Foundations in Evidence Based

Practice


Introduction to Ethics
Introduction to ethics
Our care for patients should be based on sound judgement

(or evidence based practice!!)

..some of this judgement is about having a strong sense of what is
right or wrong

..having a strong sense of what we should be doing and shouldnt be
doing as nurses

..having a strong sense of what our priorities ought to be

Introduction to ethics
Nurses frequently have to make difficult decisions for
which there is not always a quick, easy or correct answer
e.g. Can Mrs X be discharged yet? Can Mr Y manage his own
medications safely?

Nevertheless, nurses still have to be able to explain and
account for these decisions and actions

The NMC Code can act as a guide
This can be seen as a code of ethics a set of important
principles to help guide nurses


Achievement of practice outcomes includes
consideration of ethical issues
Domain 1 Professional and Ethical Practice

1.3 Demonstrate an awareness of, and apply ethical principles to, nursing
practice.

Outcomes:

1.3.1 Demonstrate respect for patient and client confidentiality

THIS OUTCOME IS ONLY ABOUT CONFIDENTIALITY. IT IS NOT ABOUT
HOW YOU RESPECT PATIENTS GENERALLY

1.3.2 Identify ethical issues in day to day practice
What is an ethical issue?
When you have to judge what is right or wrong

Choosing between options

Deciding whether to do something or do nothing

Should I or shouldnt I?

Weighing up the potential impact of your decisions or actions

A dilemma making a difficult choice



Ethical issues in health
care
We usually think of the big issues
e.g. definition of life, what is a person, quality of life, prolonging life,
ending life, human rights.

But day to day ethical issues can involve:
Respecting people
Treating people with dignity
Treating people fairly
Supporting patients choices

These principles are encompassed in the NMC code

The code is a useful source of ethical principles in health care
Another source of ideas in
health care ethics
Principles of Biomedical Ethics (Beauchamp
and Childress, 2001)

They discuss:
4 key principles
supplemented by 4 rules
4 Key Ethical Principles
autonomy
beneficence
non-maleficence
justice

Autonomy
Respect a persons right to make their own decisions

Teach people to be able to make their own choices

Support people in their individual choices

Do not force or coerce people to do things

Informed Consent is an important outcome of this principle


Beneficence (to do good)
Our actions must aim to benefit people health, welfare, comfort, well-
being, improve a persons potential, improve quality of life

Benefit should be defined by the person themselves. Its not what we think
that is important.

Act on behalf of vulnerable people to protect their rights

Prevent harm

Create a safe and supportive environment

Help people in crises
Non maleficence (to do no
harm)
do not to inflict harm on people
do not cause pain or suffering
do not incapacitate
do not cause offence
do not deprive people
do not kill

Both Beneficence and Non-maleficence underpin EBP
Justice
Treating people fairly

Not favouring some individuals/groups over others

Acting in a nondiscriminatory / non-prejudicial way

Respect for peoples rights

Respect for the law

Justice
Distributive Justice sharing the scarce resources in society in a fair and
just manner (e.g. health services, professional time)

How should we share out healthcare resources?

How do we share out our time with patients?

Deciding how to do this raises some difficult questions

Patients should get..

an equal share ?
just enough to meet their needs ?
what they deserve ?
what they can pay for ?

4 ethical rules
Veracity truth telling, informed consent, respect for
autonomy

Privacy a persons right to remain private, to not
disclose information

Confidentiality only sharing private information on a
need to know basis

Fidelity loyalty, maintaining the duty to care for all no
matter who they are or what they may have done
Ethics
2 broad philosophical theories
1) consequentialism taking the
consequences of our actions into
consideration

2) deontology basing our actions on a set of
principles or duties
Consequentialism
Actions are right or wrong according to the balance of
their good and bad consequences

the right act is the one that produces the best overall
result

Utilitarianism (what action has the greatest utility -
use/benefit/positive outcome) is a type of
consequentialism

Utilitarianism
most prominent consequence-based theory

based on the principle of utility

actions ought to produce the maximal balance of positive
value (e.g. happiness) over disvalue (e.g. harm)
Deontology
Duty or principle based theory
An act is right if it conforms to an overriding moral duty
For example do not tell lies, do not kill.

E.g. Christian ethics The Ten Commandments
But Christian ethics are not important for some people in the world
so moral duties vary between cultures and societies

A moral duty or principle is one that is:
laid down by god / supremely rational being
or is in accordance with reason / rationality
or would be agreed by all rational beings

The NMC Code of Conduct is a product of Deontological ethics it
guides action based on a set of principles/duties.
References
Beauchamp T and Childress J (2001) Principles of Biomedical Ethics 5th
Edition Oxford University Press
Hunt G (1994) Ethical Issues in Nursing Routledge. London
Seedhouse D (1998) Ethics the heart of Health Care Wiley. Winchester.
Watt H (2000) Life and Death in Health Care Ethics Routledge. London

http://www.iep.utm.edu/e/ethics.htm#SH2a
http://www.nursingethics.ca/articles.html
http://www.freedomtocare.org/iane.htm
http://www.lib.flinders.edu.au/resources/sub/healthsci/a-
zlist/ethics.html