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2 Four major components of Ethics in healthcare The four principles plus scope approach provides a simple, accessible, and culturally neutral approach to thinking about ethical issues in health care. It offers a common, basic moral analytical framework and a common, basic moral language. Although they do not provide ordered rules, these principles can help healthcare professionals to make decisions when reflecting on moral issues that arise at work. These four principles, plus attention to their scope of application, encompass most of the moral issues that arise in health care (Gillon, 1994). Autonomy Autonomy is an obligation to respect the autonomy of other persons, which is to respect the decisions made by other people concerning their own lives. This is also called the principle of human dignity. It gives the healthcare professional a negative duty not to interfere with the decisions of competent adults, and a positive duty to empower others for whom they are responsible. Corollary principles include honesty in dealing with others and an obligation to keep promises. The right to informed consent is based on the right and responsibility of every competent individual to freely and voluntarily consent or refuse to consent to recommended medical procedures, based on a sufficient knowledge of the benefits, burdens, and risks involved. This is predicated on adequate disclosure of information by the provider and comprehension of information by the patient with capacity for decision-making. An example of autonomy for a patient would be advance directive discussions and implementation. Advance directives help to preserve a patients autonomy even when he/she is no longer capable of making informed decisions. Autonomy concerns the moral and legal rights of persons to make their own decisions including treatment preferences and other health care-related decisions. If a patient is deemed to

3 have decision-making capacity, health care providers are not permitted to disregard that person's wishes. Furthermore, they must provide the person with the necessary information to undertake the best course of action that is consistent with personal values. The only restraints on autonomy are when the person's decisions or choices endanger another or when decision-making capacity is impaired. Since the patient gives informed consent and expresses his/her preferences while still competent, advance directives provide a means of projecting autonomy into the future; they allowing the patients preferences and values to guide care even when he/she lacks decisionmaking capacity. Beneficence Beneficence is an obligation to bring about good in all ones actions and must take positive steps to prevent harm. It is a very strong concept of a positive action to remove or prevent the patients problem and strives to promote the very best. Beneficence is not served by partially withholding goods or services in order to prolong or extend the services provided for increased financial gain. Beneficence is action that is done for the benefit of others. Beneficent actions can be taken to help prevent or remove harms or to simply improve the situation of others. An example of beneficence would be to reposition and perform range of motion exercises and give good skin care for a physically debilitated patient, to prevent skin breakdown. Other 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, talking to the community about STD prevention. Nonmaleficence

4 Nonmaleficence, first do no harm; where harm cannot be avoided, the healthcare professional is obligated to minimize the harm that is done; each action must produce more good than harm. Some patients problems have solutions that may not be worth the treatment when the risk-benefit ratio is considered. Non-maleficence posits that the risks of treatment (harm) must be understood in light of the potential benefits. Nonmaleficence has often been viewed as a negative injunction; i.e., to not do any actions to harm others. In health care practice however, nonmaleficence essentially means that even when we take actions that cause discomfort, or even seeming injury to persons (e.g., surgery, dressing changes, giving injections), the overall purpose is benefit. The principle of nonmaleficence obligates us to ensure that we are in possession of the knowledge base and skills to anticipate and avoid any harm caused by our actions. Ultimately, the patient must decide whether the potential benefits outweigh the potential harms, whenever possible. The ethical principle of nonmaleficence also obliges the nurse to prevent others from harming patients. The ANA Code of Ethics for Nurses (2001) states, "As an advocate for the patient, the nurse must be alert to and take appropriate action regarding any instances of incompetent, unethical, illegal, or impaired practice by any member of the health care team or the health care system or any action on the part of others that places the rights or best interests of the patient in jeopardy". Examples of non-maleficent actions: Stopping a medication that is shown to be harmful, refusing to provide a treatment that has not been shown to be effective. One of the most common ethical dilemmas arises in the balancing of beneficence and non-maleficence. This balance is the one between the benefits and risks of treatment and plays a role in nearly every medical and nursing decision (Pantilat, 2008).

5 Justice Justice is an obligation to provide others with whatever they are owed or deserve. There is an obligation to treat all people equally, fairly and impartially; to impose no burdens. Fairness is difficult to measure objectively but encompasses the distribution of goods and services; who receives benefits and to what degree. As well, all patients are to be treated on a fair and equal basis irrespective of ethnicity, social status or any other type of social and personal uniqueness. Justice is not served by using ones position of authority to engage a patient on the basis of financial benefit versus the prudent management of the patients condition or problem. Veracity includes full and honest disclosure. Patients and families rely upon physicians and other caregivers for the information they need to make informed choices about their care. They also expect to be told the truth about their care, including any errors or untoward events. Alternatively, some patients or patients families do not want to be told the truth, placing the physician, nurse or other health care professional in a situation in which his or her duty to obtain informed consent is compromised by the wishes of the patient or family. The concept of justice assumes that actions are consistent, accountable and transparent; the nurse will not discriminate on age, sex, religion, race, position or rank; she will act for the greater good of society; she will respect of the Law and will ensure equity and distribution of burden & benefits. Social justice is working to ensure equal treatment under the law and equal access to quality health care. An example of justice might be the nurse who assesses her patient assignment, prioritizing the care of the patients that may require more labor intensive or resources. Conclusion

6 The Nursing profession, today, has built for its members a high level of academic excellence leading them to a state where they have an ability to provide specific service and complete professional autonomy to make decisions. The nurse is a client advocate, the care giver, helping the patient regain health through the process of healing. The nurse is also the pivot of all communications in the health care delivery system. The nurse should always follow ethical rules or principles that govern right conduct concerning human life or health. The client is a holistic, autonomous being who has the right to make choices and decisions. Clients have the right to expect a nurse-client relationship that is based on shared respect, trust, collaboration in solving problems related to health and health care needs, and consideration of their thoughts and feelings. It is the nurses responsibility to ensure the client has access to health care services that meet health needs. The nurse advocate informs clients of their rights; provides then with the information that they need to make informed decisions; supports those decisions; remains objective; is accepting and respectful of the clients decision and intervenes on the clients behalf, often influencing others. Ethical approaches to nursing care are one aspect of nursing practice that is difficult to document in terms of economic value. The ethics of care are a primary focus for many nurses, as caring is an integral part of nursing practice.

7 References Aiken, T. D. (2004). Legal, ethical, and political issues in nursing (2nd ed.). Philadelphia: F. A. Davis. Beneficence vs. Nonmaleficence. Retrieved from http://missinglink.ucsf.edu/lm/ethics/content%20pages/fast_fact_bene_nonmal.htm Four fundamental ethical principles. (2008). Retrieved from http://www.mnstate.edu/gracyk/courses/phil%20115/Four_Basic_principles.htm Gillon, R. (1994, July 16). Medical ethics: Four principles plus attention to scope. BMJ, 309. Retrieved from http://www.bmj.com Kissinger, S. (2011). Ethics: The set of professionalism. Retrieved from http://ethicsdc.com/definitions/index.php