Ethical Principles Of Nursing

Box 4-1

Ethical Principles

Respect for autonomy : Based on human dignity and respect for individuals autonomy requires that individuals be permitted to choose those actions and goals that fulfill their life plans unless those choices result in harm to another. Nonmaleficence. According to Hippocrates, Nonmaleficence requires that we do no harm. It is impossible to avoid harm entirely, but this principle requires that health care professionals act according to the standards of due care, always seeking to produce the least  amount of harm possible. Beneficence. This principle is complementary to Nonmaleficence and requires that we do good. We are limited by time, place, and talents in the amount of good we can do. We have general obligations to perform those actions that maintain or enchance the dignity of other persons whenever those actions do not place an undue burden on health care providers  Distributive justice. Distributive justice requires that there be a fair distribution of the benefits and burdens in society based on the needs and contributions of its members. This principle requires that, consistent with the dignity and worth of its members and within the limits imposed by its resources, a society must determine a minimal level of goods and services to be available to its members.

That appeals exclusively to outocomes or consequences in determining which choice to make.

·         In other situations, nurses touch upon options open to fundamental beliefs. In such circumstances, these nurses may conclude that the action is right or wrong in itself, regardless of the amount of good that might come from it. This is the position known as deontology. It is based on the premise that persons should always be treted as ends in themselves and never as mere means to the ends of other.

·         Health professionals have specific obligations that exist because of the practices and goals of the profession. These health care obligations can be interpreted in terms of a set of principles in bioethics. The primary principles are respect for autonomy, Nonmaleficence, beneficence, and distributive justice, as shown in box 4-1. These principles have dominated the development of the field of bioethics since its inception in the 1960s (Evans, 2000). This approach has been called principlism, and one of its best descriptions and fullest articulations is in the fifth edition of beauchamp and childress principles of biomedical ethics (2001). This approach to ethical decision making in health care arose in response to life and death decision making in acute care settings, where the question to be rresolved tendd to concern a single localized issue such as the withdrawing or withholding of treatment (Holstein, 2001). In these circumstances, preserving and respecting a patient’s autonomy became the dominant issue.

ETHICAL CASE 1

Jeeff Williams, team leader in Home Health Care Services at the county health department, was preparing to visit Mr Chisholm, a 59 year old client recently diagnosed as having emphysema. Mr. Chisholm, who was unemployed because of a farming accident several years earlier, was wel known to the health department. Hypersensitive and overweight, he was also a heavy, long term cigarette smoker despite his decreased lung function. Mr. Williams visited Mr. Chisholm to find out why the client had missed his latest chest clinic appointment. He also wanted to find out if the client was continuing his medications as ordered.

As Mr. Williams parked his car in front of his client’s house, he could see Mr. Chisholm sitting in the front porch smoking a cigarette. A flash of anger made him wonder why he continued trying to each Mr. Chisholm reason for not smoking and why the took the time from his busy home care schedule to follow up on Mr chisholm’s missed clinic appointments. This client certainly did not seem to care enough about his own health to give up smoking.

During the visit, Mr. Williams determined that Mr. Chisholm had discontinued the use of his prophylactic antibiotic and was not taking his expectorant and bronchodilator medication on a regular basis. Mr. chisholm’s blood pressure was 210/114 mmHg, and he coughed almost continuously, although he listened politely to Mr. Williams concerns about his respiratory function and the continued use of his medications, Mr. Chisholm simply made no effort to take responsibility for his health care. Even so, another clinic appointment was made, and Mr. Williams encouraged the client to attend.

As he drove to his next home visit, Mr. Williams wondered to what extent he was obligated as a nurse to spend time on clients who took no personal responsibility for their health. He also wondered if there was a limit to the amount of nursing care a noncooperative client could expect from service provided in the community.
1.       What are Mr. Williams professional responsibilities for Mr. chisholms rights to health care?
2.       Is there a limit to the amount of care nurses should be expected to give to clients?
3.       What authority defines the moral requirements and moral limits of nursing care to clients?
Modified from Veatch RM, Fry ST: cass studies in nursing ethics, Philadelphia, 1995, lippincot

BRIEFLY NOTED

Deontology comes from the greek roots deon meaning duty and logos meaning study of.

Despite its success as basis for analysis in bioethics, principlism  has come under attack from a variety of quarters (e.g., Boylan, 2000; Clouser and Gert, 1990), and there are grounds for the criticism. First, some people say the principles are too abstract to serve as guides