This document provides an overview of foundations in evidence-based practice and ethics. It introduces ethics and discusses key principles like autonomy, beneficence, non-maleficence, and justice. Ethical issues that nurses may face in daily practice are described, including respecting confidentiality and identifying ethical dilemmas. Sources of guidance for healthcare ethics like the NMC Code and Principles of Biomedical Ethics are also summarized. The document contrasts consequentialism and deontology as two approaches to ethics and decision making.

1. Foundations in Evidence Based
Practice
 Introduction to Ethics
 Disability
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2. Introduction to ethics
 Our care for patients should be based on sound judgement
(or evidence based practice!!)
 ..some of this judgement is about having a strong sense of what is
right or wrong
 ..having a strong sense of what we should be doing and shouldn’t be
doing as nurses
 ..having a strong sense of what our priorities ought to be
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3. Introduction to ethics
 Nurses frequently have to make difficult decisions for
which there is not always a quick, easy or ‘correct’ answer
e.g. Can Mrs X be discharged yet? Can MrY manage his own
medications safely?
 Nevertheless, nurses still have to be able to explain and
account for these decisions and actions
 The NMC Code can act as a guide
This can be seen as a ‘code of ethics’ – a set of important
principles to help guide nurses
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4. Achievement of practice outcomes includes
consideration of ethical issues
Domain 1 Professional and Ethical Practice
1.3 Demonstrate an awareness of, and apply ethical principles to, nursing
practice.
Outcomes:
 1.3.1 Demonstrate respect for patient and client confidentiality
 THIS OUTCOME IS ONLY ABOUT CONFIDENTIALITY. IT IS NOT ABOUT
HOWYOU RESPECT PATIENTS GENERALLY
 1.3.2 Identify ethical issues in day to day practice
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5. What is an ‘ethical issue’?
 When you have to judge what is right or wrong
 Choosing between options
 Deciding whether to do something or do nothing
 Should I or shouldn’t I?
 Weighing up the potential impact of your decisions or actions
 A dilemma – making a difficult choice
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6. Ethical issues in health
care
 We usually think of the ‘big’ issues
e.g. definition of life, what is a person, quality of life, prolonging
life, ending life, human rights.
 But day to day ethical issues can involve:
 Respecting people
 Treating people with dignity
 Treating people fairly
 Supporting patient’s choices
 These ‘principles’ are encompassed in the NMC code
 The code is a useful source of ethical principles in health care
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7. Another source of ideas in
health care ethics
 Principles of Biomedical Ethics (Beauchamp
and Childress, 2001)
They discuss:
 4 key principles
 supplemented by 4 rules
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8. 4 Key Ethical Principles
 autonomy
 beneficence
 non-maleficence
 justice
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9. Autonomy
 Respect a person’s right to make their own decisions
 Teach people to be able to make their own choices
 Support people in their individual choices
 Do not force or coerce people to do things
 ‘Informed Consent’ is an important outcome of this principle
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10. Beneficence (to do good)
 Our actions must aim to ‘benefit’ people – health, welfare, comfort, well-
being, improve a person’s potential, improve quality of life
 ‘Benefit’ should be defined by the person themselves. It’s not what we think
that is important.
 Act on behalf of ‘vulnerable’ people to protect their rights
 Prevent harm
 Create a safe and supportive environment
 Help people in crises
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11. Non – maleficence (to do no
harm)
 do not to inflict harm on people
 do not cause pain or suffering
 do not incapacitate
 do not cause offence
 do not deprive people
 do not kill
 Both Beneficence and Non-maleficence underpin EBP
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12. Justice
 Treating people fairly
 Not favouring some individuals/groups over others
 Acting in a non–discriminatory / non-prejudicial way
 Respect for peoples rights
 Respect for the law
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13. Justice
Distributive Justice – sharing the scarce resources in society in a fair and
just manner (e.g. health services, professional time)
 How should we share out healthcare resources?
 How do we share out our time with patients?
 Deciding how to do this raises some difficult questions
Patients should get…..
 an equal share ?
 just enough to meet their needs ?
 what they deserve ?
 what they can pay for ?
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14. 4 ethical rules
 Veracity – truth telling, informed consent, respect for
autonomy
 Privacy – a persons right to remain private, to not
disclose information
 Confidentiality – only sharing private information on a
‘need to know basis’
 Fidelity – loyalty, maintaining the duty to care for all no
matter who they are or what they may have done
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15. Ethics
2 broad philosophical theories
 1) consequentialism – taking the
consequences of our actions into
consideration
 2) deontology – basing our actions on a set of
principles or duties
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16. Consequentialism
 Actions are right or wrong according to the balance of
their good and bad consequences
 the right act is the one that produces the best overall
result
 Utilitarianism (what action has the greatest utility -
use/benefit/positive outcome) is a type of
consequentialism
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17. Utilitarianism
 most prominent consequence-based theory
 based on the principle of utility
 actions ought to produce the maximal balance of positive
value (e.g. happiness) over disvalue (e.g. harm)
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18. Deontology
 Duty or principle based theory
 An act is right if it conforms to an overriding moral duty
For example – do not tell lies, do not kill.
 E.g.Christian ethics –TheTen Commandments
But Christian ethics are not important for some people in the world
so moral duties vary between cultures and societies
 A moral duty or principle is one that is:
 laid down by god / supremely rational being
 or is in accordance with reason / rationality
 or would be agreed by all rational beings
 The NMC Code of Conduct is a product of Deontological ethics – it
guides action based on a set of principles/duties.
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