1. Foundations in Evidence Based Practice
Introduction to Ethics

2. 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 shouldn’t be doing as nurses
..having a strong sense of what our priorities ought to be

3. 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

4. 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

5. 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 shouldn’t I?
Weighing up the potential impact of your decisions or actions
A dilemma – making a difficult choice

6. 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 patient’s choices
These ‘principles’ are encompassed in the NMC code
The code is a useful source of ethical principles in health care

7. 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

8. 4 Key Ethical Principles
autonomy
beneficence
non-maleficence
justice

9. Autonomy Respect a person’s 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

10. Beneficence (to do good)
Our actions must aim to ‘benefit’ people – health, welfare, comfort, well- being, improve a person’s potential, improve quality of life
‘Benefit’ should be defined by the person themselves. It’s 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

11. 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

12. Justice Treating people fairly
Not favouring some individuals/groups over others
Acting in a non–discriminatory / non-prejudicial way
Respect for peoples rights
Respect for the law

13. 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 ?

14. 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

15. 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

16. 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

17. 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)

18. 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.

19. References http://www.nursingethics.ca/articles.html
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
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