chapter 24 ethical obligations and accountability fundamentals of nursing: standards &...

Chapter 24Ethical Obligations and Accountability

Fundamentals of Nursing: Standards & Practices, 2E

Copyright 2002 by Delmar, a division of Thomson Learning 24-2

Concept of EthicsEthics is the study of the rightness

of conduct.Morality is behavior in accordance

with custom or tradition and usually reflects personal or religious beliefs.


Relationship Between Legal and Ethical ConceptsReasons that contribute to the

occasional discrepancies between law and ethics• Individual differences exist between

ethical opinions.• Human behavior and motivation are

too complex to be accurately reflected in law.


• The legal system judges action rather than intent.

• Laws change according to social and political influences.


Ethics in Health Care The application of general ethical

principles to health care is referred to as bioethics.

There is an emphasis on ethical issues involving life-or-death situations.

Every day nurses encounter challenges about what should be done.


Factors contributing to the need for ethical health care• An increasingly technological society• The changing fabric of our society• Clients who are more knowledgeable

about their health • Continually decreasing allocation of

federal funds for health care


Ethical TheoriesTeleology

• Principle of utilityDeontology

• Concept of the categorical imperative


Ethical PrinciplesAutonomy

• An individual’s right to choose and the ability to act on that choice

Nonmaleficence• The duty to cause no harm to others

Beneficence• The duty to promote good and to

prevent harm


Justice• Based on the concept of fairness

Veracity• Truthfulness, neither lying nor

deceiving othersFidelity

• Faithfulness and keeping promises


Values and EthicsValues influence the development of

beliefs and attitudes.Almost nothing in life is value-free.Nurses need to examine their own

value systems in order to determine the best approach to managing the care of clients with different values .


Values clarification• The process of analyzing one’s own

values to better understand what is truly important

• Three step process of valuing Choosing Prizing Acting


Ethical CodesInternational Council of Nurses Code

for NursesAmerican Nurses Association Code

of EthicsCanadian Nurses Association Code

of Ethics for Nursing


Clients’ RightsClients have certain rights including,

but not limited to, the right to• Make decisions regarding their care• Be actively involved in the treatment

process• Be treated with dignity and respect


Ethical Dilemmas An ethical dilemma occurs when there is

a conflict between two or more ethical principles.

Ethical dilemmas are situations of conflict, in that there is no right or wrong option.

The nurse must make a choice between two alternatives that may be equally unsatisfactory.


The following dilemmas occur frequently• Informed consent• Refusal of treatment• Use of scarce resources• Cost-containment initiatives that

negatively affect client well-being• Incompetent health care providers


Ethical Decision Making Ethical reasoning is the process of

thinking through what one ought to do in an orderly, systematic manner to provide justification of actions based on principles.

Ethical reasoning is used in situations in which the right decision is not clear or in which there are conflicts of rights and duties.


Ethical decision-making process• Gather relevant data in order to identify

the problem• Determine what type of ethical

dilemma exists• Establish the rights, responsibilities,

duties and decision-making abilities of all the people involved


• Identify several possible alternatives and predict the outcome of each, then select a course of action

• Evaluate the resolution process


Ethical IssuesEuthanasia

• Euthanasia refers to mercy killing (deliberate ending of life as a humane action).

• Active euthanasia refers to taking deliberate action that will hasten the client’s death.


• Passive euthanasia means cooperating with the client’s dying process.

• Assisted suicide is a form of active euthanasia in which a health care professional provides a client with the means to end his or her own life.


Refusal of Treatment• The client’s right to refuse treatment is

based on the principle of autonomy.• A client’s right to refuse treatment and

the right to die challenge the values of most health care providers.


Scarce Resources• The use of expensive services is being

examined closely.• Availability of goods is also contributing

to a scarcity of resources.


Ethics of NursingEthics committeesThe nurse as client advocateThe nurse as whistleblower

chapter 24 ethical obligations and accountability fundamentals of nursing: standards &...

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