Ethical Principles

Unit III

By
Mohammad Iqbal
KMU

Ethics: Unit III, Ethical Principles, Lecture 4

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 Objectives
By the end of this unit the students will be able to:
• Define ethical principles in health care
• Discuss the ethical dilemmas faced by nurses and
clients.
• Discuss the strategies to resolve ethical dilemma
in daily nursing practice.
• List steps of ethical decision-making

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 Ethical Principles

Ethical principles are a set of ethical rules that

provide the framework/ tools which may
facilitate individuals and society to resolve
conflict in a fair and moral manner.

The ethical principles are as follows:

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• Accountability: Answerable to oneself and others
for one’s own actions
• Autonomy: Refers to the right to make one’s own
decisions and choices.
• Confidentiality: Respect for a person’s privacy.
• Beneficence: The principle of doing good and
avoiding harm.
• Nonmaleficence: The duty to do no harm.
• Justice: The principle that deals with fairness,
equity and equality .
• Fidelity: Means to be faithful to agreements and
promises.
• Veracity: Refers to telling the truth.
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 Ethical Dilemma
Many of our ethical issues arise when dealing with
the beginning of human life or the end of
human life and the use of technology. There are
so many others.
Nurses face different ethical dilemmas in a health
care system
For Example:
• How should a nurse allocate her/his time and
effort when caring for 8 acutely ill patients?
Time and effort are resources.
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• What should a health professional do when
he/she sees a colleague engaging in an
unethical act?
• Because of the family’s wish, the terminal ill
status has not been told the patient but the
nurse is sure he/she knows he/she is dying.
What should the nurse do ethically when this
patient directly asks her/him about his/her
condition?

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• Is lying to a patient ever ethical? What
constitutes/comprises a lie? Is a placebo a lie?
• Should the nurse follow a doctor’s order if
she/he thinks there is a potential problem with
the order?

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• Two ethical principles are ‘Do No Harm and Do
Good’. What do we mean by Harm and Good?
• Health professionals have two basic ethical
obligations: (1) to extend life & (2) to lessen pain
and suffering.
• Can they do both in this situation when
morphine may shorten patient’s life?
• Should more money be spent on prevention
than on acute care and especially on terminal
care? How ethically justify spending money on
futile medical care?

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 Scenario

A patient, 30 years old, is hospitalized with AIDS.

Next day his parents come to see him. The
patient requests his nurse if his parents asks his
diagnosis please tell another one like leukemia
etc. instead of AIDS.
What the nurse should do here?
Veracity or confidentiality?

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 Strategies to Resolve Ethical dilemma

1. Identify ethical issues and problems

2. Look at the dilemma from different perspectives:
• What are the consequences of each choice?
• Who is affected and in what ways?
• Examine the choices against well accepted moral laws?
• Look at the choices using the ‘Golden Rule’ – How would I
like to be treated under similar circumstances?

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 Cont….

3. Identify and analyze available alternatives

4. Select one alternative
5. Justify the selection

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 Ethical Decision Making

Responsible ethical reasoning is rational and

systematic. It should be based on ethical
principles and codes of ethics rather than on
emotions intuition, fixed policies, or precedent.
A good decision is one that is in the client’s best
interests and at the same time preserves the
integrity of all involved.

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 Steps of Ethical Decision Making

• Identify the moral aspects.

• Gather the relevant facts that relate to the
issue.
• Determine ownership of the decision. i.e for
whom is the decision being made? Who should
decide and why?
• Clarify and apply personal values.
• Identify ethical theories and principles.
• Identify applicable laws or institutional policies.
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 Cont….
• Use competent interdisciplinary resources.
• Develop alternative actions and project their
outcomes on the client and family.
• For each alternative action, identify the risk and
seriousness of the consequences for the nurse.
• Apply nursing codes of ethics to help guide
action.
• Participate actively in resolving the issue.
• Implement the action.
• Evaluate the action taken.

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 Scenario
• Mrs. Reena, a 40 years old woman, was brought to a
hospital with multiple fractures and lacerations caused
by RTA, while she was driving self. Her husband was
brought the same hospital but dead. Mrs. Reena
freequently questions Ms. Almas, her primary nurse,
about her husband. The surgeon, Dr. Momin, has told
the nurse not to tell Mrs. Reena about the death of her
husband; however, he does not give the nurse any
reason for these instructions. Ms. Almas expresses her
concern to the charge nurse, who says the surgeon’s
order must be followed. Ms. Almas is not comfortable
with this and wonders what she should do.

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 Class Activity

Make your three groups into 1, 2, and 3.

• Question:
What the nurse Ms. Almas should do?
Should she tell her patient the truth or lie?
If truth, why? If lie, Why? Give reasons

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The END

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