction of punishment proportionate to the
for the benefit of others. crime committed”
• For nurses, this means more than delivering competent • Distributive
physical or technical care. It requires helping patients meet o “Appropriate distribution of responsibilities, share of
all their needs, whether physical, social, or emotional. rights or roles”
• Beneficence is caring in the truest sense, and caring fuses o The concept of distributive justice necessitates the
thought, feeling, and action. fair allocation of responsibilities and advantages,
• It requires knowing and being truly understanding of the especially in a society where resources may be
situation and the thoughts and ideas of the individual limited (Davis, Arokar, Liaschenko, & Drought,
(Benner & Wrubel, 1989). 1997).
• Nonmalefecence, Attentiveness, Positive Reinforcement, • Rectificatory
Helpfulness, Truth Telling o “Just compensation for transactional problems”
• Blessings, Acts of Mercy, Kindness, Charity, Altruism, Love
& Humanity THEORIES OF JUSTICE
• All forms of Action Done for the Benefit of Others • UTILITARIAN
o Aims to benefit the greater number of people
TYPES
• Ideal Beneficence THE UTILITARIAN ALTERNATIVES
o “Benevolent act” ▪ Principle of Immediate Usefulness
o Going out of one’s way to do good to others ➢ To a candidate who is of greatest immediate
• Obligatory Beneficence service to larger group
o “Mandatory act” ▪ Medical Success Principle
o To do good, give aid to those who are in need ➢ To those for whom treatment has the highest
probability of medical success
EXAMPLE OF IDEAL BENEFICENCE ▪ Principle of Conservation
• A Nurse was riding on a bus. Suddenly, one of the ➢ To candidates who require proportionally
passengers fainted probably because of hypoglycemia and smaller amount of resources
fatigue. The nurse brings her to the nearest hospital, stays ▪ Principle of General Social Value
with the patient until the patient regained full control of ➢ Those candidates believe to have the
herself. In addition, the nurse brings the patient back to her greatest general social worth
home and gave her food. ▪ Parental Role Principle
➢ To those who have the largest responsibility
EXAMPLES OF OBLIGATORY BENEFICENCE to dependents
• Practicing sterile techniques during post- op dressing • EGALITARIAN
change o Demands that each one gets equal benefit
• Helping post-op patients breathe deeply regardless of the number
• Assisting an elderly patient in ambulation
• Offering a glass of water to someone who is thirsty THE EGALITARIAN ALTERNATIVES
▪ Principle of Saving No One
• Give love to abandoned children
➢ Gives priority to no one
▪ Principle of Medical Neediness
➢ To candidates with the most pressing medical
RULES OF BENEFICENCE needs
• Protect & defend the rights of others ▪ Principle of General Neediness
• Prevent harm from occurring to others ➢ To the most helpless/neediest candidates
• Remove conditions that will cause harm to others ▪ Principle of First Come, First Served Basis
• Help persons with disability ➢ To those who arrived first
 ▪ Principle of Random Selection
➢ To those selected by chance or random
• LIBERTARIAN
o Emphasizes right to social and economic liberty
through fair procedures
• COMMUNITARIAN
o Considers the traditions and customs of practicing
justice in the community
IMPLICATIONS OF JUSTICE IN HEALTH CARE
• Individual should receive benefits due him/her by right
• Individual should receive benefits he/she deserves after
balancing competing claims of other persons against
her/him
• Individual should share in the burden of paying for the cost
of health care and health research
ACCORDING TO SOUTHEAST ASIA CENTER FOR
BIOETHICS
• Every human being has a fundamental right to health
• Individual have the primary responsibility to promote their
own health
• People have a right to seek the help of others
FIDELITY
• The principle of fidelity requires loyalty.
• It is a promise that the individual will fulfill all commitments
made to himself or herself and to others.
• Relates to loyalty within the nurse-patient relationship
• For nurses, fidelity includes the professional’s loyalty to
fulfill all responsibilities and agreements expected as part of
professional practice.
• Fidelity is the basis for the concept of accountability—taking
responsibility for one’s own actions (Shirey, 2005).
• Obligation to act in good faith, keep vows and promises and
fulfill agreements
• Cornerstone of a trusting nurse-patient relationship
MODELS
• Keeping one’s word of honor
• Loyalty to Commitments & Oaths
• Reliability
LEAN ON THE VALUES OF LOYALTY AND TRUST,
STANDING TRUE TO ONE’S WORD
CONFIDENTIALITY
• The principle of confidentiality states that anything said to
nurses and other health-care providers by their patients
must be held in the strictest confidence.
• Nondisclosure of private or secret information with which
one is entrusted
• Code of ethics: “The nurse hold in confidence personal
information and uses judgement in sharing this information”
THE ONLY FACET OF PATIENT CARE MENTIONED IN
THE NIGHTINGALE PLEDGE
“I will do all in my power to elevate the standard of my profession
and will hold in confidence all personal matters committed
to my keeping and all family affairs coming to my
knowledge”
TWO BASIC ETHICAL ARGUMENTS IN FAVOR OF
MAINTAINING CONFIDENTIALITY:
• Right to Privacy
o Patients have the right to expect that personal &
private information will not be shared unnecessarily
among health care workers.
• Utility
o If patients suspect that health care providers reveal
sensitive and personal information indiscriminately,
they maybe reluctant to seek care.
ARGUMENTS NOT IN FAVOR OF MAINTAINING
CONFIDENTIALITY:
• Principle of Harm
o can be applied when the nurse recognizes that
maintaining confidentiality -> wrongful harm to
others
• Principle of Vulnerability
o the duty to protect others from harm is stronger when
the third party is dependent on others
VERACITY
• Veracity requires nurses to be truthful.
• Truth is fundamental to building a trusting relationship.
Intentionally deceiving or misleading a patient is a violation
of this principle.
• Deliberately omitting a part of the truth is deception and
violates the principle of veracity.
• “Truthfulness” = Universal Virtue
• “Candor”
IMPORTANCE IN PROFESSIONAL – PATIENT
RELATIONSHIPS
• Based on respect owed to others
• Relationship of trust between persons are necessary for
fruitful intervention and cooperation
• Close connection to obligation of fidelity & promise keeping
ACCOUNTABILITY
• Accountability is linked to fidelity and means accepting
responsibility for one’s actions.
• Nurses are accountable to their patients and to their
colleagues.
• When providing care to patients, nurses are responsible for
their actions, good and poor.
• If something was not done, do not chart or tell a colleague
that it was.