CHAPTER 4
Questions of Values and
Ethics
OBJECTIVES
• Describe the principles of ethics
• Examine the relationship of critical thinking to the ethical
decision-making process
• Discuss how the Code of Ethics serves as a guideline to ethical
decision making
• Identify areas that are subject to frequent ethical dilemmas in
the clinical setting
• Discuss common areas of difficulty involved in making ethical
decisions.
• Differentiate between personal ethics and Professional ethics.
OBJECTIVES
• Differentiate between values and
personal/professional ethics.
• Discuss methods in which values are formed.
• Describe the process of values clarification.
• Differentiate between morals and ethics.
• Compare and contrast principles and rules of ethics.
• Apply the eight basic ethical principles to an ethical
issue.
• Compare and contrast different types of ethics.
OBJECTIVES
• Utilize the Code of Ethics for Nurses to critically
think when making decisions in professional
practice.
• Utilize strategies to enhance ethical decisions in
nursing practice.
• Discuss the influence organizational ethics have on
nursing practice
• Examine the steps to ethical dilemma resolution.
• Examine ethical dilemmas that the nurse may
encounter in professional practice and in health care.
• Apply critical thinking to client scenarios and
NCLEX-style questions.
In the beginning…
• There were no antibiotics
• There were no ICUs
• There were no CT scanners and MRIs
• There were just physicians and nurses
who cared for people in sickness and in
health
1960s
• Technological advances allowed for the
development of ICU
• New biomedical developments
• Advances in surgical techniques, such as
open heart surgery
New Questions
• The advances created new questions for
health care professionals regarding the
use of technology
• The concepts of life and death
Bioethics
• A subdiscipline of ethics
• The study of medical morality
Concepts of Ethics
• Values
• Belief systems
• Morality
Value Systems
• A set of related values
• Intrinsic values
• Extrinsic values
• Personal values
• Professional values
Value Formation
• Values are learned
• Values change with maturity and
experience
• The number of values an individual holds
is not as important as what values they
consider important
Values Clarification
• Choosing
• Prizing
• Acting
Belief Systems
• These are organized ways of thinking
about why people exist within the
universe
• Their purpose is to explain such
concepts as
• Life and death
• Good and evil
• Health and illness
Morals
• An individual’s own code for
acceptable behavior
• They arise from an individual’s
conscience
• They act as a guide for individual
behavior
• Learned
Ethics
• Ethics deals with the “rightness” or
“wrongness” of human behavior
• Concerned with the motivation behind
the behavior
• Bioethics is the application of these
principles to life-and-death issues
Ethical Theories
• Deontological
• Teleological
• Principalism
Ethical Principles
• Autonomy
• Nonmaleficence
• Beneficence
• Justice
• Fidelity
• Confidentiality
• Veracity
• Accountability
Autonomy
• The freedom to make decisions about
oneself
• Nurses need to respect clients’ rights to
make choices about health care
Nonmaleficence
• Requires that no harm be caused to an
individual, either unintentionally or
deliberately
• This principle requires nurses to protect
individuals who are unable to protect
themselves
Beneficence
• This principle means “doing good” for
others
• Nurses need to assist clients in meeting
all their needs
• Biological
• Psychological
• Social
Justice
• Every individual must be treated equally
• This requires nurses to be nonjudgmental
Fidelity
• Loyalty
• The promise to fulfill all commitments
• The basis of accountability
Confidentiality
• Anything stated to nurses or health
care providers by clients must remain
confidential
• The only times this principle may be
violated are
• If clients may indicate harm to
themselves or others
• If the client gives permission for the
information to be shared
Veracity
• This principle implies “truthfulness”
• Nurses need to be truthful to their clients
• Veracity is an important component of
building trusting relationships
Accountability
• Individuals need to be responsible for
their own actions
• Nurses are accountable to themselves and
to their colleagues
Ethical Codes
• These are formal statements of the
rules of behavior for a particular group
of individuals
• Ethical codes are dynamic
• Most professions have a “code of
ethics” to guide professional behavior
Virtue Ethics
• Focus on virtues or moral character
• View helping others as charitable or
benevolent
Organizational Ethics
• Focus on the workplace
• Ethical culture makes a difference
• Senior leadership must promote an
ethical culture
Ethical Dilemmas
• Occur when a problem exists between
ethical principles
• Deciding in favor of one principle usually
violates another
• Both sides have “goodness” and
“badness” associated with them
Resolving Ethical
Dilemmas
Using the Nursing Process
• Assessment
• Planning
• Implementation
• Evaluation
Approach to Ethical Dilemmas
Approach
Assessment
Planning
Implementation
Evaluation
Am I involved?
Determine goals
of treatment
Work toward
a mutually
acceptable
decision
Determine
whether desired
outcomes have
been reached
Collect the
facts
Identify
decision-makers
Use of
discussion and
negotiation
Re-evaluate
as necessary
What values
are in conflict?
List and rank
the options
Current Ethical Issues
Issues to Consider
• Assisted suicide
• Technology issues
• Gene therapies
• “Designer babies”
• Organizational climate
Conclusion
• An issue is not an ethical issue for the
nurse unless he or she has been asked
• Always gather the facts prior to decisionmaking
• Consider your personal beliefs and values