ETHICAL THEORIESAND PRINCIPLES

THE ICN CODE IDENTIFIES 4 AREAS OF RESPONSIBILITY FOR NURSESPromotion of healthPrevention of illnessRestoration of healthAlleviation of suffering

THREE MAJOR ETHICAL SYSTEMSEmotivismFormalismUtilitarianism/Consequentialism

EMOTIVISMDavid Humes system.It is granted that one cannot go from the is to the ought by means of human reason but only by means of an emotional faculty.Concludes that values have no rational basis for determining good and evil actions and are prompted only by emotional experience when making such decisions.

FORMALISMBY Immanuel Kant.People cannot claim to be ethical or moral unless they legislate for themselves in a rational way, free of self-interest.Sometimes called ethical rationalism or altruism.

UTILITARIANISM/CONSEQUENTIALISMDeveloped by Jeremy Bentham.Stated that a persons emotional acceptance or rejection of human act as good or bad is founded upon an estimation of how much pleasure or pain it gives the person performing the act.

ETHICAL THEORIESDeontologyTeleology

DEONTOLOGYBased on dutiful actions.An action is right when it conforms to laws or rules laid down by the legitimate authorityApplication of Kants hypothetical imperative (if-then):If I want to show compassion toward my patient, then I should perform a compassionate action for my patient.

DEONTOLOGYApplication of Kants categorical imperative:If I perform this action, should it become a universal law?Application of deontology to health care:Duty to honor a patients autonomyDuty to promote good and well-beingDuty to keep promise and confidentiality

DEONTOLOGYThe Code of Ethics for Nurses BON Resolution 220 series 2004Provides guidance for carrying out nursing responsibilities consistent with the ethical obligations of the profession.

TELEOLOGYConcerned with the consequences or end product of our actions.An action is right if it brings increased happiness or benefit for those concerned; an action is wrong if it decreases peoples happiness or benefit.

TELEOLOGYApplication of teleology to health care:The principle of utilityThe principle of the greatest happiness for the greatest number of people

VALUESAre ideals, beliefs, customs, modes of conduct, qualities, or goals that are highly prized or preferred by individuals, groups or society.Learned in both conscious and unconscious ways, become part of a persons make up.Provide direction and meaning to life and a frame of reference for integrating, explaining and evaluating new experiences, thoughts and relationships.

VALUESCultural, ethnic, familial, environmental, educational and other experiences of living help to shape our values.Many values are formally adapted by groups and are written in professional codes of ethics, religious doctrines, societal laws and statements of an organizations philosophy.

PRINCIPLEFrom the Latin word principium which means source or beginning.A fundamental truth or doctrine that is the source of inspiration or direction for moral action or used as the starting point for moral reasoning.

MORALSFrom the Latin word mores which means custom or convention.Generally refers to the domain of personal values and rules of behavior; conventional rules of conduct regulating our social interactions.

MORALITYBehavior in accordance with custom or tradition and usually reflects personal or religious beliefs.

VIRTUEPossessing moral goodness, the quality of engaging in ethical thinking and actions.The 4 characteristics:Compassion: desire to alleviate sufferingDiscernment: possessing acuteness of judgmentTrustworthiness: reliable and dependableIntegrity: having and maintaining sound moral principles

COMMON ETHICAL PRINCIPLES AND RULESBeneficence: duty to do good to others; maintain a balance between benefits and harm.Nonmaleficence: principle of doing no harmJustice: principle of fairness that an individual receives what is due, owed or legitimately claimed.

COMMON ETHICAL PRINCIPLES AND RULESAutonomy: respect for individual liberty and persons right to self determination.Fidelity: the principle of keeping ones promise.Respect for others: right of people to make their own decisions.

COMMON ETHICAL PRINCIPLES AND RULESVeracity: obligation to tell the truth.Paternalism: holds that an authority figure such as the state, or ones father, knows best and that each individual is obligated to comply with the authority.

HISTORICAL/PHILOSOPHICAL INFLUENCES GUIDING ETHICAL PERSPECTIVES & NURSING PRACTICEReligious: early nursing training emphasized on church-supported values of obedience, humility and sacrifice. Womens issues: women have historically been perceived as more sensitive, nurturing and caring.

HISTORICAL/PHILOSOPHICAL INFLUENCES GUIDING ETHICAL PERSPECTIVES & NURSING PRACTICEPhilosophy of nursing: philosophy is rational investigation of truths and principles of knowledge, reality and human conduct.Values:Values are personal beliefs about the truth of ideals, standards, principles and behaviors that give meaning and direction to a persons life.

HISTORICAL/PHILOSOPHICAL INFLUENCES GUIDING ETHICAL PERSPECTIVES & NURSING PRACTICEValues:Values clarification is the process of analyzing ones values to better understand what is important.3 steps to values clarification:ChoosingPrizingActing

STEPS FOR ETHICAL DECISION-MAKINGGather data and identify conflicting claimsIdentify participantsDetermine moral perspectives and development of participantsDetermine desired outcomesIdentify optionsTake action on the choiceEvaluate outcomes of action chosen

COMMON MORAL PRINCIPLESPrinciple of human dignityPrinciple of a well-formed consciencePrinciple of moral discernmentPrinciple of stewardshipPrinciple of totality and integrity of the human personPrinciple of autonomy

COMMON MORAL PRINCIPLESVII. Principle of informed consentVIII. Principle of confidentialityIX. Principle of beneficenceX. Principle of non-maleficenceXI. Principle of professional communicationXII. Principle of justice

COMMON MORAL PRINCIPLESXIII. Principle of double effectXIV. Principle of personalized sexualityXV. Principle of legitimate cooperationXVI. Principle of ordinary and extraordinary means

I. PRINCIPLE OF HUMAN DIGNITYAll ethical decisions must aim at human dignity, that is, the maximum, integrated satisfaction of the innate and cultural needs of every human person, including his biological, psychological. Social and spiritual needs as a member of the community.

I. PRINCIPLE OF HUMAN DIGNITYBasis of human dignityMan is Gods image and likenessMan is redeemed by ChristMan has an ultimate destiny

II. PRINCIPLE OF A WELL-FORMED CONSCIENCETo attain the rule goals of human life by responsible actions, in every free decisions involving an ethical question, people are morally obliged to do the following:Know the factsKnow the law/s related to the factsMake a decision according to the fact & law and apply the principleBe RESPONSIBLE

III. PRINCIPLE OF MORAL DISCERNMENTTo make a conscientious ethical decision, one must:Proceed on the basis of a fundamental commitment to GodAmong possible actions exclude those that contradict to the commitmentConsider how ones motives & other circumstances may contribute to or nullify the effectives of other possible actionsAmong the possible means, select one that will most likely fulfill the commitment

III. PRINCIPLE OF MORAL DISCERNMENTSources of morality1. Object of the act (objective)Refers to what the person doesGood act = meritBad act = punishment

III. PRINCIPLE OF MORAL DISCERNMENTSources of morality2. Motive of the agent (subjective)What the person wants to achieve3. CircumstancesEvents or occasions accompanying the object of the act or motive of the agent

IV. PRINCIPLE OF STEWARDSHIPGuides people in ethical management of life with others and of the limited resources of this world.Calls for personal, social and ecological responsibility.Personal is to care for selfSocial is to care for othersEcological is to care for the environment

V. PRINCIPLE OF TOTALITY AND INTEGRITY OF THE HUMAN PERSONTo promote human dignity in community, every person must develop, use care for and preserve all of his/her natural physical and psychic functions in such a way that:Lower functions are never sacrificed except for the better functioning of the whole person and even then with an effort to compensate for this sacrifice.

V. PRINCIPLE OF TOTALITY AND INTEGRITY OF THE HUMAN PERSONThe basic capacities that define human personhood are never sacrificed unless this is necessary to preserve life.Key points:The good of the parts is essentially subordinate to the good of the whole.In case of danger to itself, the whole can dispose of the parts for its own benefit.For the unitary and subsistent life of the organism, the parts considered separately have no meaning or purpose.

VI. PRINCIPLE OF AUTONOMYThe right of the patient to accept or refuse the physicians treatment; his option to choose is based on respect of his free will.The ability to govern self is dependent upon many factors such as:Sound mindSound bodyFull information of the issuesFreedom from force or coercion

VII. PRINCIPLE OF INFORMED CONSENTElements of informed consentDisclosureExplanation of the disease, treatment or procedure must be in the manner understood by the patient.Avoid technical terms that may confuse the patient or cloud his judgment.

VII. PRINCIPLE OF INFORMED CONSENT2. Understanding or comprehension on the part of the patient3. Voluntariness4. CompetenceConsider the age of the patient = must be 18 years old and abovePatient must be free from mental illnessPatient must not be under the influence of drugs when he/she gives consent.

VII. PRINCIPLE OF INFORMED CONSENT5. ConsentWhat are the information the doctor should give to patients?DiagnosisTherapy or treatmentPrognosisAffordability

VII. PRINCIPLE OF INFORMED CONSENTWho should give the consent?PatientSpouseChildrenParentsGrandparents/relativesState/Administrator

VII. PRINCIPLE OF INFORMED CONSENTIt is the doctors responsibility to explain and get the patients informed consent.The nurse acts as the witness of the explanation that transpired between the doctor and the patient signed the consent form and gave his informed consent and he/she was not forced to give consent.If the patient is incompetent (below 18 years old, unconscious, mentally ill, under the influence of drug) proxy consent is sought.

VIII. PRINCIPLE OF CONFIDENTIALITYThe following should not be revealed to anybody (except for grave cause):Private secretsContractual secretsProfessional secretsGraver cause:Legal casesAbuseIntent to kill self or someoneCommunicable disease

IX. PRINCIPLE OF BENEFICENCEAn act of goodness, kindness, an action done for the good and benefit of others.This is the duty of care, to protect the weak and vulnerable; the duty of advocacy, defending the rights of those incompetent or temporarily unable to defend their own.This is the duty to do good

X. PRINCIPLE OF NONMALEFICENCEAsserts an obligation not to inflict evil or harm intentionally on anyone.It is related to the following human rights:Right not to be killedRight not to have bodily injury or pain inflicted to oneselfRight not o have ones confidence revealed to others.

XI. PRINCIPLE OF PROFESSIONAL COMMUNICATIONStrive to establish and preserve trust at both the emotional and rational levels.To share info as they possess which is legitimately needed by others in order to have an informed conscience.

XI. PRINCIPLE OF PROFESSIONAL COMMUNICATIONTo refrain from lying or giving misinformation.To keep secret info which is not legitimately needed by others, but if revealed might either harm the patient or others or destroy trust.Nurses must remember to apply the therapeutic communication technique.

XII. PRINCIPLE OF JUSTICEIt means giving each his due. One acts justly towards a person when he gives that person what is his due.What is due an individual is determined by either or both of the following:Criterion of what he deserves by right, either his natural gifts or rights granted him by law, independent of claims of others.

XII. PRINCIPLE OF JUSTICEBalancing of competing claims of other persons against an individuals claim according to some morally relevant property or merit.

XIII. PRINCIPLE OF DOUBLE EFFECTTo form a good conscience when an act is foreseen to have both ethically beneficial and physically harmful effects, the following conditions should be met:The directly intended object of the act must not be intrinsically contradictory to ones fundamental commitment to God and neighbor.

XIII. PRINCIPLE OF DOUBLE EFFECTThe intention of the agent must be to achieve the beneficial effects and as far as possible to avoid the harmful effect.The foreseen beneficial effects must be equal to or greater than the foreseen harmful effects.The beneficial effects must follow from the action at least as immediately as do the harmful effects.

XIV. PRINCIPLE OF PERSONALIZED SEXUALITYThe gift of sexuality must be used in keeping with its intrinsic, indivisible, specifically human teleology.

XV. PRINCIPLE OF LEGITIMATE COOPERATIONTypes of cooperationFormal cooperationIdentification with the purposeDirectly intend the evil actionDoes the actAgreesAdvisesPromotesCondones

XV. PRINCIPLE OF LEGITIMATE COOPERATIONMaterial cooperationYou cooperated in the act but not in the purpose

XVI. PRINCIPLE OF ORDINARY AND EXTRAORDINARYOrdinary meansNot only food, drink and rest but all medicines, treatments and operations, which offer a reasonable hope of benefit for the patient and which can be obtained without expense, pain or other inconveniences.

XVI. PRINCIPLE OF ORDINARY AND EXTRAORDINARYExtraordinary meansWhen the means used do not offer reasonable hope of any notable benefit to the patient