Chapter III.

Ethical
Principles and Nursing
Katlyn Elaine V. Valerio
 “Ethics is knowing the
difference between what
you have the right to do
and what is right to do.” Principles of
-Potter Stewart, former U.S. Supreme Court Ethics
Justice
Respect for
Autonomy
(Person)
For John Stuart Mill, the concept of
respect for autonomy involves the
capacity to think, decide and act on
the basis of such thought and decision
freely and independently.
Autonomous Decision
By Beauchamp & faden

intentional voluntary
understanding
 Definition and Extent
Autonomy

 The word autonomy comes from the Greek words autos-nomos meaning “self-

rule” or “self-determination”.

 This ethical principle was affirmed in a court decision by Justice Cardozo in 1914
with the epigrammatic dictum, “Every human being of adult years and sound mind
has a right to determine what shall be done with his own body”
 Beneficence
• Comes from two Latin words:
 “bonus where bene was taken to mean “good”
 “fic” where fiche was taken to mean “to act or do”.
• Action done for the good of others.
• In health setting, this principle highlights the duty of health provider to do good and
take positive steps, such as prevention, removal of harm to the patient
 Beauchamp, Childress and Pesche believed that Beneficence could be seen through
the associated acts of kindness, charity, humanity, altruism and love
 Non-maleficence

 Comes from Latin words: “non” to mean “not”, “malos”

meaning “bad/evil” and “faceo” wich means “do/make”.
 Non-maleficence, means not to make or to do bad or evil
things intentionally.
 In health care setting, it means, not to inflict harm.
 Non-maleficence: Negligence
 The principle of non-maleficence can be applied in one’s own common
language, that is called NEGLIGENCE, that is, if one imposes harm or
become careless and produces unreasonable risk of harm upon another.

 Criteria in determining Negligence:

1. The professional must have the duty to the affected party
2. The professional must breech that duty
3. The affected party must experience a harm
4. the harm must be caused by the breech of duty
Withholding Versus Withdrawing Treatment

Withdrawal of therapy is
relatively easily defined as the
removal of a therapy that was
started in an attempt to sustain life
but has become futile and is just
prolonging the dying process.
Withholding Versus Withdrawing Treatment

Withholding therapy, on the other hand, concerns the

concept of no therapeutic escalation.
 Practical application/implication of the
Principle of Non-maleficence
 Withholding Treatment and Withdrawing Treatment
Many healthcare professionals and the family feel guilty when treatment is withdrawn
or withheld. Both of them are bioethical issues which can be acted upon or justified by
the following conditions:

1. When the case is irreversible, any form of treatment will not benefit the patient.

2. When death is imminent or when the patient is already dead.

 Ordinary Versus Extraordinary Measures
Ordinary Treatment comprises of the provision of necessities of life that usually pertain to food,
normal respiration and elimination process. Hence like intravenous fluids, nasogastric tube feeding,
indwelling catheters are some among the many considered ordinary and necessary measure of treatment
and may e sustained even if the case is irreversible.
Extraordinary Treatment comprises the use of aggressive modalities with regards the capacities of the
family maybe some family who can very well afford it, continue to give extra ordinary measure. This is
also a way of artificially prolonging the life of a patient.

Traditionally, the rule on extraordinary treatment can be legitimately be forgone, whereas, ordinary
treatment cannot be legitimately be forgone. This may also lead towards accounting whether death was
letting die or perhaps killing.
 Killing Versus Letting go
According to Beauchamp and Childress, 2001:
1. Killing is a casual action that deliberately brings about another’s death.
 In a medical environment it conjures up images of healthcare workers secretly
their patients, handicapped infants and elderly people in an institution being
quietly snuffed out of wicked experimental programs.
2. Letting go/ Letting die is the intentional avoidance of casual intervention as that
of disease.

 Suggest the much acceptable practice of “letting nature take its course”, facing up
the limitations of medicine and the fact of impending death and avoiding heroic
measures such as aggressive surgery, drug therapies or intrusive devices.
 Sources:
https://www.slideshare.net/JoDiNe07/beneficence-and-non-maleficence
https://www.msjonline.org/index.php/ijrms/article/view/1198
http://www.beaumont.ie/media/OrdinaryandExtraordinaryTreatment1.pdf
https://www.slideshare.net/UthamalingamMurali/autonomy-in-bioethics
https://prezi.com/p/l2ofgugl1hqq/patients-autonomy/
https://www.karger.com/Article/FullText/509119