Health care ethics

Foundations in Evidence Based
 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 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
Domain 1 Professional and Ethical Practice
1.3 Demonstrate an awareness of, and apply ethical principles to, nursing
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’?
 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
 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
 Principles of Biomedical Ethics (Beauchamp
and Childress, 2001)
They discuss:
 4 key principles
 supplemented by 4 rules
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)
Our actions must aim to ‘benefit’ people – health, welfare, comfort, wellbeing, 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
 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
 Veracity – truth telling, informed consent, respect for
 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
2 broad philosophical theories
 1) consequentialism – taking the
consequences of our actions into
 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
 Utilitarianism (what action has the greatest utility -
use/benefit/positive outcome) is a type of
 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
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