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. Development of subject
The nature of nursing means that nursing ethics tends to examine the ethics of
caring rather than 'curing' by exploring the everyday interaction between the
nurse and the person in care. Early work to define ethics in nursing focused more
on the virtues that would make a good nurse, which historically included
loyalty to the physician, rather than the focus being on nurse's conduct in
relation to 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. Distinctive nature
Although much of nursing ethics can appear similar to medical ethics, there
are some factors that differentiate it. Brier-Mackie suggests that nurses' focus
on care and nurture, rather than cure of illness, results in a distinctive
ethics. Furthermore, nursing ethics emphasizes the ethics of everyday
practice rather than moral dilemmas. Nursing ethics is more concerned with
developing the caring relationship than 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, where the
health professional makes a decision based upon a perspective of acting in
the patient's best interests. However, it is argued by some that this approach
acts against person-centred values found in nursing ethics.
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. Themes that emphasize the
dignity of the patient by promoting a respectful and caring attitude from
nurses are also commonly seen. Some themes in nursing ethics
Nurses seek to defend the dignity of those in their care. Being able to
respond to the vulnerability of patients in a way that provides dignifying care
is a key concept in the field. In terms of standard ethical theory,
respecting dignity can also be 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 consent 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 suggested 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. 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. Finally, the role of
empirical ethics has become prominent in recent years.
By giving consideration to the themes above, the nurse can endeavour to
practice in an ethical way. Unfortunately,this key outcome in
nursing practice is sometimes challenged by resource, policy or environmental
constraints in the practice area, which can lead to moral distress.
See also Bioethics
Bullying in nursing Clinical governance
Health care Human experimentation in the United
States Medical ethics
Patient advocacy Philosophy of healthcare
References ^ Hunt, G.. Craig E, ed. Routledge
Encyclopedia of Philosophy 7. London: Routledge. pp. 56–57. ISBN
978-0-415-18712-1. ^ a b c d Storch, J.L.. "Ethics in
Nursing Practice". In Kuhse H & Singer P. A Companion to Bioethics. Chichester
UK: Blackwells. pp. 551–562. ISBN 9781405163316.
^ McHale, J & Gallagher, A. Nursing and Human Rights. Butterworth Heinemann.
ISBN 0-7506-5292-6. ^ "The ICN Code of Ethics for Nurses".
International Council of Nurses. 2006. Retrieved 2009-06-27.
^ Breier-Mackie, Sarah. "Medical Ethics and Nursing Ethics: Is There Really Any
Difference?". Gastroenterology Nursing 29: 182–3. Retrieved 2 February 2012.
^ a b Tschudin, Verena. Ethics in Nursing: the caring relationship.
Edinburgh: Butterworth-Heinemann. ISBN 978-0-7506-5265-0.
^ a b c Rumbold, G. Ethics in Nursing Practice. Balliere Tindall. ISBN
0-7020-2312-4. ^ Armstrong, Alan. Nursing Ethics: A
Virtue-Based Approach. Palgrave Macmillan. ISBN 978-0-230-50688-6.
^ a b Baille L, Gallagher A. & Wainwright P.. Defending Dignity. Royal
College of Nursing. ^ a b Gastmans, C.. "Dignity-enhancing
nursing care: A foundational ethical framework". Nursing Ethics 20: 142–149.
doi:10.1177/0969733012473772. ^ Tuckett, A.. "Truth-Telling in
Clinical Practice and the Arguments for and Against: a review of the
literature". Nursing Ethics 11: 500–513. doi:10.1191/0969733004ne728oa. PMID
15362359. External links
International Centre for Nursing Ethics, University of Surrey, UK
Nurses and Human Rights from Amnesty International