ETHICAL

PRINCIPLES
ETHICAL PRINCIPLES
• Basic and obvious moral truths that guide deliberation
and action
• Presuppose a basic respect for persons
• Included in moral theories, although sometimes in
different ways
• Autonomy
• Beneficience
• Nonmalfecience
• Veracity
• Fidelity
• Justice
• Confidentiality

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford,
CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
 RESPECT FOR AUTONOMY
• Definition: self-governing
– Freedom to make decisions about issues that affect one’s life free
from lies, restraint, or coercion.

• The autonomous person

– Is respected
– Is able to determine personal goals
– Has the capacity to decide upon a plan of action
– Is free to act on choices

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and Bartlett,
Burlington, MA.
THINK ABOUT IT

• A homeless psychotic man stops his anti-psychotic

medication because it makes him sleepy.
– How do you view this man’s autonomy?
– Are there subtleties of autonomy in this case?

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
THINK ABOUT IT

• Is autonomy good?
• Should patients be autonomous?
• How far should autonomy go?
• Can you reconcile the concepts of personal autonomy
and noncompliance?

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and Bartlett, Burlington, MA.
 1. AUTONOMY
• Value of autonomy is culturally dependent.
– Some cultures don’t regard all people as of
equal value.
– Some cultures value social structure over
individual rights.
• Respect for autonomy does not require respect for all autonomous
decisions.
– Must uphold respect for self and others who
might be harmed by another’s choices.
– Respect the principle rather than each action
or choice.

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and Bartlett, Burlington, MA.
INFORMED CONSENT

• Practical application of the principles of respect for

autonomy.
– Demonstrates legal protection of personal autonomy in
regard to specific medical treatments and procedures
• Contemporary informed consent is a direct outcome of
past research atrocities.

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
 PATERNALISM AND
ADVOCACY
• Paternalism: places power in the hands of the person who is
making the decision for the patient. Implies that the decision
maker knows what is best.
• Advocacy: ensures the patient’s welfare and respects the patient’s
autonomy because it aims to act according to the patient’s values.

– May unwittingly cross from advocacy to

paternalism

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
 NONCOMPLIANCE
• Lack of participation in a regimen that has been planned by the
health care professional but must be carried out by the patient.

– Patient must have autonomous

participation in plan formation
– Nurse must assess the patient’s ability to
carry out the plan
• Ultimately, choices about health care practices belong to the
patient.

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
 2. BENEFICENCE
• Requires one to act in a way that benefits others:
– Do or promote good
– Prevent harm
– Remove evil or harm

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
 DO OR PROMOTE GOOD
• Ask yourself:
– How does one decide what is good?
– When people disagree, who gets to decide?
– Should other ethical principles, such as truthfulness and
autonomy, be violated in the process of doing good?

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford,
CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
 PREVENT HARM
• Ask yourself:
– In what instances might a nurse be compelled to prevent
harm?
– How far should a nurse go to prevent harm?

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
 REMOVE EVIL OR HARM
• Ask yourself:
– In what type of situations would a nurse need to remove
harm?
– What are the risks to the nurse?
– What characteristics does a nurse need in order to remove
harm in a difficult situation?

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
 3. NONMALEFICENCE
• Requires one to refrain from causing harm, including:
– Deliberate harm
– Risk of harm
– Harm that occurs during the performance of beneficial
acts

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
 THINK ABOUT IT
• Doing good often includes causing harm; for instance, a
surgeon might save a life (doing good) by amputating a
limb (causing harm).
– How does one balance good and harm?
– When the outcome is unsure, who decides?

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
 4. VERACITY
• Definition: telling the truth
– Implies respect for others.
– Is required of those who support autonomy of others.
– Authorities disagree on the absolute necessity of truth
telling in all instances.

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
 5. CONFIDENTIALITY
• Definition: nondisclosure of private or secret information
about another person
– A traditional tenet of nursing and medical ethics
– A legal mandate in nearly all cases
– Is sometimes limited by harm and vulnerability
– Flows from respect for persons and their autonomy

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
 6. JUSTICE
• Relates to fair, equitable, and appropriate treatment in
light of what is due or owed to persons
• Recognizes that giving to some will deny receipt to
others who might otherwise have received these things

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
 DISTRIBUTIVE JUSTICE
• Application of the principle of justice that focuses on distribution of goods and
services
– To each equally
– To each according to need
– To each according to merit
– To each according to social contribution
– To each according to the person’s 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
Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
MATERIAL RULES OF
DISTRIBUTIVE JUSTICE

• Systematic means of deciding such as:

– Give to each person equally
– Give to those who need it most
– Give to those who deserve it most
– Give to those who can pay for it
– Give to those who arrive first

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
USE OF MATERIAL RULES

• Which material rule is used when:

– Private hospitals turn away indigent patients?
– Immunizations are given to all fifth graders?
– A free clinic accepts only the first 30 patients?
– Scholarships go to those with low incomes?

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
CLASS DISCUSSION

• A patient smells of alcohol and marijuana. She drove

herself to the clinic and admits to beer and a “herbal
remedy” today. She refuses blood and urine tests and
demands a refill of her “nerve” pills. “I’m leaving. Send
me my refills in the mail.”

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
7. FIDELITY

• Definition: faithfulness and promise keeping

• Nurses must faithfully
– Uphold the profession’s code of ethics
– Practice within established scope of practice
– Practice competently
– Keep promises to patients

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.
 THINK AND DISCUSS
• What are the ethical principles and
implications?
• Should the nurse notify security of the
potential hazards of patient endangering self
and others?
• How does the nurse express fidelity,
confidentiality, beneficence, nonmaleficence,
autonomy, respect for persons, veracity, and
justice in this situation?

Burkhardt, M.A., Nathanial, A.K. (2014). Ethics & Issues: In Contemporary Nursing, 4th ed. Cengage, Stamford, CT.
Morrison, E. E., Furlong, B. (2018). Health Care Ethics: Critical Issues for the 21st Century. (4th ed). Jones and
Bartlett, Burlington, MA.