Whether you define ethical principles as a “moral compass” or “what you do when no one is watching” you capture the common thread of their role in decision-making affecting you personally, others around you or society in general. Ethical principles in the healthcare industry are rooted in ancient Greece, where Hippocrates is credited with identifying an ethical code for physicians.
Over the centuries, the nursing profession has adopted the four ethical principles that serve as a common thread across disciplines. These principles have survived the test of time as they hold patients’ best interests as their underpinning.
What are the Four Ethical Principles That Guide Nurses and Nursing Practice
Beneficence is the obligation that nurses hold to act for the benefit of the patient. Nurses operationalize this ethical principle each time they carry out any of the following acts:
- Protect the patient from harm.
- Protect the patients’ individual rights.
- Removing conditions that could cause harm.
- Helping persons with disabilities.
- Rescuing persons from dangerous or hazardous conditions.
Hence, conducting a “time-out” in the OR, implementing fall precautions for an elderly patient or identifying the need for suicide precautions are just a few examples of beneficence in nursing practice.
The obligation of the nurse to not cause harm to a patient is the principle of nonmaleficence. This principle is demonstrated by the nurses’ morals related to:
- Do not kill.
- Do not cause pain or suffering.
- Do not incapacitate.
- Do not cause offense.
- Do not deprive others of the goods of life.
Nurses, in concert with the patient, physicians and other members of the health care team, demonstrate this principle when developing and implementing individual plans of care for patients that preserve quality of life, minimize pain and suffering and address end-of-life issues as they arise.
The principle of autonomy is rooted in the belief that human beings have an unalienable right and capacity for self-determination. Nurses demonstrate this principle whenever they engage in:
- Informed consent
- Following advanced directives
- Maintaining confidentiality
Nurses frequently become entangled in the ethical dilemmas associated with autonomy when a patient’s competence (mental and physical) is in question. In these situations, nurses, along with other members of the healthcare team, have an obligation to consult with the organization’s Ethics Committee to bring thoughtful and timely resolution.
The prevention of breaches of a patient’s right to confidentiality is a constant focus of nurses. Breaches of confidentiality challenge the patient’s autonomy through disclosure of information without consent. Nurses’ vigilance in maintaining patient confidentiality is pivotal to building and sustaining patient trust in providers, staff and the organization.
During the recent pandemic, the principle of justice was brought to the forefront in the healthcare industry and thus to nurses serving on the front line. Justice in healthcare implies that all persons should have fair and equitable access to appropriate healthcare services.
Nurses experience challenges to this principle on a regular basis whenever they and members of the healthcare team are faced with the need to allocate scarce resources. This includes manpower, equipment, tests, medication and transplantable organs, to name a few. In a broader sense, nurses may also experience socioeconomic challenges to justice in the communities they serve. This is typically demonstrated by inadequate services (primary care, behavioral health, etc.) being provided to underserved communities.
Ethical Principles in Nursing: What is the Nurses’ Role When Conflicts Between Ethical Principles Arise
Although we would like to believe that guiding principles serve to minimize or eliminate conflicting situations, real-life situations frequently challenge strict interpretation and adherence to ethical principles.
The two principles that are frequently in conflict are beneficence and autonomy. An example of this conflict arises when a life-saving treatment is initiated (i.e. ventilator) and the patient expresses the desire to terminate the treatment. The treatment was initiated out of beneficence, while the patient’s wishes were a demonstration of autonomy.
When ethical conflicts such as this arise, the nurse plays a substantial role in ensuring the patient’s desires are well represented. This is achieved through:
- Obtaining copies of advanced directives if they exist.
- Communicating with family and significant others who may speak on behalf of the patient in the event they cannot do so themselves.
- Documentation of interactions between the nurse and the patient may contribute to a clearer understanding of the patient’s wishes.
- Participating in ethics committee meetings either in person or by proxy should the need arise.
- Participating in family conferences and/or meetings with the patient wherein explanations of the benefits and risks of treatment are clearly discussed, along with the impact on quality of life.
Situations wherein ethical dilemmas are identified and resolved are typically emotionally taxing for members of the care team, families and all others involved. It is important for nurses to keep emotions in check and strive to maintain professional objectivity throughout the process. A veil of confidentiality must be maintained as ethical dilemmas are resolved. Hence, discussion of situations with persons not directly involved with the situation is forbidden.
However, nurses and other involved team members are encouraged to seek mental health support as needed. This can be achieved through personal counseling or EAP (Employee Assistance Programs) offered by the organization.
Finally, ethical dilemmas often call upon one’s spiritual strength and background. Speaking with members of the clergy, prayer and meditation can be useful tools as professionals assist patients and families in navigating these situations.
Conclusions for Ethics in Nursing Practice
Though the ethical principles outlined above serve as a moral compass for all healthcare disciplines, nurses, as the most consistent and closest professional to the bedside, play a unique role in creating nurse-patient relationships.
In their daily interactions with patients, nurses serve to protect patients from harm and preserve their rights as individuals. Nurses, as professionals and citizens, are in a position to influence fairness and equity in the delivery of health care services. The nurses’ cognizance and vigilance of these principles serve as a foundation of trust between patients, the profession, the community and the healthcare organization.