Legal and Ethical Case Study Nursing

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CHAPTER 2

ETHICAL THEORY

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ETHICS AND NURSING

  • It is through the intimacy and trust of the nurse-patient relationship that nurses become critical participants in the process of ethical decision making.
  • By developing a working knowledge of ethical theory, nurses can make clear and consistent decisions.

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PHILOSOPHY

  • The intense and critical examination of beliefs and assumptions.
  • It gives coherence to the whole realm of thought and experience and offers principles for deciding what actions and qualities are most worthwhile.
  • It gives shape to what would otherwise be a chaos of thoughts, beliefs, assumptions, values, contradictions, and superstitions.

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MORAL THEORY

  • Provides a framework for cohesive and consistent ethical reasoning and decision making.
  • The best moral theories are part of larger integrated philosophies.
  • Two moral theories having the greatest influence on contemporary bioethics and nursing: utilitarianism and deontology.

MORALS AND ETHICS

  • Moral philosophy is the philosophical discussion of what is considered good or bad, right or wrong, in terms of moral issues.
  • Moral issues are those which are essential, basic, or important and deal with important moral issues.
  • Ethics is a formal process making logical and consistent decisions, based upon moral philosophy.

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ETHICAL THEORIES

  • Ethical theories explain values and behavior related to cultural and moral norms.
  • As a morally central health care profession, nursing requires astuteness concerning moral and ethical issues.
  • Professional codes of ethics provide a formal process for applying moral philosophy and ethics.

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NATURALISM

  • Regards ethics as dependent upon nature and psychology.
  • Proposes that nearly all people have a tendency to make similar ethical decisions despite differences in culture.
  • Sympathy is a motivating factor in moral decision making.

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RATIONALISM

  • Rationalists believe feelings or perceptions, though they may seem similar in many people, may not actually be similar in all people.
  • Believe there exist universal truths, independent from humans, that can be known through the process of reasoning.

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UTILITARIANISM

  • Sometimes called consequentialism, holds that an action is judged as good or bad in relation to the consequence, outcome, or end result that is derived from it.
  • Holds that no action is in itself either good or bad.
  • Mill believed it to be in the spirit of the golden rule, “Do unto others as you would have them do unto you.”

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TYPES OF UTILITARIANISM

  • Act-utilitarianism: people choose actions that will, in a given circumstance, increase the overall good.
  • Allows for different, sometimes opposing, action in different situations.
  • Rule-utilitarianism: people choose rules in all situations that increase the overall good.
  • Rules that maximize happiness and reduce unhappiness.
  • Rules are easy to learn and should be strictly followed.

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DEONTOLOGY

  • Deontology is based upon the idea that rightness or wrongness of an act depends upon the nature of the act, rather than its consequences.
  • Ethical rules are universal, and humans can derive certain consistent principles to guide action.
  • Moral rules are absolute and apply to all people.

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KANTIANISM

  • Kantianism is a particular deontological theory developed by Immanuel Kant.
  • The categorical imperative assumes that if an action is morally right, it is reasonable to imagine it as a strict universal law.
  • The practical imperative requires that one treat others always as an end and never as a means only.

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VIRTUE ETHICS

  • No rules or principles. Rather, actions are based upon a degree of innate moral virtue.
  • A moral virtue is a character trait that is morally valued.
  • A virtuous person has consistent moral action and morally appropriate desire and will naturally choose the morally correct action.

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FOCAL VIRTUES

  • Although people have different character traits, all have the capacity to learn or cultivate those that are important to morality.
  • Compassion
  • Discernment
  • Trustworthiness
  • Integrity

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COMPASSION

  • The ability to imagine oneself in the situation of another
  • An attitude of active regard for another’s welfare with an imaginative awareness and emotional response of deep sympathy

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DISCERNMENT

  • A sensitive insight involving acute judgment and understanding, and eventuating in decisive action
  • Allows us to see appropriate actions in a given situation and requires sensitivity and attention attuned to the demands of a particular context

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TRUSTWORTHINESS

  • A confident belief in and reliance upon the ability and moral character of another person
  • Entails a confidence that another will act with the right motives in accord with moral norms

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INTEGRITY

  • Moral integrity means soundness, reliability, wholeness, and an integration of moral character.
  • Refers to our continuing to follow moral norms over time.
  • One with integrity has the consistency of convictions, actions, and emotions and is trustworthy.

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MORAL PARTICULARISM

  • Embraces the uniqueness of particular cases including the context, culture, situations, relationships, and individuals involved
  • Recognizes the need for rules that allow for exceptions in situations that deviate from the norm
  • Relies on other relevant moral principles for the starting point of judgment

THINK ABOUT IT AND DISCUSS

  • Identify specific ethical codes, including professional codes. What ethical theory is seen in the code?
  • List virtues you feel are important for nurses to attain, and describe why you feel they are important.
  • Can different ethical theories be utilized in making an ethical decision? Why or why not?

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