Nursing ethics
Encyclopedia
Nursing ethics is a branch of applied ethics
that concerns itself with activities in the field of nursing
. Nursing ethics shares many principles with medical ethics
, such as beneficence, non-maleficence
and respect for autonomy
. It can be distinguished by its emphasis on relationships, human dignity
and collaborative care.
that would make a good nurse, rather than looking at what conduct is necessary to respect the person in the nurse's care. However, recently, the ethics of nursing has also shifted more towards the nurse's obligation to respect the human rights of the patient and this is reflected in a number of professional codes for nurses. For example, this is made explicit in the latest code from the International Council of Nurses
.
, there are some factors that differentiate it. Generally, the focus of nursing ethics is more on developing a caring relationship than concerns about broader principles, such as beneficence and justice. For example, a concern to promote beneficence may be expressed in traditional medical ethics by the exercise of paternalism
. However, this approach arguably acts against important values found in nursing ethics. Nursing theory
seeks a collaborative relationship with the person in care. Themes that emphasize respect for the autonomy
and dignity of the patient
by promoting choice and control over their environment are commonly seen. This is in contrast to paternalistic practice where the health professional chooses what is in the best interests of the person from a perspective of wishing to cure them.
The distinction can be examined from different theoretical angles. Despite the move toward more deontological themes by some, there continues to be an interest in virtue ethics
in nursing ethics and some support for an ethic of care. This is considered by its advocates to emphasise relationships over abstract principles and therefore to reflect the caring relationship in nursing more accurately than other ethical views.
that should be respected by the nurse. Although much of the debate lies in the discussion of cases where people are unable to make choices about their own treatment due to being incapacitated
or having a mental illness
that affects their judgement. A way to maintain autonomy is for the person to write an advance directive, outlining how they wish to be treated in the event of them not being able to make an informed choice, thus avoiding unwarranted paternalism.
Another theme is confidentiality
and this is an important principle in many nursing ethical codes. This is where information about the person is only shared with others after permission of the person, unless it is felt that the information must be shared to comply with a higher duty such as preserving life..
Also related to information giving is the debate relating to truth telling
in interactions with the person in care. There is a balance between people having the information required to make an autonomous decision and, on the other hand, not being unnecessarily distressed by the truth. Generally the balance is in favour of truth telling due to respect for autonomy, but sometimes people will ask not to be told, or may lack the capacity to understand the implications.
By observing the principles above, the nurse can act in a way that respects the dignity of the individual in their care. Although this key outcome in nursing practice is sometimes challenged by resource, policy or environmental constraints in the practice area.
Applied ethics
Applied ethics is, in the words of Brenda Almond, co-founder of the Society for Applied Philosophy, "the philosophical examination, from a moral standpoint, of particular issues in private and public life that are matters of moral judgment"...
that concerns itself with activities in the field of nursing
Nursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
. Nursing ethics shares many principles with medical ethics
Medical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
, such as beneficence, non-maleficence
Primum non nocere
is a Latin phrase that means "First, do no harm". The phrase is sometimes recorded as .Nonmaleficence, which derives from the maxim, is one of the principal precepts of medical ethics that all medical students are taught in medical school and is a fundamental principle for emergency medical...
and respect for autonomy
Autonomy
Autonomy is a concept found in moral, political and bioethical philosophy. Within these contexts, it is the capacity of a rational individual to make an informed, un-coerced decision...
. It can be distinguished by its emphasis on relationships, human dignity
Dignity
Dignity is a term used in moral, ethical, and political discussions to signify that a being has an innate right to respect and ethical treatment. It is an extension of the Enlightenment-era concepts of inherent, inalienable rights...
and collaborative care.
Development of subject
The nature of nursing means that nursing ethics tends to examine the ethics of caring rather than 'curing' by exploring the relationship between the nurse and the person in care. Early work to define ethics in nursing focused more on the virtuesVirtue ethics
Virtue ethics describes the character of a moral agent as a driving force for ethical behavior, rather than rules , consequentialism , or social context .The difference between these four approaches to morality tends to lie more in the way moral dilemmas are...
that would make a good nurse, rather than looking at what conduct is necessary to respect the person in the nurse's care. However, recently, the ethics of nursing has also shifted more towards the nurse's obligation to respect the human rights of the patient and this is reflected in a number of professional codes for nurses. For example, this is made explicit in the latest code from the International Council of Nurses
International Council of Nurses
The International Council of Nurses is a federation of more than 130 national nurses associations. It was founded in 1899 and was the first international organization for health care professionals...
.
Distinctive nature
Although much of nursing ethics can appear similar to medical ethicsMedical ethics
Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
, there are some factors that differentiate it. Generally, the focus of nursing ethics is more on developing a caring relationship than concerns about broader principles, such as beneficence and justice. For example, a concern to promote beneficence may be expressed in traditional medical ethics by the exercise of paternalism
Paternalism
Paternalism refers to attitudes or states of affairs that exemplify a traditional relationship between father and child. Two conditions of paternalism are usually identified: interference with liberty and a beneficent intention towards those whose liberty is interfered with...
. However, this approach arguably acts against important values found in nursing ethics. Nursing theory
Nursing theory
Nursing theory is the term given to the body of knowledge that is used to define or explain various aspects of the profession of nursing.-Grand nursing theories:...
seeks a collaborative relationship with the person in care. Themes that emphasize respect for the autonomy
Autonomy
Autonomy is a concept found in moral, political and bioethical philosophy. Within these contexts, it is the capacity of a rational individual to make an informed, un-coerced decision...
and dignity of the patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
by promoting choice and control over their environment are commonly seen. This is in contrast to paternalistic practice where the health professional chooses what is in the best interests of the person from a perspective of wishing to cure them.
The distinction can be examined from different theoretical angles. Despite the move toward more deontological themes by some, there continues to be an interest in virtue ethics
Virtue ethics
Virtue ethics describes the character of a moral agent as a driving force for ethical behavior, rather than rules , consequentialism , or social context .The difference between these four approaches to morality tends to lie more in the way moral dilemmas are...
in nursing ethics and some support for an ethic of care. This is considered by its advocates to emphasise relationships over abstract principles and therefore to reflect the caring relationship in nursing more accurately than other ethical views.
Some themes in nursing ethics
Nurses seek to defend the dignity of those in their care. In terms of standard ethical theory, this is aligned with having a respect for people and their autonomous choices. People are then enabled to make decisions about their own treatment. Amongst other things this grounds the practice of informed consentInformed consent
Informed consent is a phrase often used in law to indicate that the consent a person gives meets certain minimum standards. As a literal matter, in the absence of fraud, it is redundant. An informed consent can be said to have been given based upon a clear appreciation and understanding of the...
that should be respected by the nurse. Although much of the debate lies in the discussion of cases where people are unable to make choices about their own treatment due to being incapacitated
Capacity (law)
The capacity of both natural and legal persons determines whether they may make binding amendments to their rights, duties and obligations, such as getting married or merging, entering into contracts, making gifts, or writing a valid will...
or having a mental illness
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
that affects their judgement. A way to maintain autonomy is for the person to write an advance directive, outlining how they wish to be treated in the event of them not being able to make an informed choice, thus avoiding unwarranted paternalism.
Another theme is confidentiality
Confidentiality
Confidentiality is an ethical principle associated with several professions . In ethics, and in law and alternative forms of legal resolution such as mediation, some types of communication between a person and one of these professionals are "privileged" and may not be discussed or divulged to...
and this is an important principle in many nursing ethical codes. This is where information about the person is only shared with others after permission of the person, unless it is felt that the information must be shared to comply with a higher duty such as preserving life..
Also related to information giving is the debate relating to truth telling
Honesty
Honesty refers to a facet of moral character and denotes positive, virtuous attributes such as integrity, truthfulness, and straightforwardness along with the absence of lying, cheating, or theft....
in interactions with the person in care. There is a balance between people having the information required to make an autonomous decision and, on the other hand, not being unnecessarily distressed by the truth. Generally the balance is in favour of truth telling due to respect for autonomy, but sometimes people will ask not to be told, or may lack the capacity to understand the implications.
By observing the principles above, the nurse can act in a way that respects the dignity of the individual in their care. Although this key outcome in nursing practice is sometimes challenged by resource, policy or environmental constraints in the practice area.
See also
- BioethicsBioethicsBioethics is the study of controversial ethics brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philosophy....
- Clinical governanceClinical governanceClinical governance is the term used to describe a systematic approach to maintaining and improving the quality of patient care within a health system. The term became widely used in health care following the Bristol heart scandal in 1995, during which anaesthetist Dr Stephen Bolsin exposed the...
- Health careHealth careHealth care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
- Human experimentation in the United StatesHuman experimentation in the United StatesThere have been numerous experiments performed on human test subjects in the United States that have been considered unethical, and were often performed illegally, without the knowledge, consent, or informed consent of the test subjects....
- Medical ethicsMedical ethicsMedical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
- Patient advocacyPatient advocacyA Patient Advocate acts as a support structure and if legally contracted to do so may act as a liaison between a patient and their Health Care Provider. Most health care professionals see themselves as advocates for their patients, however their time and scope are limited by their job function...
- Philosophy of healthcarePhilosophy of healthcareThe philosophy of healthcare is the study of the ethics, processes, and people which constitute the maintenance of health for human beings. For the most part, however, the philosophy of healthcare is best approached as an indelible component...
External links
- International Centre for Nursing Ethics, University of Surrey, UK
- Nurses and Human Rights from Amnesty International