This document discusses ethical principles and theories relevant to healthcare. It defines key concepts like autonomy, informed consent, beneficence, and non-maleficence. It also outlines several ethical theories used in decision making, including virtue ethics, deontology, utilitarianism, and rights-based approaches. The document uses examples to illustrate ethical dilemmas that may arise in nursing practice and the importance of ethical decision making frameworks.

1. ETHICAL PRINCIPALS AND THEORIES
UNIT III
By
Sehrish Naz
Lecturer INS-KMU

2. OBJECTIVES
At the end of this session learners will be able
to:
• Define ethical principles and theories in health
care.
• Discuss the ethical dilemmas face by nurses
and clients.
• Discuss the strategies to resolve ethical
dilemma in daily nursing practice.
• List steps of ethical decision making.

3. Ethical principles
1. Autonomy: Refers to the right to make one’s own
decisions and choices free of harm to others.
Synonyms
• Self-government
• Independence
• Self-rule
• Home rule
• Sovereignty
• Self-determination
• Freedom

4. INFORMED CONSENT
Definition
• It is an agreement by a client to accept a
course of a treatment, procedure or research
after being provided complete information
including benefits and risks.
• Obtaining informed consent is the
responsibility of the person performing the
procedure or research.

5. TYPES OF CONSENT
Types of consent
1- Expressed Consent 2- Implied Consent
• Expressed Consent may either be oral or
written.
Written consent is preferred if there are greater
risks of a procedure.
• Implied consent
Exists when the client’s nonverbal behavior
indicates agreement.

6. ELEMENTS OF CONSENT
Four Basic Elements
1. The consent must be given voluntarily.
2. The consent must be given by a
client/participant with the Capacity and
competence to understand.
3. The consent must be specific to the procedure
& Person.
4. The client/participant must be given enough
information including benefits and possible
risks.

7. IMPORTANCE OF CONSENT
• The requirement of consent reflects the ethical
principle of patient’s/participant’s autonomy
• It also reflects the principles of beneficence and
non-maleficence.
• It saves both health care member/researcher and
patient/participant legally in exceptional
circumstances, medical treatment must not be
administered without obtaining patient’s valid
consent.
• Treatment/investigations/research performed
without consent constitutes “battery”

8. PATERNALISM
• Implies well intended actions of kind decision
making, leadership ,protection ,& discipline.
• Decision making on behalf of the patients
without their full consent or knowledge.
• Professionals restricts others autonomy, to
protect that person from perceived & anticipated
harm, but also promoting good in a positive way.
(Burkhardt & Nathaniel,2008)

9. 2. BENEFICENCE
• This principle means do or promote good, prevent
harm, remove evil or harm.
• Nurses need to assist clients in meeting all their needs
– Biological
– Psychological
– Social
ICN says, the nurse takes appropriate action to safe
guard individual ,family ,communities when their care
is endangered by a coworker or any other person
(Burkhardt & Nathaniel,2008)

10. 3. NON-MALEFICENCE
• Non-maleficence literally means to “do no harm.”
• Make sure that the procedure does not harm the
patient.
• Non-maleficence “obligation not to inflict harm on
others.
(Beauchamp and Childress, 2009)

11. NON –
MALEFICENCE
Non-maleficence
Literally- “Doing no
harm”.
• Make sure that the
procedure does not
harm the patient.
BENEFICENCE
Beneficence Literally –
“Being charitable or
doing good”.
Where a Health care
provider should act in
the “best interests” of
the patient, the
procedure be provided
with the intent of doing
good to the patient.

12. 4. JUSTICE
• According to Salmond, “Justice means provide
everyone his share”
• According to Plato, ‘Justice is a quality. In simple
words the meaning of justice is to discharge one’s
duties honestly and not to interfere in other
actions.
• So justice is concerned with human welfare.

13. RELATIONSHIP BETWEEN LIBERTY AND
JUSTICE
Liberty is the first need of justice. Every ruler who
attacks the civil liberties is considered unjust
ruler. We can not even think of one without the
other.
• Purpose of both is common.
• Liberty is the first condition of justice But
absolute freedom is against justice.

14. ETHICAL THEORIES
14

15. Ethical Theories
• Ethical theory is means by which we
justify a particular ethical decision.
15

16. ETHICAL SCHOOL OF
THOUGHTS
1- Absolutism
2- Relativism
16

17. ABSOLUTISM
Absolutism refers to the idea that
reality, truth, or morality is “absolute”.
the same for everybody, everywhere,
and every-when, regardless of
individual culture or cognition, or
different situations or contexts.
17

18. RELATIVISM
 No universal norms of right and wrong
 One person can say “X is right,” another can say “X is
wrong,” and both can be right
 Relativism, roughly put, is the view that truth and falsity,
right and wrong, standards of reasoning, and procedures of
justification are products of differing conventions and
frameworks of assessment and that their authority is
confined to the context giving rise to them.
 relativism is a theory, which claims that there are no
universally valid moral principles.
 relativism theory says that the moral rightness and
wrongness of actions varies from society to society and that
there are no absolute universal moral standards binding on
all men at all times.
18

19. CLASSIFICATION OF ETHICAL THEORIES
1- Virtue based theory
2- Conduct based theory
i-Teleological
• Utilitarianism
• Hedonism
• Egoism
ii-Deontological
3- Right based theory
19

20. 1- VIRTUE BASED ETHICAL THEORY
20
Your conduct or action is ethical if you
focus on values (character)
Plato’s Aristotle’s Socrates
 wisdom
Justice
Courage
Temperance
•Golden mean
approach
•Middle path
approach
Knowledge

21. VIRTUE BASED ETHICAL THEORY
• Types of virtue
Intellectual virtue:
Associated with reasoning, ability to understand and
truth
Moral virtue:
 virtue of character (honesty )
A good person does the right thing at the right time for
the right reason
21

22. CONDUCT ETHICAL THEORIES
i: Teleological:
Focus on the end
Focus on consequences
Don’t focus on means
• Maintains that morality of an action is determined
solely by its consequences.
• Basically, it looks on the outcomes, situation and from
that one decides what is ethical.
• Thus, from a consequentialist standpoint, a morally
right action is one that produces a good outcome, or
consequence.
22

23. i.i. UTILITARIANISM ETHICAL THEORY
GHGN (Great happiness for great Number)
Democracy
Democratic concept
What makes something good or bad, right or
wrong, is that it produces the greatest amount
of pleasure (or lack of pain) for the greatest
number of people
23

24. PRINCIPLE OF GREATEST HAPPINESS
• An action is good in so far as it produces the
greatest happiness for greatest number of
people, and bad in so far it produces more harm
than benefit for the greatest number of
individuals.
• Happiness: is intended pleasure and absence of
pain.
• Pain: unhappiness
24

25. TWO FORM OF UTILITARIAN THEORY
A: Act utilitarian
B: Rule utilitarian
A: Act utilitarianism
o It asks a person to assess the effects of all actions
o Rejects the view that actions can be classified as
right or wrong in themselves
o Example: lying is ethical if it produces more good
than bad
o Act Utilitarianism is the belief that an action is good
if its overall effect is to produce more happiness
than unhappiness
25

26. TWO FORM OF UTILITARIAN THEORY
B: Rule utilitarianism:
It asks a person to assess actions according to a set of
rules designed to yield the greatest net benefit to all
affected
• Compares act to rules
.• Rule Utilitarianism is the belief that we should adopt a
moral rule and if followed by everybody, would lead to
a greater level of overall happiness
• Does not accept an action as right if it maximizes net
benefits only once
• Example: lying is always wrong (driving rules, drink )
26

27. EXAMPLE OF ACT & RULES UTILITARIANISM
• A judge sending a murderer to prison. The judge knows
the convict will not commit any more violent crimes,
and wants to be lenient (maybe the convict is very old
or terminally ill). The judge knows that this will make
the convict family and friends very happy. Imagine that
the victim’s family has forgiven the convict and will not
feel pain as a result of this decision.
• Should the judge let the convict go?
• Act utilitarianism says yes
• But rule utilitarianism says no
27

28. EXAMPLE
• A few doctors decide that a number of
experiments on a few people, even if most of
them died, would be worth it if they could find a
cure for a disease that would relieve the
suffering of millions of people. Utilitarianism
would give the approval for such because it
produces the greatest good for the greatest
number of people.
28

29. i.ii. HEDONISM ETHICAL THEORY
• Hedonism- is an ethical doctrine which claims
pleasure as norm of morality.
• Pleasurable is good
• Pain is evil is a view that good involves
happiness and pleasure, and evil as unhappiness
and pain.
• Pleasure
• When your conduct/action increases your
happiness or pleasure
29

30. HEDONISM ETHICAL THEORY
• Pleasure in the context means satisfaction
of desire; hence the greater the pleasure, the better.
30

31. A: INTELLECTUAL PLEASURE
A. Intellectual pleasure- derives from one’s
• Discovery of truth,
• Desire for knowledge
31

32. B. AESTHETIC PLEASURE
B. Aesthetic pleasure- refers to one’s interested feeling of
beholding something beautiful.
32

33. C. PHYSICAL PLEASURE
C. Physical pleasure satisfaction of luxurious or sexual
desire.
What if you attend the office at
11:00am instead of 8am???
33

34. i.iii. EGOISM ETHICAL THEORY
• Your conduct or action is ethical if it focus on
self-interest
• What makes something good or bad, right or
wrong, is that it satisfies one’s desires, or
meets one’s needs
•Basic Principle:
Self-interest of person doing, considering, or
affected by the action
• One should choose the action which most
realizes or conduces to one’s own self-interest
34

35. TYPES OF EGOISM
Individual Ethical Egoism
• Judges actions only by their effects on one’s interests
• Usually rejected by moral philosophers as a defensible basis
of ethics
Universal Ethical Egoism
• Can include the interests of others when assessing one’s
actions
• Still self-centered: pursuing pleasure and avoiding pain
• “Enlightened self-interest.” Considers the
interests of others because the person wants others to do
the same toward him or her
35

36. OBJECTIONS TO EGOISM
Not all human acts are selfish by nature, and some are
truly altruistic.
Egoism is not a moral theory at all: Egoism misses the
whole point of morality, which is to restrain our selfish
desires for the sake of peaceful coexistence with
others.
Does not resolve conflicts in people’s interests
One party would always have the pursuit of his or her
interests blocked
36

37. ii. DEONTOLOGY ETHICAL THEORY
• Deontologism- Duty Ethics
• Greek: deon-duty
• Deontos: that which is binding, right, proper;
• Emphasis on universal imperatives such is moral laws,
duties, obligations, prohibitions.
• It is sometimes also called imperativism.
• Focus on means
• eg telling truth, Ban on killing, adherence with
religious beliefs
37

38. DEONTOLOGY ETHICAL THEORY
• It looks on one’s duties and obligations
in determining what is ethical.
• It is also known as Duty Ethics.
• An ethical act is the one that meets
obligations, responsibilities and
duties.
38

39. KANT’S THEORY
Represent deontological ethics
For him a right action consists solely in an
action that is ruled and justified by a rule
or principle.
It was the rational and autonomous
conformity of one’s will to see right the
universal moral law
39

40. RIGHTS BASED THEORY
• Does not leads to violate the rights of others
Right: a person’s just claim or entitlement
• Focuses on the person’s actions or the actions of others
toward the person
Types
• Legal rights: defined by a system of laws
• Moral rights: based on ethical standards
• Purpose: let a person freely pursue certain actions without
interference from others
40

41. RIGHTS BASED THEORY
• Features
 Respect the rights of others
Lets people act as equals
Moral justification of a person’s action
• Examples
• Legal right: right to a fair trial in the Pakistan
• Moral right: right to due process within an organization
41

42. RIGHTS BASED THEORY
• Rejects view of assessing the results of actions
• Expresses moral rights from individual's view, not
society's. Does not look to the number of people who
benefit from limiting another person's rights
• Example: right to free speech in the Pakistan stands
even if a person expresses a dissenting view
42

43. TYPES OF RIGHTS
• Negative rights: do not interfere with another
person’s rights
• Positive rights: A person has a duty to help others
pursue their rights
Example
Negative: do not stop a person from whistle-blowing
Positive: coworker helps another person blow the whistle
on unethical actions
43

44. COMPARISON
Teleology Deontology Virtue Ethics
Morality is about
good outcomes
Morality is about good rules Morality is about
good people
We should make decisions
based on what will most
likely result in the outcomes
we want
We should come up with a
logical system of moral rules
and always follow it no
matter what
We should strive to become
more courageous, honest,
generous, and
compassionate.
“The ends justify the
means”
The means do not justify the
end
Such a person will make
good moral decisions on
their own without the need
for abstract moral rules.
Focus on desire outcomes/
consequences
Focus on the means/act
regardless of end/result
Moral link with personal
characteristics
44

45. DONATION CASE -I
• The Reluctant Donor Case: Suppose that you are famous transplant
• surgeon, and that your transplants always work. You have five patients,
• each of whom needs a transplant. One needs a heart, one a brain, two
• need one lung each, and one needs a liver. You have a patient named
• “Mr. Kumar” who has come in today to find out the results from some
• lab work. You know from the results of the lab work that Mr. Kumar
• would be a perfect donor for each of your five other patients, and you
• know that there are no other available donors. So you ask Mr. Kumar if
he would be willing to be cut up and have his organs distributed. He
declines your kind offer. But you then realize that you could cut Mr.
Kumar up without his permission during some minor surgery he has
already consented to.
Is it permissible for you do so?
45

46. • State will create a new stretch
of highway
• New highway segment will circumvent towns
allowing trucks
an alternate route.
• Some wildlife habitat would
be destroyed
• Taxes will be raised
Highway Scenario case-II

47. – Shazia earning an “A” on all work so far
– Carla doesn’t have time to write final
report
• Shazia purchases report; submits it as
her own work
PLAGIARISM SCENARIO
CASE -III
• Shazia
– Single mother
– Works full time
– Takes two evening courses/semester
• History class
– Requires more work than normal

48. WHAT TO DO ??? CASE-IV
48

49. ETHICAL DILEMMA, ETHICAL
DECISION MAKING & CODES OF
ETHICS FOR NURSES

50. ETHICAL DILEMMAS
• Ethical dilemmas, also known as a moral dilemmas, are
situations in which there is a choice to be made
between two options, neither of which resolves the
situation in an ethically acceptable fashion.
• An ethical dilemma or ethical paradox is a decision-
making problem between two possible moral
imperatives, neither of which is unambiguously
acceptable or preferable. The complexity arises out of
the situational conflict in which obeying would result in
transgressing another.

51. ETHICAL
DILEMMAS
Ethical dilemmas are
situations where two
ethical values or
requirements seem to
be incompatible
A conflict of interest
arises when an
individual has a duty to
two or more parties
Ethical dilemmas involve
unclear choices of what
is right and what is
wrong
Any decision where
moral considerations are
relevant can potentially
give rise to an ethical
dilemma
For example: A decision
that requires a choice
between rules.
A decision where there
is no rule, precedent or
example to follow.

52. Continue
A decision that morally requires two or more courses of action,
which are in practice incompatible with each other.
A decision that should "taken in one’s self interest, but which
appears to violate a moral principle that you support. It is the
imperative to act, combined with the uncertainty of which action to
take, that causes a dilemma.
Doing morally right Bad outcome
Doing morally wrong Good outcome
In such a dilemma, choosing one moral will result in violating
another; or, doing one thing could bring positive results but is
morally wrong. A common example is “stealing from the rich to
feed the poor.”

53. ETHICAL
DILEMMAS
Ethical dilemmas are situations
involving conflicting morals claims,
and give rise in such questions as
What ought I to do?
What harm and benefit result from
this decision or actions?
What is good (virtue) or what is duty
(right)?
Aroskar et al

54. ETHICAL DILEMMAS
IN SOCIAL WORK
• Ethical dilemma occurs when
social workers must choose
between two contradictory
ethical principles or
directives.
• Conflict may arise between
patients, families, agency
staffs, and government
regulations.
• Tensions may arise in
homecare
National Association of Social
Workers

55. SOCIAL WORKERS DILEMMA
• Social workers reported that the most common issues
were patient competence and confusion because of
the lack of advance directives
Some examples of ethical dilemmas are:
• A social worker's personal or professional values
conflict with serving their client
• A social worker's values or conduct deviate from the
professional code of ethics that governs social work.
• A social worker must decide whether to break
confidentiality for the good of their client
• An organization or colleague violates a standard of
ethical conduct

56. SOCIAL WORKERS DILEMMA AND
DECISION MAKING
• The National Association of Social Workers (NASW)
provides the Code of Ethics as a decision-making model
that all social workers use.
Function of the code is to ensure the conditions under which
social workers practice:
– Maintaining appropriate boundaries
– Following privacy rules
– Obtaining proper legal consent from clients
– Protecting confidentiality
• the code reminds social workers of their professional values
and mission. These standards benefit both social worker
and client, and, ideally, create an environment that is
conducive to progress.

57. ETHICAL DILEMMAS PHYSICIANS FACED
Three possible areas of decision making have
been Identified
1. Using all possible means to keep the patients
alive (ordinary & extraordinary means).
2. Surgeons experience ethical dilemmas in
deciding the right treatment in different
situations.
3. Taking some “positive” steps to hasten
individual’s death.

58. ETHICAL DILEMMAS IN NURSING
• The challenge of decision making .
• The sanctity of life vs the quality of life.
• Truth-telling
A code of ethics in nursing basically states that
nurses are responsible for respecting human
rights and treating all patients with respect
while promoting health, minimizing suffering,
and preventing sickness.

59. 4 COMMON NURSING ETHICS DILEMMAS
1. Informed consent
Concerns that patients and their families have not been fully informed about their
treatments or clinical prognosis is a common ethical concern of nurses, Ulrich
reported.
2. Disclosing medical conditions
Another example of an ethical dilemma is telling the truth to a patient vs. being
deceptive,
“Sometimes families request that patients not be told about their medical
condition or diagnosis. “The nurse must consider the patient's right to know. How
does the nurse know what the family is saying is true?” (Altman)
The nurse has an obligation to the patient and the ethical principles of
nonmaleficence and fidelity—the obligation to prevent harm and to be faithful to
your colleagues, “The nurse’s own value of truth telling must also be considered.”

60. 4 COMMON NURSING ETHICS DILEMMAS
3. Incompetence among peers
• Another dilemma when a nurse notes incompetence in
a fellow health care team member and struggles with
speaking up or staying silent,
• They may feel the behavior should be reported
because of the threat to patient safety but hesitate to
do so because it would worsen inadequate staffing,
• “Some dilemmas can be framed as competing
obligations, such as protecting the patient on one
hand and protecting the staff on the other. The
principles to consider are nonmaleficence and fidelity.

61. 4 COMMON NURSING ETHICS DILEMMAS
4. Broader ethical issues
• According to Felicia “Liz” Stokes, JD, RN, senior policy advisor at the ANA’s
Center for Ethics and Human Rights, ANA considers the top three
nursing ethics issues as:
• Creating and maintaining an ethical work environment
• Nursing’s role in social justice, such as opposing capital
punishment
• Moral distress and moral resilience.
“The Code of Ethics for Nurses with Interpretive
Statements is clear that nurses are bound in their duty to
protect human health,” (Ruth McBain on behalf of ANA).

62. ETHICAL DILEMMA VIDEO
• https://www.youtube.com/watch?v=-
GxuvKRL7ks
• https://www.youtube.com/watch?v=oQl6b-
fN1BI

63. ETHICAL DECISION MAKING
• In the context of decision making, your ethics
are your personal standards of right and
wrong. They are your basis for making
ethically sensitive decisions.
• Ethical decision making is a cognitive process
that considers various ethical principles, rules,
and virtues or the maintenance of
relationships to guide or judge individual or
group decisions orinted actions

64. ETHICAL DECISION-MAKING MODEL
• Ethical decision-making models provide a
suggested mechanism for critical thinking and
planning for the resolution of ethical dilemmas.
An ethical decision-making model is a tool that
can be used by health care providers to help
develop the ability to think through an ethical
dilemma and arrive at an ethical decision.
• The goal of each model is to provide a framework
for making the best decision in a particular
situation with which the health care provider is
confronted.

67. References
• Aroskar; M.A., Davis, A., Drought, T.,
Liaschenko, J.(1997). Ethical dilemmas and
nursing practice
• https://www.noodle.com/articles/ethical-
dilemmas-in-social-work-what-to-know-
about-nasw-code-of-ethics Retrieved on 6
April 2020

68. References
1 Wake E. Commentary on Twycross A, Finley GA (2013) Children’s and parents’
perceptions of postoperative pain management: A mixed methods study. Journal
of Clinical Nursing 22, 3095-3108. Vol. 23, Journal of Clinical Nursing. 2014. p.
3290–1.
2 American Academy of Pediatrics. Committee on Psychosocial Aspects of Child
and Family Health, Task Force on Pain in Infants C and A. The assessment and
management of acute pain in infants, children, and adolescents. Pediatrics.
2001;108(3):793–7.
3 Tein AJ, Roosa MW, Michaels M. Agreement Between Parent and Child Reports
on Parental Behaviors. J Marriage Fam. 2012;56(2):341–55.
4 Cordell WH, Keene KK, Giles BK, Jones JB, Jones JH, Brizendine EJ. The high
prevalence of pain in emergency medical care. Am J Emerg Med. 2002
May;20(3):165–9.
5 Stevens BJ, Abbott LK, Yamada J, Harrison D, Stinson J, Taddio A, et al.
Epidemiology and management of painful procedures in children in Canadian
hospitals. CMAJ. 2011 Apr 19;183(7):E403-10.
6 Online guide to Ethics and Moral Philosophy . (1996). Kant's Ethics.
Recuperado el 22 de Febrero de 2013, de Onlie guide to Ethics and Moral
Philosophy :
http://caae.phil.cmu.edu/Cavalier/80130/part1/sect4/Kant.html
68

69. References
5 Immanuel Kant Biography –
6 life, family, childhood, children, death, history, school, information,
born, tall, t ime. (n.d.).Encyclopedia of World Biography. Retrieved
February
7 25, 2013, from http://www.notablebiographies.com/Jo-Ki/Kant-
Immanuel.html#b
8 Immanuel Kant Biography - Facts, Birthday, Life Story -
Biography.com . (n.d.). Famous Biographies & TV Shows -
Biography.com . Retrieved February 25, 2013, from
http://www.biography.com/people/immanuel-kant- 9360144 (2011).
Kant's ethical theory. Retrieved February 24th. 2013, de
RSRevision from:
http://www.rsrevision.com/Alevel/ethics/kant/index.htm Fledderman, Ch.
(2014). Engineering Ethics. International Edition, Pearson Prentice Hall.
9 Encyclopedia Britannica, Inc. 2003. www.search.eb.com Online Ethics Center for Engineering and Science. 2004.
http://onlineethics.org
10 Fledderman, Ch. (2014). Engineering Ethics. International Edition, Pearson Prentice Hall. Encyclopedia Britannica, Inc. 2003. www.search.eb.com
11 Online Ethics Center for Engineering and Science. 2004. http://onlineethics.org

70. Ethical dilemmas
A decision that morally requires two or more courses of action,
which are in practice incompatible with each other.
A decision that should "taken in one’s self interest, but which
appears to violate a moral principle that you support. It is the
imperative to act, combined with the uncertainty of which action to
take, that causes a dilemma.
Doing morally right Bad outcome
Doing morally wrong Good outcome
In such a dilemma, choosing one moral will result in violating
another; or, doing one thing could bring positive results but is
morally wrong. A common example is “stealing from the rich to
feed the poor.”

71. Ethical
dilemmas
Ethical dilemmas are situations
involving conflicting morals claims,
and give rise in such questions as
What ought I to do?
What harm and benefit result from
this decision or actions?
What is good (virtue) or what is duty
(right)?
Aroskar et al

72. Ethical Dilemmas
in Social Work
• Ethical dilemma occurs when
social workers must choose
between two contradictory
ethical principles or
directives.
• Conflict may arise between
patients, families, agency
staffs, and government
regulations.
• Tensions may arise in
homecare
National Association of Social
Workers

73. Social Workers dilemma
• Social workers reported that the most common issues
were patient competence and confusion because of
the lack of advance directives
Some examples of ethical dilemmas are:
• A social worker's personal or professional values
conflict with serving their client
• A social worker's values or conduct deviate from the
professional code of ethics that governs social work.
• A social worker must decide whether to break
confidentiality for the good of their client
• An organization or colleague violates a standard of
ethical conduct

74. Social Workers dilemma and Decision
making
• The National Association of Social Workers (NASW)
provides the Code of Ethics as a decision-making model
that all social workers use.
Function of the code is to ensure the conditions under which
social workers practice:
– Maintaining appropriate boundaries
– Following privacy rules
– Obtaining proper legal consent from clients
– Protecting confidentiality
• the code reminds social workers of their professional values
and mission. These standards benefit both social worker
and client, and, ideally, create an environment that is
conducive to progress.

75. Ethical Dilemmas Physicians Faced
Three possible areas of decision making have
been Identified
1. Using all possible means to keep the patients
alive (ordinary & extraordinary means).
2. Surgeons experience ethical dilemmas in
deciding the right treatment in different
situations.
3. Taking some “positive” steps to hasten
individual’s death.

76. Ethical Dilemmas in Nursing
• The challenge of decision making .
• The sanctity of life vs the quality of life.
• Truth-telling
A code of ethics in nursing basically states that
nurses are responsible for respecting human
rights and treating all patients with respect
while promoting health, minimizing suffering,
and preventing sickness.

77. 4 Common Nursing Ethics
Dilemmas
1. Informed consent
Concerns that patients and their families have not been fully informed about their
treatments or clinical prognosis is a common ethical concern of nurses, Ulrich
reported.
2. Disclosing medical conditions
Another example of an ethical dilemma is telling the truth to a patient vs. being
deceptive,
“Sometimes families request that patients not be told about their medical
condition or diagnosis. “The nurse must consider the patient's right to know. How
does the nurse know what the family is saying is true?” (Altman)
The nurse has an obligation to the patient and the ethical principles of
nonmaleficence and fidelity—the obligation to prevent harm and to be faithful to
your colleagues, “The nurse’s own value of truth telling must also be considered.”

78. 4 Common Nursing Ethics
Dilemmas
3. Incompetence among peers
• Another dilemma when a nurse notes
incompetence in a fellow health care team
member and struggles with speaking up or
staying silent,
• They may feel the behavior should be
reported because of the threat to patient
safety but hesitate to do so because it would
worsen inadequate staffing,
• “Some dilemmas can be framed as competing

79. 4 Common Nursing Ethics
Dilemmas
4. Broader ethical issues
• According to Felicia “Liz” Stokes, JD, RN, senior policy advisor
at the ANA’s Center for Ethics and Human Rights, ANA
considers the top three nursing ethics issues
as:
• Creating and maintaining an ethical work
environment
• Nursing’s role in social justice, such as
opposing capital punishment
• Moral distress and moral resilience.
“The Code of Ethics for Nurses with Interpretive

80. Ethical Dilemma Video
• https://www.youtube.com/watch?v=-
GxuvKRL7ks
• https://www.youtube.com/watch?v=oQl6b-
fN1BI

81. Ethical decision making
• In the context of decision making, your ethics
are your personal standards of right and
wrong. They are your basis for making
ethically sensitive decisions.
• Ethical decision making is a cognitive process
that considers various ethical principles, rules,
and virtues or the maintenance of
relationships to guide or judge individual or
group decisions orinted actions

82. Ethical Decision-making Model
• Ethical decision-making models provide a
suggested mechanism for critical thinking and
planning for the resolution of ethical
dilemmas. An ethical decision-making model
is a tool that can be used by health care
providers to help develop the ability to think
through an ethical dilemma and arrive at an
ethical decision.
• The goal of each model is to provide a
framework for making the best decision in a

84. ETHICAL DECISION-MAKING
PROCESS
Article Activity
Please read the article carefully, and fill the
questions table with your own nursing practice
issues, how you identified the problem and
what was your decision for resolving that
problems
Note: please answer all the question. This is a
graded activity

86. References
• Aroskar; M.A., Davis, A., Drought, T.,
Liaschenko, J.(1997). Ethical dilemmas and
nursing practice
• https://www.noodle.com/articles/ethical-
dilemmas-in-social-work-what-to-know-
about-nasw-code-of-ethics Retrieved on 6
April 2020

87. Case
A 32-year-old pregnant woman, who came for
vaginal delivery. She had two previous babies with
emergency cesarean section. The second baby was
born just a year back. Due to this doctors wanted Mrs.
X to avoid any risk and to get her baby delivered
through c- section. The staff members tried to
convince Mrs. X and her husband, but to no avail.
Finally, the patient was sent home for trail of normal
labor. Two weeks later she came up with strong pains,
but during delivery her uterus got rupture. The baby
was delivered normally, whereas, mother was
transferred to the intensive care unit for close
observation. Unfortunately a few weeks later she
died.
Sayani, A.H (2015)
6 May 2021 87

88. Question
“Could medical paternalism have saved
patient life?” and if so, how could the
principle of autonomy be justified?”
6 May 2021 88

89. • In this emblematic ethical dilemma, if
couple autonomy was respected, women
were exposed to complications. While if a
health care professional’s decision was taken
into account, then patients autonomy, was
violated.
• According to Beuchamp and Childress there
is a disparity between the principle of
paternalism and autonomy.
Sayani, A.H (2015)
6 May 2021 89

90. Medical Paternalism
69 years male diagnosed with metastatic likely terminal
cancer. Based on a long relationship, the man's physician
knows that the patient has a history of psychiatric illness
and is emotionally fragile. When the patient blurts out,
"Am I OK? I don't have cancer, do I?" the physician
answers, "You're as good as you were ten years ago,"
knowing that the response is a paternalistic lie, but also
believing it justified in protecting the health and well-
being of the patient.
6 May 2021 90

91. Futility
• Medical futility is described as proposed
therapy that should not be performed
because available data have shown that it will
not improve the patient's medical condition.
James L. Bernat, 2005
6 May 2021 91

92. Cont:
• Futility in medicine is an ancient concept;
Hippocrates clearly stated that physicians
should “refuse to treat those who are
overmastered by their disease, realizing that
in such cases medicine is powerless
Deborah L. Kasman, October 2004
6 May 2021 92

93. What can physicians do when their professional judgm
differs from preferred patient or family choices?
• First, it is important to determine who has the
moral and legal right to make medical
decisions.
• The patient has the right to make decisions
regarding his own care as long as he is
mentally competent. If a patient is deemed
mentally incompetent to make decisions, a
surrogate must be identified.
(Deborah L. Kasman, 2004)
6 May 2021 93

94. Cont:
• This surrogate can be legally assigned by the
patient prior to incapacity (a durable power of
attorney), or his next of kin.
• If there is not an identifiable surrogate by
either means, the courts must assign a morally
valid proxy who can act in the patient’s best
interest.
(Deborah L. Kasman, 2004)
6 May 2021 94

95. Process to consider a treatment futile
•Patient’s Right ( e.g. spirituality)
•Surrogate Involvement (incapable patient)
•Physicians Decision
•Nurse play an important role (as a bridge)
•Court
•Effective communication is mandatory
(Nathaniel A.K Burkhadt M.A 2008)
6 May 2021 95

96. Futility Differs for Different Age and
Case
A futile care / Procedure for one is not futile for all; it
may be a useful for another…
Child
Young
Old
Acute
Chronic
(Nathaniel A.K Burkhadt M.A 2008)
6 May 2021 96