DEFINITIONS
These definitions will assist nurses and health care providers in developing a greater understanding of ethical concepts.
(ETHICAL THEORETICAL PERSPECTIVES; Keatings & Smith., 2010)
Ethics
· A branch of philosophy; the philosophical study of morality.
· Systematic exploration of what is morally right and morally wrong.
· The study of ethics allows us to recognize and evaluate the variables that influence our moral decisions, obligations, character, sense of responsibility, social justice, and the nature of the good life (Grassian, 1981).
(TOWARD A MORAL HORIZON; Rodney, P., Burgess, M., McPherson, G. & Brown, H., 2004)
Ethical Practice
· Practice that requires requires thoughtful scrutiny of the beliefs and values that underpin our adoption of ethical theories and our ethical theorizing.
· It demands that we understand the sources of theories that guide us, including the assumptions that are embedded in them, and how that theory is evolving.
(ETHICAL THEORETICAL PERSPECTIVES, Keatings & Smith., 2010)
Ethical Dilemma
· Also known as moral dilemmas, an ethical dilemma occurs when the best course of action is unclear, and when conflict arises between what is right or wrong when there are strong moral reasons that support each position.
· We must choose between what is most right and least wrong.
Moral Distress
· Moral distress occurs when we know the right thing to do, or understand a particular course of action is right, but are unable to act or to influence the decision due to institutional constraints that make it difficult or impossible to pursue the right course of action.
· Results when we are not able to face these issues and deal effectively with them.
· If unable to do what we think is best, moral distress can contribute to feelings of guilt, discomfort, and dissatisfaction.
(TOWARD A MORAL HORIZON; Rodney, P., Burgess, M., McPherson, G. & Brown, H., 2004)
Moral Residue
· Moral residue is what we carry with us when we know how we should act, but are unwilling or unable to do so.
· The experience of moral residue can encourage the moral agent to reflect on and improve his or her practice.
· Moral residue can also lead the moral agent to move toward denial, trivialization, or unreflective acceptance of the incoherence between beliefs and action.
(ETHICAL THEORETICAL PERSPECTIVES; Keatings & Smith., 2010)
Values
· A value is an ideal that has significant meaning or importance to an individual, a group, or society.
· Nurses care for patients and families whose basic value systems may differ from their own (beliefs, rituals, and customs).
· Values emerge through our associations with others such as family, friends, classmates, teachers, colleagues – life experiences, religious beliefs, and the environment we live in.
Prima Facie Duties
· Duties that one must always act upon unless they conflict with those of equal or stronger obligation (Beauchamp & Walters, 2003).
· Are not absolute, and can be overridden.
Principles
· Ethical theories provide a framework of principles and guidelines to help identify ethical issues and reconcile problems or conflicts.
· Principles help to guide ethical reflection and discussion, and serve as a guide to assist nurses in justifying their moral position to others.
PRINCIPES
Principles help to identify ethical issues and provide a guide in reconciling problems or conflicts.
(ETHICAL THEORETICAL PERSPECTIVES; Keatings & Smith., 2010)
Autonomy
· The principle of autonomy asserts that a capable and competent individuals is free to determine, and to act in accordance with, a self-chosen plan (Beauchamp & Childress, 2001).
· Based on the notion that respect, worth, and moral dignity should be recognized, and the moral agent should be allowed to make decisions based on their own evaluations, choices and actions.
· Founded on respect for persons; gives rise to the duty of respecting a person’s values and choices.
· Autonomy assumes the person is competent; has the ability to decide rationality, rather than impulsively; and has the ability to act upon those decisions and choices (Beauchamp & Childress, 2001).
Informed Consent
· Based on respect for the principle of autonomy, and an individual’s right to the information required to make decisions about one’s health care.
· Failure to provide a patient with adequate information limits that person’s autonomy and interferes with his or her rights.
Veracity
· Derived from the principle of autonomy, veracity ensures the duty to tell the truth.
· This principle is central to ensuring and maintaining trust within the nurse-client relationship.
· Veracity is linked with autonomy – for example: patients have the right to expect that the nurses caring for them will provide honest responses to their questions and communicate truthfully to them about the nature of their condition and the care they receive.
Nonmaleficence
· “Above all, do no harm.”
· There are four elements related to nonmaleficence: (1) One ought not to inflict evil or harm, (2) One ought to prevent evil or harm, (3) One ought to remove evil or harm, (4) One ought to do or promote good (Beauchamp, 1982).
· CRNBC standards of practice and competencies, nurses must ensure the provision of safe patient care. Temporary harm is justified (restraining patients, intravenous insertion) if autonomy is respected, and if it is a means to producing good.
Beneficence
· Sets a higher standard than nonmaleficence.
· One must make a positive move to produce some good or benefit for another; one not only protects patients from harm, but also produces some good or benefit.
Fidelity
· Fidelity (being loyal, keeping promises, truth telling) comes into play when nurses uphold their commitment to provide adequate pain control; to provide quality care, comfort, and support when needed; to represent the interest of their clients; and to tell the truth.
Justice
· Based on the notion of fairness.
· The focus is how we treat individuals and groups within society, how we distribute benefits and burdens in an equitable way, and how we compensate those who have been unfairly burdened or harmed.
Descriptive Ethics
· Descriptive Ethics refer to the study of what people actually do; how people do in fact behave (Glannon, 2005). It is the factual descriptions and explanations of moral behaviors and beliefs. By looking at a wide range of moral beliefs and behaviors, this field of study attempts to explain how moral attitudes, codes and beliefs differ from person to person and across societies and cultures (Glannon, 2005).
Normative Ethics
· In this type of ethical theory, attempts are made to identify the basic principles and virtues that guide morality and to provide coherent, systematic, and justifiable answers to moral questions (Grassian cited in Keatings & Smith, 2010). Through the development of ethical theory, normative ethics provides a system of moral principles or virtues and focuses on the reasons or arguments that guide decisions about what is right and what is wrong (Grassian cited in Keathings & Smith, 2010). Utilitarianism and deontology are examples of normative ethical theories.
Applied Ethics
· Applied ethics entails the application of ethical principles or ethical norm and value theories on practical problems and conflict situations in different areas of life. Applied ethics is thus as old as ethics itself (Paracelsus Medical University, n.d.). In practice applied ethics has only been established as a separate academic discipline over the last 30 years. According to the specific field of application, numerous independent sub-disciplines have emerged. These include bioethics, medical ethics, environmental ethics, animal science ethics, engineering ethics, business ethics, political ethics, legal ethics, professional ethics for doctors, nurses, technicians, assistants, journalists, attorneys etc (Paracelsus Medical University, n.d.).
Utilitarian Theories
· Utilitarian ethics was formulated first by Jeremy Bentham, and later championed and elaborated by the philosopher John Stuart Mill (Encyclopædia Britannica, 2009). This ethic states that the rightness of an action entirely depends on the value of its consequences, and that the usefulness can be rationally estimated. The value of said consequences are often measured by the Greatest Happiness Principle, which states that each person's happiness counts for exactly the same as every other's, and that value of an action is positive if and only if that action increases the total happiness in the world. Other forms of utilitarian ethics use other bases for maximization (Encyclopædia Britannica, 2009). The central idea of the utilitarian theory is that ethics is a reality which can be demonstrated. One can define it without religious dogma, nor external regulation, starting from the only elementary motivations of human nature -- seeking happiness or pleasure, and to escape suffering (Encyclopædia Britannica, 2009).
Deontological Theories
· According to deontology, rules are established to determine what is right or wrong based on one’s obligations and duties, the foundation of which is the unchanging or absolute principles derived from universally shared values (Keatings & Smith, 2010). Deontologists believe that standards for moral behaviour exist independently of means or ends. Perhaps one of the best known rule-oriented deontological theories was formulated by Immanuel Kant. According to Kant, philosophy is the concept that morality could be explained as the ultimate commandment of reason or imperative from which all duties and obligations derive. Kant’s categorical imperative or moral law suggests that one’s actions are only acceptable if they are to become universal law (Keatings & Smith, 2010).
Feminist Ethics
· Feminist Ethics is an attempt to revise, reformulate, or rethink traditional ethics to the extent it depreciates or devalues women’s moral experience (Stanford Encyclopedia of Philosophy, 2009). As women’s moral experiences are undervalued in traditional ethics, feminist ethics tries to change this way of thinking. The goal of Feminist Ethics is the creation of a gendered ethics that aims to eliminate or at least improve the oppression of any group of people, but most particularly women (Stanford Encyclopedia of Philosophy, 2009).
Virtue Ethics
· It emphasizes that ethical actions ought to be consistent with certain ideal virtues that provide for the full development of our humanity (Stanford Encyclopedia of Philosophy, 2007). These virtues are dispositions and habits that enable us to act according to the highest potential of our character and on behalf of values like truth and beauty. Virtue ethics asks of any action, "What kind of person will I become if I do this?" or "Is this action consistent with my acting at my best?" According to virtue ethics, acting from duty is not the mark of excellence (Stanford Encyclopedia of Philosophy, 2007). The ideal is a virtuous person who places value in being morally good and actions flow from this virtuous way of being. Honesty, courage, compassion, generosity, tolerance, love, fidelity, integrity, fairness, self-control, and prudence are all examples of virtues (Stanford Encyclopedia of Philosophy, 2007).
WEBSITES FOR MORE INFORMATION ON ETHICS TERMS
Ethical Issues in Nursing: Introduction: Concepts, Values, and Decision Making (YouTube)
Santa Clara University – What is Ethics? http://www.scu.edu/ethics/practicing/decision/whatisethics.html
Santa Clara University – Consistency & Ethics http://www.scu.edu/ethics/practicing/decision/consistency.html
Santa Clara University – Thinking Ethically http://www.scu.edu/ethics/practicing/decision/thinking.html
Santa Clara University – Who Counts http://www.scu.edu/ethics/practicing/decision/whocounts.html
Santa Clara University – Utilitarian Perspective
Santa Clara University – Calculating Consequences: The Utilitarian Approach to Ethics
Utilitarianism Resources
PHG Foundation- Interactive Tutorials: Moral Theories
References
Canadian Nursing Association. (2010). The code of ethics for registered nurses. Retrieved February 11, 2011 from
Encyclopædia Britannica. (2009). Utilitarianism. Retrieved February 11, 2011 from
Glannon, W. (2005). History and theories (pp. 1-13). In Biomedical Ethics New York: Oxford University Press.
Paracelsus Medical U National Defense of Canada – Defense Ethics Programme
Stanford Encyclopedia of Philosophy. (2009). Feminist Bioethics. Retrieved February 11, 2011 from
Stanford Encyclopedia of Philosophy. (2007). Virtue Ethics. Retrieved February 11, 2011 from
Keatings, M., & Smith, O. (2010. Ethical & Legal Issues In Canadian Nursing. (3rd Edition. pp. 15-32). Toronto: Elsevier.
Rodney, P., Burgess, M., McPherson, G. & Brown, H. (2004). Our Theoretical Landscape: A Brief History of Health Care Ethics (pp. 57, 163). In Storch, J., Rodney, P., Starzomski, R., (2004). Toward a Moral Horizon Nursing Ethics for Leadership and Practice.
