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Ethical Issues in Nursing / Midwifery

Antoinette Attard

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Principles of ethical discussion

Autonomy

Beneficence

Nonmaleficence

Justice

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Autonomy

Derived from Greek:

Autos means self and

Normos means rule, governess or law

Autonomy means self rule

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Autonomy

Personal autonomy refers to personal rule of the self while remaining free from both controlling interferences by others and personal limitations, such as inadequate understanding, that prevent meaningful choice

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Autonomy

But can a person ever have full

understanding of his / her illness?

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Autonomy

Autonomy provides the justification for the right to make autonomous decisions which in turn takes the form of specific autonomy related rights such as liberty and privacy

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Autonomy

Autonomous actions are not to be subjected to controlling restraints by others.

Can you identify commonplace controlling restraints that patients face?

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Autonomous actions:

Autonomous actions are analysed in terms of:

Intentionality

Understanding

Free from coercion – not forced in any way

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Beneficence

This is an obligation to help others further their important and legitimate actions.

But is this absolute?

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Beneficence

A moral dilemma can arise between the principles of autonomy and of beneficence - allowing one to choose what’s best for him/her and helping him/her to choose what is best!!!

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Beneficence

This principle has been cited as justification for paternalistic behaviouri.e. making decisions for others on the premise that one is in a better position to decide what’s best for other people.

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Paternalism

Paternalism can be justified only if:

The harm prevented from occurring or the benefits provided to the person, outweigh the loss of independence and the sense of invasion caused by the interference;

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Paternalism (cont)

The person’s condition seriously limits his/ her ability to choose autonomously

The interference is universally justified under relevantly similar circumstances

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Beneficence

The obligation to benefit members of society including future generations, is commonly cited as the primary justification for scientific research.

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Beneficence

The justification for using children as research subjects when they will not benefit individually from the research is that they are often the only subjects who can be used to study childhood disorders and development in order to help other children

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Beneficence

However, it is one thing to maintain that actions or programs are morally justified, and another to maintain that they are morally required on grounds of a prima facie obligation. Even if the support of research is justified on grounds of beneficence, this does mean that one is obliged to participate.

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Nonmalificence

This principle refers to the duty of not harming patients / clients. Harm here refers to harm caused by negligence(e.g. not turning a patient who cannot move) or willful harm (e.g. purposely doing a procedure incorrectly)

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Nonmalificence

The notion of ‘professional mal practice’ is

based on this principle.

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This principle conflicts with the principle of beneficence e.g.:

Patient is terminally ill and in severe pain – give strong dose of analgesia to relieve pain even if such dose can cause ‘harm’

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Principle of double effect

Action not intrinsically wrong;

Agent must intend the good effect, although bad effect may be foreseen;

Bad effect must not be a means to the end of bringing about the good effect;

Good result outweigh the bad effect permitted

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Justice

One acts justly towards a person when that person has been given what s/he deserves.

Justice is important when discussing allocation of resources

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Justice

One who has a claim based in justice has a claim of entitlement and in this strong sense is due something.

An injustice in turn, involves a wrong where one has been denied that to which one is entitled.

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Justice

Distributive justice refers to just distribution in society (of what is available) structured by various moral, legal and cultural principles

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Justice

In general rules and laws are unjust when they make distinctions between classes of persons that are actually similar in relevant respects, or fail to make distinctions between classes that are actually different in relevant respects.

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JusticeOne issue about justice and classes of persons, concerns the selection of human subjects of research.

Should a particular class be used at all? e.g. prisoners, fetuses, children and those institutionalized for reasons of mental disability

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Justice

Formal justice:

According to Aristotle: equals must be treated equally; and unequals must be treated unequally

But on what criteria are we determining whether two or more individuals are equal?

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Justice

The principle of need:

To say that someone has a fundamental need for something is to say that the person will be harmed or detrimentally affected in a fundamental way if that thing is not obtained.

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JusticeThe notions of a fundamental need is the basis of a policy for social distributions

By contrast if one accepts only a principle of free market distribution then one would be opposed to the use of a principle of need for developing public policy

Thank you for your attention.

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Autonomy

Kant argues that respect for autonomy flows from the recognition that all persons have unconditioned worth, each having the capacity to determine his or her own destiny. To violate a person’s autonomy is to treat that person merely as a means

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AutonomyMill was more concerned with the autonomy (or individuality) of action or thought. He argued that social control over individual actions is legitimate only if it is necessary to prevent harm to other individuals and that citizens should be permitted to develop their potential according to their personal convictions, as long as they do not interfere with a like expression of freedom by others.