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Foundations in Evidence Based Practice. Introduction to Ethics. Introduction to ethics. Our care for patients should be based on sound judgement (or evidence based practice!!) ..some of this judgement is about having a strong sense of what is right or wrong

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introduction to ethics
Introduction to ethics
  • Our care for patients should be based on sound judgement

(or evidence based practice!!)

  • ..some of this judgement is about having a strong sense of what is right or wrong
  • ..having a strong sense of what we should be doing and shouldn’t be doing as nurses
  • ..having a strong sense of what our priorities ought to be
introduction to ethics3
Introduction to ethics
  • Nurses frequently have to make difficult decisions for which there is not always a quick, easy or ‘correct’ answer

e.g. Can Mrs X be discharged yet? Can Mr Y manage his own medications safely?

  • Nevertheless, nurses still have to be able to explain and account for these decisions and actions
  • The NMC Code can act as a guide

This can be seen as a ‘code of ethics’ – a set of important principles to help guide nurses

achievement of practice outcomes includes consideration of ethical issues
Achievement of practice outcomes includes consideration of ethical issues

Domain 1 Professional and Ethical Practice

1.3 Demonstrate an awareness of, and apply ethical principles to, nursing practice.


  • 1.3.1 Demonstrate respect for patient and client confidentiality
  • 1.3.2 Identify ethical issues in day to day practice
what is an ethical issue
What is an ‘ethical issue’?
  • When you have to judge what is right or wrong
  • Choosing between options
  • Deciding whether to do something or do nothing
  • Should I or shouldn’t I?
  • Weighing up the potential impact of your decisions or actions
  • A dilemma – making a difficult choice
ethical issues in health care
Ethical issues in health care
  • We usually think of the ‘big’ issues

e.g. definition of life, what is a person, quality of life, prolonging life, ending life, human rights.

  • But day to day ethical issues can involve:
    • Respecting people
    • Treating people with dignity
    • Treating people fairly
    • Supporting patient’s choices
  • These ‘principles’ are encompassed in the NMC code
  • The code is a useful source of ethical principles in health care
another source of ideas in health care ethics
Another source of ideas in health care ethics
  • Principles of Biomedical Ethics (Beauchamp and Childress, 2001)

They discuss:

  • 4 key principles
  • supplemented by 4 rules
4 key ethical principles
4 Key Ethical Principles
  • autonomy
  • beneficence
  • non-maleficence
  • justice
  • Respect a person’s right to make their own decisions
  • Teach people to be able to make their own choices
  • Support people in their individual choices
  • Do not force or coerce people to do things
  • ‘Informed Consent’ is an important outcome of this principle
beneficence to do good
Beneficence (to do good)
  • Our actions must aim to ‘benefit’ people – health, welfare, comfort, well-being, improve a person’s potential, improve quality of life
  • ‘Benefit’ should be defined by the person themselves. It’s not what we think that is important.
  • Act on behalf of ‘vulnerable’ people to protect their rights
  • Prevent harm
  • Create a safe and supportive environment
  • Help people in crises
non maleficence to do no harm
Non – maleficence (to do no harm)
  • do not to inflict harm on people
  • do not cause pain or suffering
  • do not incapacitate
  • do not cause offence
  • do not deprive people
  • do not kill
  • Both Beneficence and Non-maleficence underpin EBP
  • Treating people fairly
  • Not favouring some individuals/groups over others
  • Acting in a non–discriminatory / non-prejudicial way
  • Respect for peoples rights
  • Respect for the law

Distributive Justice – sharing the scarce resources in society in a fair and just manner (e.g. health services, professional time)

  • How should we share out healthcare resources?
  • How do we share out our time with patients?
  • Deciding how to do this raises some difficult questions

Patients should get…..

  • an equal share ?
  • just enough to meet their needs ?
  • what they deserve ?
  • what they can pay for ?
4 ethical rules
4 ethical rules
  • Veracity – truth telling, informed consent, respect for autonomy
  • Privacy – a persons right to remain private, to not disclose information
  • Confidentiality – only sharing private information on a ‘need to know basis’
  • Fidelity – loyalty, maintaining the duty to care for all no matter who they are or what they may have done
ethics 2 broad philosophical theories
Ethics 2 broad philosophical theories
  • 1) consequentialism – taking the consequences of our actions into consideration
  • 2) deontology – basing our actions on a set of principles or duties
  • Actions are right or wrong according to the balance of their good and bad consequences
  • the right act is the one that produces the best overall result
  • Utilitarianism (what action has the greatest utility - use/benefit/positive outcome) is a type of consequentialism
  • most prominent consequence-based theory
  • based on the principle of utility
  • actions ought to produce the maximal balance of positive value (e.g. happiness) over disvalue (e.g. harm)
  • Duty or principle based theory
  • An act is right if it conforms to an overriding moral duty

For example – do not tell lies, do not kill.

  • E.g. Christian ethics – The Ten Commandments

But Christian ethics are not important for some people in the world so moral duties vary between cultures and societies

  • A moral duty or principle is one that is:
    • laid down by god / supremely rational being
    • or is in accordance with reason / rationality
    • or would be agreed by all rational beings
  • The NMC Code of Conduct is a product of Deontological ethics – it guides action based on a set of principles/duties.

Beauchamp T and Childress J (2001) Principles of Biomedical Ethics 5th Edition Oxford University Press

Hunt G (1994) Ethical Issues in Nursing Routledge. London

Seedhouse D (1998) Ethics the heart of Health Care Wiley. Winchester.

Watt H (2000) Life and Death in Health Care Ethics Routledge. London