When a person meets the unfortunate circumstance of being admitted to a hospital for an illness they are depending on healthcare personnel to have their best interest in mind and make them better. When people think of who it is taking care of them and making them better they specifically think of Doctors and Nurses. As Doctors and more specifically Registered Nurses it is their duty to have a client’s best interest in mind and always act in their benefit. This raises the question, what guides Nurses to maintain this mindset of always putting the patient first? The answer is their ethical duty, meaning every nurse is guided by ethical theories and principles which help guide them as a patient advocate. It is these ethics that make a nurse so valuable to clients and ultimately makes a nurse the client’s best advocate. In this paper the core ethical theories and principles will be discussed and how exactly this helps RN’s be the best possible advocate and what benefits the clients themselves derive from these ethical theories. In order to properly understand the ethical theories of nursing one must first know what the core ethical principles and theories in nursing are. The ethical principles of nursing are Autonomy, Beneficence, Fidelity, Informed consent, Integrity, Justice, Nonmaleficence, Paternalism, Veracity, as well as Privacy and confidentiality. Some ethical theories that influence nursing practice are Consequentialism, Deontology, Ethical Relativism, Utilitarianism theory, Teleology, Virtue ethics, and Justice and equity.
To a layperson some of these words may make sense and others may not. In order to better understand how these theories and principles shape the practice of nursing you must better understand what they mean. A brief description of some of these terms will be given before their influence on nurses is discussed. Autonomy refers to the patients’ own rights to make decisions about their healthcare, health, and lives without the interference from healthcare personnel such as the physician, the nurse, or other team members. This means the nurse would have to resist the urge to interject his or her own feelings, values or beliefs onto the patient. This principle was made more evident with the passing of the Patient Self Determination Act by Congress in 1990 (“Ethical Principles,” n.d., para. 2). Beneficence is very simple, it is referring to always doing what is beneficial to the patient and therefore in their best interest (Silva & Ludwick, 1999). This principle also involves taking actions to help benefit others and prevent both physical and mental harm of the patient. Fidelity is synonymous with faithfulness and is therefore achieved by remaining loyal, fair, and truthful to patient and encompassing the idea of being a patient advocate.
An example of fidelity would be keeping a promise to a patient of coming back to check on them even if they become slammed with a heavy workload. Informed consent is directly related to autonomy in the fact that it allows the patient to make an informed decision about their treatment (Daly, 2009). This means that accurate information must be provided to the patient in order to make an informed decision. Three elements involved in informed consent are Informed, Competent, and Voluntary. What this means is the patient has all the accurate information, they are in a stable and competent mindset to make the decision, and that they are voluntarily making the decision. Justice is simply referring to fairness and equality. It is applied to healthcare by providing equitable access to nursing care. Nonmaleficence literally translates to “do no harm” and is a concept that originated from the Hippocratic Oath. Nurses apply this principle by not causing injury, being either physical, psychological, emotiona, or financial (“Ethical Principles,” n.d., para. 16).
Paternalism is a negative principle of nursing and is implied when a nurse does not respect the patients’ right to autonomy by making decisions for the patient because he or she thinks she knows what’s best for that patient (Sliva & Ludwick, 1999). Privacy and Confidentiality is relating to maintaining the security of a patient’s information and only sharing that information on a need-to-know basis with other healthcare members involved with that patients care and act to prevent breaches of confidentiality. Veracity as a word is associated with truthfulness. In nursing it is a duty to disclose pertinent information and the obligation to respect confidentiality at the same time. This means giving truthful information about the risks of a procedure while still respecting the patient’s confidentiality. These are the main principles of ethics as far as it pertains to nursing and knowing this information is vital to understanding ethical theories and how to better apply them as a practicing nurse.
As mentioned earlier some of the Ethical theories are Consequentialism, Deontology, Ethical Relativism, Teleology, Virtue ethics, and Justice and equity. It is important for Nurses to understand the definition of each of these, as well as how to apply them, and how it benefits the patient. It is pivotal for nurses because it will ensure that they are preforming their jobs and duties with the highest regard to patient advocacy and maintain the ethics which nursing is based on. Consequentialism, also referred to as utilitarianism, seems simple enough to understand as the word “consequence” is evident. Consequentialist ethics refers to the idea that the correct moral response is always going to be related to the outcome, or consequence, of the act.
This idea can also be thought of in a way that if a decision must be made it would be wisest to make the decision with the central aim of doing the maximum amount of greatest good for the greatest number of people. The actual ‘good’ that is being referred to can be expressed in numerous ways such as referring to values such as happiness, being pain or symptom free, or another life enhancing outcome (“Ethical Theories,” n.d., para. 2). There can be a backside to this theory however which can cause acts that would be contrary to the rights of individuals if the end result is one that would improve care for many others, this is referring back to the theory of doing the greatest good for the greatest amount of people.
Deontology is simply following the moral theory of doing unto others as you would want them to do unto you. This theory is placing more value on the intentions of the individual as opposed to the actual outcome of any action. It also focuses on rules, obligations, and duties. In order to follow the theory of deontology it requires absolute adherence to these obligations and acting from duty is viewed as acting ethically. An ethical person must always follow the rules, even if doing so causes a less desirable outcome. Since with this theory it is the motives of the actor that determine the value of the act a bad outcome may be acceptable if the intent of the actor was good. On the back side of this theory there is a criticism in healthcare that applying a strictly deontological approach to healthcare can lead to conflicts of interest between equally entitled individuals which can be difficult or even seemingly impossible to resolve (“Ethical Theories,” n.d. para. 4).
Teleology is a theory that is opposite to deontology in a sense. Whereas with deontology it is the intent of the decision made that determines the value as opposed to the outcome, with teleology it is the outcome that determines whether the act is good or of value and that achievement of a good outcome justifies using a less desirable means to attain the end. Ethical relativism takes into account for the variability in what is considered to be normal or acceptable to any given culture. What this is saying is that every culture has their own set of norms and therefore certain behaviors that may be acceptable in one culture may not be acceptable in others. A nurse must keep in mind that ethical standards are relative to person, place, time, and culture. The nurse must take on the fact that whatever a person thinks is right, is right. Right and wrong is not definite in most cases as there are no absolute truths. While there are no universal truths in ethical relativism there are few topics that are not open to debate, such as incest (American Nurses Association, 2011). Although this theory has been largely rejected it is still valuable for a nurse to consider when caring for their patients. If a nurse is better educated on the culture of their client and what is considered normal or taboo they will be better equipped to provide excellent care in that persons eyes without infringing on their culture or having a biased opinion of them.
Virtue ethics is different from other ethical theories in that it places much less emphasis on which rules people should follow and instead focuses on helping people develop good character traits, such as kindness and generosity. These character traits will, in turn, allow a person to make the correct decisions later on in life. Virtue theorists also emphasize the need for people to learn how to break bad habits of character, such as greed or anger. These are called vices and stand in the way of becoming a good person. This theory, while having the patients best interest in mind, focuses on the healthcare provider and asking them to learn good habits while breaking bad habits in order to predispose them to making the correct decision automatically while providing care to their clients. It requires the nurse to take a look at his or herself and make judgments on their character and work to change whatever is deemed unethical about themselves for the greater good of their patients. This is an essential process of becoming a nurse as nobody is perfect and allowing oneself to be open minded about change will allow them to be the best nurse possible. Justice and equity is simple, it refers to being fair and equal to all patients no matter their socioeconomic status or resources at their disposal.
This ethical theory is meant to protect the less privileged people in society and give them access to fair and equal healthcare access without bias from the healthcare members caring for them. The theory states that a “veil of ignorance” should be worn regarding who is affected by a decision and should be used by all decision makers because it allows for unbiased decision making. An ethical person should choose the action that is fair to all, including both the advantaged and disadvantaged groups in society. This theory is in place to protect those less fortunate people and is essential to all of society to keep the balance and fairness when it comes to healthcare. Now that all of the ethical principles have been defined it is easier to make sense of how the ethical theories came about for our healthcare system and all the members of the healthcare team taking care of the patients.
It is essential for these theories to be understood and applied by nurses all across the world in order to attain the best results for patients and the future of our healthcare system. It is essential of nurses to be well versed in the ethical principles and even more so in ethical theories to help guide them in their decision making when caring for clients. A nurse who knows the ethical theories and furthermore applies them in the field will have better client outcomes and prevent errors that can cause harm to a client in any way shape or form. These theories truly help protect not only the patients being cared for but also the nurses caring for those patients.