These notes are aimed to provide basic knowledge about nursing ethics for BS Nursing students

1. UNIT- 03
ETHICAL PRINCIPLES & THEORIES
Sadiq Ali Chandio
BSN , DIPLOMA IN GENERL NURSING ,
P.B DIPLOMA IN PEDIATRIC NURSING
P.B DIPLOMA IN WARD ADMN

2. Objectives
• Discuss Ethical Principles in health care in the light
of ethical theories.
• Discuss the ethical Dilemmas face by nurses &
Clients
• Discuss the strategies to resolve ethical dilemma in
daily nursing practice.
• List steps of Ethical Decision making.

3. • ETHICS : Ethics are philosophical ideas of right or
wrong behavior.
• It is science of ideal human behavior.
• Ethics is moral philosophy concerned with what is
good and bad and morally right or wrong .

4. Ethical principles
1.Respect for person
2.Respect for autonomy
3. Respect for freedom
4. Respect for beneficence(doing good)
5. Respect for non-malfeasance (avoiding harm)
6.Respect for veracity(truth telling)
7. Respect for justice( fair and equal treatment)
8.Respect for rights 9. Confidentiality
10. Respect for fidelity (fulfilling promises and
commitments)

5. Ethical principles
1. Justice :
 Justice is fairness. Nurses must be fair when they
distribute care, for example, among the patients in the
group of patients that they are taking care of. Care
must be fairly, justly, and equitably distributed among
a group of patients.
 2. Autonomy: The respect for individual liberty to
take decision. ‘Informed Consent’ is an important
outcome of this principle.

6. 3. Beneficence:
• Beneficence is doing good and the right thing for the
patient. Our actions must aim to ‘benefit’ people –
health, welfare, comfort, well-being, improve a
person’s potential, improve quality of life.
4. Non Maleficence: (To do no harm)
• No Maleficence is doing no harm.
• do not cause pain or suffering
• do not incapacitate (injure) and kill
• do not deprive people

7. 5. Accountability:
• Accountability is accepting responsibility for one's
own actions. Nurses are accountable for their nursing
care and other actions. They must accept all of the
professional and personal consequences that can
occur as the result of their actions.

8. 6. Fidelity:
• Fidelity is keeping one's promises. The nurse must be
faithful and true to their professional promises and
responsibilities by providing high quality, safe care in
a competent manner.
7. Veracity:
• Veracity is being completely truthful with patients;
nurses must not withhold the whole truth from clients
even when it may lead to patient distress.

9. Discuss ethical theories
• An ethical theory provides a frame work within
which agents can reflect on the acceptability of action
& can evaluate moral judgments & moral characters.
• Teleology
• Deontology
• Intutionism
• Ethics of caring
• Situational theory

10. Ethical theories
1.Teleology: ( Consequentialism) the value of a
situation is determined by its consequences.
• Teleology looks to the consequences of an action in
judging whether that action is right or wrong. It
emphasizes duty, rationality and obedience to rules.
• The difference between teleology and deontology can
be seen when each approach is applied to the issue of
abortion.

11. Ethical theories..
2.Deontology: People should adhere to their
obligations and duties.
• In deontology rule is more important than the
consequences : As in case of abortion, deontology
approach says termination of life is a violation of rule
“do not kill” and therefore would not abort the foetus,
regardless of the consequences to the mother.
• The difference b/w teleology and deontology can be
seen to the issue of abortion.

12. Ethical theories..
3. Intitutionism:
• The notion that people inherently know what is right
or wrong
• It resolves ethical dilemmas by appealing to one's
intuition, a moral faculty of a person which directly
knows what is right or wrong ( A gut feeling of
knowing what is right)

13. Ethical theories..
4. Ethics of caring: Caring-Based Theory (Virtue
ethics) It focuses on emotions, feelings, and
attitudes. Virtue ethics are also called “ethics of love”
All human are dependent upon themselves : Children
are dependent upon parents and elders are dependent
upon their children and handicapped are dependent
on care givers.
5. Situational Theory - holds that there are no set rules
or norms. Each situation must be considered
individually.

14. Ethical codes
• Codes are used to help nurses act ethically.
• These have been developed by nursing organizations
such as the ICN and the ANA.

15. Dilemma VS Ethical dilemma
Dilemma Ethical Dilemma
• A dilemma is defined
as a situation requiring a
choice between two
equally desirable or
undesirable alternatives
• A conflict between two or
more ethical principles.
• Ethical dilemmas arise
every day in clinical
practice and it might be
challenging to find a good
solution.
i)Truth VS loyalty
ii) Justice VS mercy

16. Major types of ethical dilemma
1. Euthanasia.( Merciful death/ intentional death of
patient suffering from terminal stage of disease)
2. Refusal of Treatment.(A client’s rights to refuse
treatment and to die often challenge the values of
most health care providers)
3. Scarcity of Resources.(The allocation of scarce
resources (e.g. organs, specialists) is emerging as a
major medical dilemma)

17. Situations of ethical dilemma faced by nurses
• Abortions
• Disclosure of HIV/ AIDS status to spouse
• Sterilization
• Genetic research on congenital malformations in
fetus
• Age for written consent
• Resuscitation
• Euthanasia
• Unsafe nurse – patient ratio

18. Ethical Issues In Practice
• Nurses have the responsibility to identify ethical issues
that affect staff members and patients; and they also have
the responsibility to inform staff members and affected
clients of ethical issues that can and do affected client
care.
• For example, providing nursing care for clients
undergoing an abortion may raise ethical and moral
concerns and issues for some nurses; and some patients
may be affected with a liver transplant rejection because
donor livers are not abundant enough to meet the needs of
all patients who request it.

19. • Although a rare occasions, a patient may, at times,
ask you to do something that is not ethical. For
example, a patient may ask a nurse to assist in their
suicide at the end their life

20. Some other Examples of Ethical Dilemmas:
1.Honesty vs. withholding information:
• Family members may want to withhold medical
information from sick patients to protect their
emotions. However, patients have the right to know
about their medical conditions. Deciding how to
share this information, especially if it goes against the
family’s beliefs, can be a touchy situation. ANA
advocates for truth telling, or veracity, as a key factor
in nurse patient relationships.

21. Examples of ethical dilemma…
2. Science vs. spirituality:
• Healthcare , which is science-based and results
driven, can impede religious or personal beliefs.
Some religions restrict medical interventions and
lifesaving techniques. Nurses focus on providing
medical care to reduce suffering and to allow patients
to concentrate on self-care. For patients or their
families with strong religious or spiritual convictions,
the focus may be on adhering to a strict set of
guidelines

22. 3. Autonomy vs. Beneficence:
Nurses are required to administer prescribed medicine,
but patients, at the same time, can refuse them.
Patient autonomy can go against medical directives,
despite clearly defined needs. Patients have a right to
refuse all medical care.

23. STEPS OF ETHICAL DECISION MAKING
1. Identify the ethical problem
2. Collect relevant information
3.Consider alternatives
4. Make a decision
5. Implement

24. Ethical Decision Making
• Identify Problem : Problem definition is the clear
description of the ethical dilemma and the
circumstances revolving around it.
• Collect data : During this phase of the ethical
decision making process includes a review of ethical
codes, published evidence based practices,
declaratory statements, professional position papers
and the professional literature

25. • Data Analysis. The collected data is then organized
and analyzed. Identify and explore possible solutions
of problem. Explore all possible alternatives to
• Consider alternatives. All potential solve ethical
dilemma.
• solutions and alternatives are considered and then the
best and most ethical action is taken.

26. • Make a decision: of Action to Resolve the Ethical
Dilemma.
• Implement:. Take actions to resolve ethical issues
which are evaluated and measured in terms of their
effectiveness to resolve the ethical dilemma.