MORAL/ETHICAL PRINCIPLES (CONCEPTS)

Ethics is the part of philosophy that deals with the rightness or wrongness of human behavior. It
is also concerned with the motives behind behaviors.

Bioethics, specifically, is the application of ethics to issues that pertain to life and death. The
implication is that judgments can be made about the rightness or goodness of healthcare
practices.

Ethical codes are based on principles that can be used to judge behavior. Ethical
principles assist decision making because they are a standard for measuring actions. They may
be the basis for laws, but they themselves are not laws.

Laws are rules created by a governing body. Laws can operate because the government has the
power to enforce them. They are usually quite specific, as are the punishments for disobeying
them.

Moral/ethical principles (concepts)

• Are statements about broad, general philosophic concepts such as autonomy and justice
• They provide the foundation for moral values, which are specific prescriptions for actions
(e.g. “people should not lie” (rule) is based on the moral principle of respect of autonomy for
people.
• Are basic ideas that are starting points for understanding and working through a
problem. Ethical principles presuppose that nurses should respect the value and uniqueness
of persons and consider others to be worthy of high regard. These principles are
tents that are important to uphold in all situations.

Ethical principles are not confined to specific behaviors. They act as guides for appropriate
behaviors. They also take into account the situation in which a decision must be made. You
might say that ethical principles speak to the essence or fundamentals of the law, rather than to
the exactness of the law (Macklin, 1987).

Here is an example:

Mrs. Van Gruen, 82 years old, was admitted to the hospital in acute respiratory distress. She was
diagnosed with aspiration pneumonia and soon became septic, developing adult respiratory
distress syndrome (ARDS). She had a living will, and her attorney was her designated healthcare
surrogate. Her competence to make decisions was uncertain because of her illness. The physician
presented the situation to the attorney, indicating that without a feeding tube and tracheostomy,
Mrs. Van Gruen would die.
According to the laws governing living wills and healthcare surrogates, the attorney could have
made the decision to withhold all treatments. However, he felt he had an ethical obligation to still
discuss the situation with his client. The client requested that the tracheostomy and the feeding
tube be inserted, which was done.

In some situations, two or more principles may conflict with each other. Making a
decision under these circumstances is very difficult. We now consider several of the ethical
principles that are most important to nursing practice—autonomy, nonmaleficence, beneficence,
justice, confidentiality, veracity, and accountability — and then look at some of the ethical
dilemmas nurses encounter in clinical practice.