Ethics & Values

Chapter 22
NUR 100
Spring 2020
Critical Thinking: What Should You Do?
• While preparing a client for surgery scheduled in 1 hour, the
client states to the nurse:” I have changed my mind. I don’t want
this surgery.” What should the nurse do?
What is Ethics?
• Branch of philosophy
• Study of conduct and character’ science
or study of moral values
• Concerned with the distinction b/w right
& wrong, good or valuable for
individuals, groups & society
 Ethical Principles for Client Care**
Autonomy
Right to self-determination
Commitment to include patients
in decisions about all aspects of care

Beneficence Duty to do good for others without any self-interest

Nonmaleficence Duty to do or cause no harm

Justice Being fair in care delivery and use of resources

Fidelity Agreement to keep promises; be faithful to agreements and

responsibilities.
Veracity
Tell the truth
Paternalism Assuming the right to make decisions for another
Undesirable outcome of beneficence
Nursing Code of Ethics
• Guide for the expectations and standards of a • International Council of Nurses (ICN)
profession – Guides nurses on a global level
• Outlines the nurse’s responsibility to the client – 4 Fundamental Principles
& the profession of nursing • To promote health
• Assists the nurse in make ethical decisions • Prevent illness
• Restore health
• 1st Nursing Code of Ethics
• Alleviate suffering
– Est. by the American Nurses Association (ANA)
– Principles of Advocacy
– Responsibility
– Accountability
– Confidentiality

• g
 Principles of Code of Ethics
• Advocacy • Social Networking
– Support and defend client’s health, wellness, – Use of social media
safety, wishes and personal rights including
– Risk to patient privacy is great
privacy

• Responsibility
– Willingness to respect obligations and follow
through on promises

• Accountability
– Ability to answer for one’s own actions

• Confidentiality
– Protection of privacy without diminishing
access to high-quality care
– Agency mandating this principle:
____________________________________
 • Processing an Ethical Dilemma
Ethical Dilemma – Step 1: Ask if this is an ethical dilemma.
• Problems involve more than 2 or more – Step 2: Gather all relevant information.
ethical principles – Step 3: Clarify values.
– Step 4: Verbalize the problem.
• No correct decision exists & the nurse
must make a choice b/w 2 alternatives – Step 5: Identify possible courses of action.
that are equally unsatisfactory. – Step 6: Negotiate a plan.
– Step 7: Evaluate the plan.
• May occur as a result of differences in
cultural or religious beliefs
• Ethical reasoning/Ethical decision-
making
 Address unusual or complex
ethical issues
Ethics committee Interprofessional approach
to dialogue dilemmas

Ethical Decision- Nurses: ANA Code of

Ethics for Nurses
Making Example of w/Interpretative
Statements (2015)
ethical guidelines International Council of
Nurses’: ICN Code of
Moral distress Ethics for Nurses (2012)
Occurs when the nurse is placed in a
difficult situation where the actions taken
are different from what the nurse feels is
ethically correct
Values & Values Clarification/Nsg & Values
• Values
– Personal beliefs about the worth of a
given idea, attitude, custom, or object
that set standards that influence
behavior.
• Values clarification
– Process of analyzing one’s own values
to understand oneself more completely
regarding what is truly important.
• Ethical dilemmas almost always
occur in the presence of conflicting
values.
• To resolve ethical dilemmas, one
needs to distinguish among values,
facts, and opinion.
• Sometimes people have such strong
values that they consider them to be
facts, not just opinions.
• Sometimes people are so passionate
about their values that they provoke
judgmental attitudes during conflict.
 Ethics and Philosophy (Ethical Theories)

Deontology
Defines actions as right or wrong
focuses on the rightness or wrongness of actions themselves, as opposed to
the rightness or wrongness of the consequences of those actions
(Consequentialism) 
emphasize roles or responsibilities that one is morally obligated to fulfill.
(E. Kant)
Utilitarianism (Consequentialism, Teleology)
Proposes that the value of something is determined by its usefulness
Main emphasis: outcome or consequences of action
“Greatest good for the greatest number of people”
Nurses Collaborate With Other Professionals

• Consensus building: an act of

discovery in which “collective
wisdom” guides a group to the
best possible decision
• A nurse’s point of view offers a
unique voice in the resolution of
ethical dilemmas.
 Issues in Health Care Ethics
Quality of life: central to discussions about end-of-life care, cancer
therapy, physician-assisted suicide, and DNR

Genetic screening: What are the risks and benefits to individuals and to
society of learning about the presence of a disease that has not yet caused
symptoms, or for which a cure is not yet available?

Care at the end of life: interventions unlikely to produce benefit for the
patient

Access to care: As a nurse, you will certainly deal with ethical issues
related to access to care.
Key Points
• Ethics is the study of conduct and character. It is concerned with determining what is good or
valuable for individuals and society at large. • The ANA code of ethics provides a foundation for
professional nursing.
• • Professional nursing promotes accountability, responsibility, advocacy, and confidentiality.
• • Principles of ethics in health care include autonomy, beneficence, nonmaleficence, justice, and
fidelity.
• • The process of values clarification helps you explore values and feelings and decide how to act on
personal beliefs and respect values of others, even if they differ from yours.
• • Ethical problems arise in the presence of differences in values, changing professional roles,
technological advances, and social issues that influence quality of life.
• • A process for resolving ethical dilemmas that respects differences of opinions and all participants
equally helps health care providers resolve conflict about right actions.
• • A nurse's point of view offers a unique voice in the resolution of ethical dilemmas.
Quick Quiz 1
A patient is about to undergo a controversial orthopedic procedure. The procedure
may cause periods of pain. Although nurses agree to do no harm, this procedure may
be the patient’s only treatment choice. This example describes the ethical principle of:
A. Autonomy.
B. Fidelity.
C. Justice.
D. Nonmaleficence.
Quick Quiz 3
A nurse is working with a terminally ill adult patient. The nurse decides to tell the adult
children that they need to decide how to advise their father about taking analgesics during
the terminal phase of his illness. This step of processing an ethical dilemma is
A. Articulation of the problem.
B. Evaluation of the action.
C. Negotiation of the outcome.
D. Determination of values surrounding the problem.
Quick Quiz 3
• A child's immunization may cause discomfort during administration, but the benefits of
protection from disease, both for the individual and society, outweigh the temporary
discomforts.
• Which principle is involved in this situation?

A. Fidelity
B. Beneficence
C. Nonmaleficence
D. Respect for autonomy
Quick Quiz 2
The nurse decides to withhold a medication because it might further lower the patient’s
blood pressure, the nurse will be practicing the principle of:
A. Responsibility.
B. Accountability.
C. Competency.
D. Moral behavior.
References
• Potter & Perry, Chapter 22 Box 22
• Cherry, chapter 9