Morals are an individualized code for acceptable behavior, arising from the individual’s conscience. Ethics is the systematic and critical approach in studying the values in human conduct— the study of “right conduct”. Nurses are obligated to act ethically, a non-negotiable aspect of nursing (ANA, 2001). There are two major classifications of ethical principles in nursing:
- Deontology: both the means and ends must be ethical.
- Utilitarianism: this follows the phrase “the ends justify the means”. It also follows the principle of “the greatest good for the greatest number”, prioritizing the needs of many over the needs of one.
Ethical Principles
- Beneficence: “doing good”; actively acting for the best interest of the patient.
- Example: child immunization that causes discomfort during administration, but creates protection from disease for both the individual and society.
- Non-maleficence: “avoiding evil”; acting to protect the patient against harm, especially for patients who are unable to protect themselves.
- Autonomy: allowing the patient to exercise self-determination and freedom from duress; protection of their independence and freedom.
- Example: the preoperative consent assured in writing.
- An exemption is applied allowing restriction of autonomy in cases where harm to oneself or others may occur or has occurred.
- Privacy: the right of the patient to be free from unjustified access by others.
- Confidentiality: the protection of information, limited only to the healthcare team directly involved in patient care and those given authorization.
- An exemption is applied allowing the breach of confidentiality in cases where harm to oneself or others may occur or has occurred, and when direct consent has been provided by the patient.
- Fidelity: “promise-keeping”; the act of fulfilling all preordained and uptaken roles and responsibilities by the nurse.
- Example: after assessment for pain and offering a plan to manage it, this principle encourages the nurse to do their best in keeping to the plan and improving patient comfort.
- Veracity: truthfulness and honesty, so long as the information will not result in harm to the patient.
- Justice: the principle of fairness. It implies equal treatment for all clients, and the distribution of resources to those who require them the most (social justice).
- Accountability: taking responsibility for one’s own actions.
Is a nurse obligated to serve in a disaster?
In a disaster, the nurse is not legally required to answer a call to help according to the American Nurses Association Code of Ethics. While a nurse is primarily committed to the patient (Provision 2), the nurse also has an ethical obligation to care for themselves— the nurse owes the same duty to self as to others (Provision 5).
Ethical Dilemmas
Problems can arise wherein different actions will abide to different, exclusive ethical principles. This produces a dichotomy wherein multiple seemingly equally “good” and equally “bad” responses are weighed against one another. The nurse may apply the familiar nursing process in tackling such ethical dilemmas:
- Assessment: is the nurse involved? What are the facts of the problem, and which ethical values are being considered?
- Planning: what is the final goal? Who are the ones to make the decisions? What are all the available options?
- Implementation: discuss and negotiate with the parties concerned to work towards a mutually acceptable decision.
- Evaluation: determine if the desired outcomes were reached, and re-evaluate as necessary.
Ethical Decision Making Process
The nurse describes the problem (assessment) in terms of the facts, values, reactions, principles, and legal rules being considered. All parties involved then explore options and alternatives to decide on a recommended course of action, from which an action plan is developed and executed.
Salient Points in Ethical Dilemmas (American Nurses Association, 2017)
- Nurses must be professionally and personally prepared.
- Nurses must be aware of ethical situations that arise in the healthcare setting, especially in times of scarcity. Times will arise where unimaginable patient care decisions must be made.
- Nurses must advocate for systems and protocols that protect their ethical obligations as nurses and ensure equity and fairness in disaster medical care planning. Provision 8 of the ANA Code of Ethics states the nurses are obligated to always “stress human rights protection under all costs,” with particular attention to vulnerable groups such as women, children, the elderly, prisoners, refugees, and socially stigmatized groups.