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Chapter 22
Ethics and Values
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Basic Terms in Health Ethics
Autonomy
Commitment to include patients
in decisions
Beneficence
Taking positive actions to help
others
Nonmaleficence
Avoidance of harm or hurt
Justice
Being fair
Fidelity
Agreement to keep promises
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Professional Nursing Code of
Ethics


Code of nursing ethics

A set of guiding principles that all members of a profession
accept

Helps professional groups settle questions about practice
or behavior

Includes advocacy, responsibility, accountability, and
confidentiality
Social networking

Presents ethical challenges for nurses
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Principles of ANA Code of
Ethics

Advocacy


Responsibility


Refers to a willingness to respect one’s professional
obligation and follow through on promises. Nurses are
responsible for their actions and actions of those to
whom you delegate
Accountability


Support of a particular cause. Ex: As a nurse,
you advocate for clients’ health, safety, rights,
including privacy
Refers to ability to answer for one’s own actions.
Confidentiality

HIPPA mandates the protection of patient’s personal
health information.
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Case Study

Anna Moreno is an 82-year-old African-American widow
and retired schoolteacher. She lives with her 55-yearold daughter and three teenage grandchildren. Her
daughter, Lucille, is a single mother and a full-time
nurse.

Anna assists with the care of her grandchildren when
her daughter is at work. She also volunteers at the
library and at her church. She has diabetes and high
blood pressure, both controlled with diet and
medication.
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Quick Quiz!
1. Your patient is about to undergo a controversial
orthopedic procedure. The procedure may cause
periods of pain. Although nurses agree to do no harm,
this procedure may be the patient’s only treatment
choice. Which ethical principle does this situation
describes?
A. Autonomy.
B. Fidelity.
C. Justice.
D. Nonmaleficence.
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Values

Value


A value is a personal belief about the worth of a given
idea, attitude, custom, or object that sets standards that
influence behavior.
Values clarification

Ethical dilemmas almost always occur in the presence of
conflicting values.

To resolve ethical dilemmas, one needs to distinguish
among values, facts, and opinion.
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Ethics and Philosophy
Deontology
Defines actions as right or wrong
Utilitarianism
Proposes that the value of something is determined by its
usefulness
Feminist Ethics
Focuses on the inequality between people
Ethics of Care
Emphasizes the importance of understanding relationships,
especially as they are revealed in personal narratives
Casuistry
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Case-based reasoning
8
Case Study (Cont.)

Lucille accompanies her mother to the physician’s office
for a routine visit. When her mother steps out to have
some lab work done, Lucille asks to speak privately to
the nurse, Mary Ann, and reveals some serious concerns.

Lucille had received a call from the manager of the
library where her mother volunteers. The manager
described finding Ms. Moreno in the janitor's closet one
day, confused and tearful.
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Case Study (Cont.)

The manager expressed growing concern about Ms.
Moreno’s ability to finish tasks, such as reshelving books
and taking phone messages. She recommended that
Lucille get an evaluation of her mother’s mental status.

Lucille tells the nurse that she is not at all convinced
that her mother is having mental problems.
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Nursing Point of View

Nurses generally
engage with patients
over longer periods of
time than other
disciplines.

Patients may feel
more comfortable
revealing information
to nurses.
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Processing an Ethical
Dilemma

Step 1: Ask if this is an ethical dilemma.

Step 2: Gather all relevant information.

Step 3: Clarify values.

Step 4: Verbalize the problem.

Step 5: Identify possible courses of action.

Step 6: Negotiate the outcome.

Step 7: Evaluate the action.
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Institutional Resources

Ethics committees are usually multidisciplinary and
serve several purposes: education, policy
recommendation, and case consultation.

Any person involved in an ethical dilemma, including
nurses, physicians, health care providers, patients, and
family members, can request access to an ethics
committee.
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Issues in Health Care Ethics
Quality of life: Central to discussions about endof-life care, cancer therapy, physician-assisted
suicide, and Do Not Resuscitate (DNR)
Disabilities: Antidiscrimination laws enhance the
economic security of people with physical,
mental, or
emotional challenges
Care at the end of life: Interventions unlikely to
produce benefit for the patient
Health Care Reform: Facilitated access to care for
millions of uninsured Americans
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Ethics and Access to Care

The number of uninsured in the united states grew
from 39 million people in 2000 to more than 46.3
million people by 2008—more than 15% of the total
population.

Many of the uninsured are women and children.

Although two thirds of the uninsured are poor,
nearly 80% come from working families.
Ethical Issues on Aging

Older people usually are not as familiar with the
concept of autonomy as are people from younger
generations.

As people age, they develop clinical conditions
that affect the communication process. Some
patients become incapacitated by stroke or
disease. Most older adults take multiple
medications, some of which affect cognitive skills
in subtle ways.

Consensus about medical goals for the older adult
is hard to achieve.
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Quick Quiz!
2. If a nurse decides to withhold a medication because it might further
lower the patient’s blood pressure, which principle will the nurse
will be practicing?
A. Responsibility.
B. Accountability.
C. Competency.
D. Moral behavior.
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22 - 17
Case Study (Cont.)

From Mary Ann’s perspective, Lucille seems angry and
defensive about the manager’s report. She even accuses
the manager of discrimination against older adults. She
adamantly refuses offers of a physical or mental
evaluation for her mother, or even to discuss the issues
with her mother. Instead, she requests that the nurse
write a letter that validates her mother’s good health.

What do you think about Lucille’s reaction?

Do you agree with Mary ANN?

What do you think Mary ANN will do?
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Case Study (Cont.)

After all, Lucille argues, her mother’s blood pressure is
normal, and her blood glucose levels are within normal
limits.

Mary Ann realizes that this situation is complex. She will
need to get the help of others to sort out the best
response to Lucille’s request.

Is this an ethical dilemma for Mary Ann?
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Case Study (Cont.)

Mary Anne has determined that the situation is an
ethical dilemma. Now she must:

Step 2: Gather all information relevant to the case.

Step 3: Examine and determine her own values and
opinions about the issues.
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Case Study (Cont.)

Step 4: State the problem clearly.

Step 5: Consider possible courses of action.

Step 6: Negotiate the outcome.

Step 7: Evaluate the action.
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Who is most likely to encounter
an ethical dilemma?
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Question

Which of the following provides a
foundation for professional nursing?

A. American Nursing Association Code
of Ethics.

B. The institutional Ethics Committee.

C. The nurse’s values clarification.

D. The hospital’s policy and procedure
manual.
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Group Activity

Defined and provide an example of each principles
of the ANA Code of Ethics: Accountability,
Responsibility, Advocacy, and Confidentiality

Describe each of the following philosophies and
provide an example each: Deontology,
Utilitarianism, Feminist Ethics, Ethics of Care, and
Cauistry.

Describe and provide an example of autonomy,
beneficence, nonmaleficence, justice, and
fidelity.

Provide examples of how culture can cause an
ethical dilemma.
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