UNIT 3 Ethical Principles & Theories-1.ppt

UNIT-III: ETHICAL
PRINCIPLES AND
THEORIES
By: Farzana Kausar Khattak
Lecturer
KMU-INS

OBJECTIVES
At the end of the session learner will be able to:
• Discuss ethical principles in health care in the light of ethical
theories.
• Discuss the ethical dilemmas face by nurses and client.
• Discuss the strategies to resolve ethical dilemma in daily
nursing practice.
• List steps of ethical decision-making
EDITOR PROF DR.NINJA 2

ETHICAL PRINCIPLE AND
ETHICAL THEORIES
• Ethical principles are a set of ethical rules that provide the
framework/ tools which may facilitate individuals and society to
resolve conflict in a fair and moral manner.
• They are the foundations of ethical analysis because they are the
viewpoints from which guidance can be obtained along the
pathway to a decision.

ETHICAL PRINCIPLE AND
ETHICAL THEORIES
• However, in order for an ethical theory to be useful, the
theory must be directed towards a common set of goals.
• Ethical principles are the common goals that each
theory tries to achieve in order to be successful. These
goals include all principles of Ethics.

ETHICAL PRINCIPLES
1. Autonomy: Right to make one’s own decisions and choices.
2. Veracity: Refers to telling the truth.
3. Confidentiality: Respect for a person’s privacy.
4. Beneficence: The principle of doing good and benefits someone.
5. Non-maleficence: The duty to do no harm (Prevent unintentional
harm).
6. Justice: The principle that deals with fairness, equity and equality.
7. Fidelity: Means to be faithful to agreements and promises.
8. Accountability: Answerable to oneself and others for one’s own
actions.

ETHICAL THEORIES
1. Consequence-based (teleological) theories.
2. Principle-based (deontological) theories.
3. Relationships-based (caring) theories.

1. TELEOLOGICAL THEORIES
also known as consequentialist theories, are a category
of ethical theories that focus on the outcomes or
consequences of actions to determine their moral value.
 In teleological ethics, the rightness or wrongness of an
action is determined by the overall good or value it
produces. Here are some notable teleological ethical
theories:
• Utilitarianism
• Hedonism
• Egoism

UTILITARIANISM
 The right action is the one that maximizes overall
happiness.
 In utilitarianism, happiness is typically
understood as pleasure and the absence of pain.
 Actions that promote the greatest happiness for the
greatest number of people are considered morally
right (even if its ethically wrong).

HEDONISM
 Hedonism specifically focuses on the pursuit of
pleasure and the avoidance of pain as the ultimate goal
of human life.
 Hedonistic theories argue that the right action is the
one that maximizes pleasure or minimizes suffering.
 Hedonism is based on the principle that actions are
morally right if they maximize pleasure or happiness and
minimize pain or suffering.

EGOISM
 Ethical egoism argues that individuals should act in
their own self-interest and seek to maximize their own
happiness.
 Egoism argues that individuals should act in their
self-interest to maximize their own well-being.
 It's a form of ethical egoism that focuses on the
personal consequences of actions.

2. DEONTOLOGICAL THEORIES
 often referred to as duty-based ethics, is an ethical theory that
emphasizes the intrinsic nature of actions or duties as the basis
for determining their moral value.
 In deontological ethics, certain actions are considered
inherently right or wrong, regardless of their consequences.
Here are some notable deontological theories:
• Kantian Ethics (Deontology)
• Divine Command Theory
• Rights-Based Ethics

KANTIAN ETHICS
Kantian ethics states that individuals should act only
according to principles that could be universal laws
without contradiction.
 It emphasizes the importance of moral duties and the
inherent worth of individuals, asserting that we have a
duty to act morally regardless of the consequences.

DIVINE COMMAND
THEORY
 This theory asserts that the moral rightness or
wrongness of actions is determined by divine
commands or the will of a higher power, such as God.
 It relies on religious texts and authority for moral
guidance, where obedience to divine rules is
paramount.

RIGHTS-BASED ETHICS
emphasizes individual rights as a fundamental aspect of
morality.
 It argues that individuals have certain inherent rights,
and respecting these rights is a moral duty.
 Actions are considered morally wrong if they violate
someone's rights, and it is our moral duty to protect and
uphold these rights, regardless of the overall consequences.

3. CARING THEORIES
 Relationship-based caring theories
 emphasize the significance of interpersonal relationships and
human connection in healthcare and caregiving.
 These theories guide healthcare professionals in building
meaningful relationships with patients and providing care that
is both patient-centered and culturally sensitive. Here are some
relationship-based caring theories:
• Madeleine Leininger's Cultural Care Theory
• Swanson's Theory of Caring
• Travelbee's Human-to-Human Relationship Model

MADELEINE LININGER'S
CULTURAL CARE THEORY
highlights the importance of culturally
congruent care, where healthcare providers
understand and respect the cultural beliefs and
values of their patients.

SWANSON'S THEORY
OF CARING
This theory outlines five caring processes that guide
the nurse-patient relationship:
1.Maintaining Belief
2.Knowing
3.Being With
4.Doing For
5.Enabling

TRAVELBEE'S HUMAN-TO-
HUMAN RELATIONSHIP
MODEL
focuses on the interpersonal aspects of nursing care
and therapeutic relationship between the nurse and
patient,
highlighting the significance of communication,
empathy, and understanding in providing holistic care.

ETHICAL DILEMMAS IN
NURSING
 Nurses face ethical dilemmas on a daily basis
regardless of where they practice. No matter where
nurses function in their varied roles, they are faced
with ethical decisions that can impact them and their
patients.
 There is no “right” solution to an ethical dilemma.

There are many ethical issues nurses can encounter in the
workplace. These include:
1. Quality vs quantity of life
2. Pro-choice (abortion) vs Pro-life (conception).
3. Freedom vs control.
4. Truth telling vs deception (trick or fraud).
5. Distribution of resources.
6. Empirical knowledge vs personal beliefs.
ETHICAL DILEMMAS IN
NURSING

QUALITY VS QUANTITY OF
LIFE
 Quantity may address how long a person lives or perhaps
how many people will be affected by the decision.
 Quality pertains to how “good” a life a person may have and
this varies depending on how a person defines “good”.
 So how does the nurse support a patient deciding between a
therapy that will prolong life but the quality of life will be
compromised? The person may live longer, but will likely
experience significant side effects from the therapy. What
should the nurse’s position be?

PRO-CHOICE VS PRO-LIFE

FREEDOM VS CONTROL

TRUTH TELLING VS
DECEPTION

DISTRIBUTION OF
RESOURCES
They must determine which patients will benefit the most
from the available resources, balancing the need for fair
distribution while saving as many lives as possible.

EMPIRICAL KNOWLEDGE VS
PERSONAL BELIEF

STRATEGIES TO ENHANCE
ETHICAL DECISION
The following strategies should be taken by a nurse to overcome the
moral distress on the job:
1.Become aware of your own values and ethical aspects of nursing.
2.Be familiar with nursing codes of ethics.
3.Seek continuing education opportunities to stay knowledgeable about
ethical issues in nursing.
4.Respect the values, opinions, and responsibilities of other health care
professional that may be different from your own.
5.Serve on institutional ethics committees.
6.Strive for collaborative practice in which nurses function effectively in
cooperation with other health care professionals.

STEPS OF ETHICAL DECISION
MAKING
1. Gather the facts
2. Define the ethical issues
3. Identify the affected parties (stakeholders)
4. Identify the consequences
5. Identify the obligations (principles, rights, justice)
6. Consider your character and integrity (honest).
7. Think creatively about potential actions
8. Check your gut
9. Decide on the proper ethical action and be prepared to deal with
opposing arguments.

1. GATHER THE FACTS

2. DEFINE THE ETHICAL
ISSUES
 Identify and clarify the specific ethical problems
 What are the conflicting values or principles at play?
 Don’t jump to solutions without first identifying the
ethical issues in the situation.
 Define the ethical basis for the issue you want to focus on.
 There may be multiple ethical issues, focus on one major
one at a time.

3. IDENTIFY AFFECTED
PARTIES
 Identify all of the stakeholders.
 Determine who is impacted by the ethical decision.
 Consider the various stakeholders and their interests in
the outcome.

4. IDENTIFY
CONSEQUENCES
 Think about potential positive and negative
consequences for affected parties by the decision
(Focus on primary stakeholders to simplify analysis
until you become comfortable with the process).
 Short term vs. Long term consequences-will decision
be valid over time.

5. IDENTIFY THE RELEVANT
PRINCIPLES, RIGHTS, AND JUSTICE
ISSUES
 Consider ethical principles, rights, and notions of justice
that apply to the situation.
 What moral obligations do you or the organization have?

6. CONSIDER YOUR CHARACTER &
INTEGRITY
 Reflect on your own character and integrity. Are you being
honest with yourself about your motivations and values? How
do your actions reflect your character?
 Consider what your relevant community members would
consider to be the kind of decision that an individual of
integrity would make in this situation.

7. THINK CREATIVELY ABOUT
POTENTIAL ACTIONS
 Generate a list of possible actions or solutions to the ethical
dilemma.
If you have come up with solutions “a "and “b,” try to
brainstorm and come up with a “c” solution that might
satisfy the interests of the primary parties involved in the
situation.

8. CHECK YOUR GUT
 Trust your intuition and emotions to some extent. Even
though the prior steps have argued for a highly rational
process, but it is always good to “check your gut.”
 How do you feel about the potential solutions? Gut
feelings can sometimes provide valuable insights.
 Particularly relevant if you have a lot of experience in the
area-expert decision making.

9. DECIDE ON YOUR COURSE OF
ACTION AND PREPARE RESPONSES
TO THOSE WHO MAY OPPOSE YOUR
POSITION
 Based on the previous steps, make a decision on
the most ethically sound course of action.
 Be ready to defend your decision and address
opposing arguments, as ethical dilemmas often
involve differing perspectives.

SCENARIO
You are a nurse working in a hospital. A patient, Mr. Smith,
has been admitted with a severe illness. After a few days, he
tells you in confidence that he's been secretly taking an
experimental, unapproved drug he bought online because he
believed it would cure him. He's worried about the potential
side effects of this drug and asks you not to inform the
medical team or his family.
 Make a decision for this patient in light of Ethical
Decision-Making Steps.

ETHICAL DECISION-MAKING
STEPS
1. Gather the facts: You gather information by listening to Mr. Smith's
story and understanding the nature of the drug and his concerns.
2. Define the ethical issues: The primary ethical issue is patient
autonomy and informed consent. It's also about ensuring patient safety
and well-being.
3. Identify the affected parties (stakeholders): The affected parties
include Mr. Smith, his family, the medical team, and yourself.
4. Identify the consequences: If Mr. Smith's secret drug use is not
disclosed, there's a risk of potential harm due to drug interactions or
side effects. On the other hand, breaching his confidentiality might
harm the trust between the patient and healthcare professionals.

5. Identify the obligations (principles, rights, justice): You have an
obligation to uphold patient confidentiality, but you also have an
ethical duty to protect Mr. Smith's well-being. The principles of
autonomy, beneficence, and non-maleficence come into play.
6. Consider your character and integrity (honest): Reflect on your
own integrity and values. Are you acting honestly and in the best
interest of the patient?
7. Think creatively about potential actions: Explore various options,
such as discussing the situation with Mr. Smith, seeking guidance
from a medical ethics committee, or informing his family while
respecting his autonomy.
STEPS

8. Check your gut: Consider how you feel about each option. Your
intuition may guide you toward the most ethical action.
9. Decide on the proper ethical action and be prepared to deal with
opposing arguments: After careful consideration, you decide to
discuss the situation with Mr. Smith, emphasizing your concern for his
well-being. You're prepared to address his fears and explore the best
path forward.
In this example, the ethical decision-making process involves balancing
respect for patient autonomy and confidentiality with the
responsibility to ensure patient safety and well-being. The chosen
action prioritizes open communication and trust-building with the
patient while considering the potential consequences of the situation.
STEPS

ETHICAL DILEMMAS
 What should a health professional do when he/she sees a
colleague engaging in an unethical act?
 Because of the family’s wish, the terminal ill status has not been
told the patient but the nurse is sure he/she knows he/she is dying.
What should the nurse do ethically when this patient directly asks
her/him about his/her condition?
 Is lying to a patient ever ethical? What constitutes a lie? Is a
placebo a lie?
 Should the nurse follow a doctor’s order if she/he thinks there is a
potential problem with the order?

 Two ethical principles are ‘Do No Harm and Do Good’. What
do we mean by Harm and Good?
 Health professionals have two basic ethical obligations: (1) to
extend life & (2) to lessen pain and suffering. Can they do both in
this situation when Morphine may shorten patient’s life?
 How do you balance a patient's right to make their own medical
decisions (autonomy) with your duty to provide the best care
possible (beneficence) when they refuse a treatment that you
believe is in their best interest?
ETHICAL DILEMMAS

REFERENCES
 American School Counselor Association. (2004). Ethical
standards for school counselors, Alexandria, VA: Author.
 Kushner, H. S. (2001). Living a life that matters. NY:
Anchor Books
 National Association of School Nurses (2010). Code of
ethics. Author.
 www.google.com

Provided To You By Prof Dr. Ninja

UNIT 3 Ethical Principles & Theories-1.ppt

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UNIT 3 Ethical Principles & Theories-1.ppt