The Importance of Ethical Theories and Principles in Decision Making for Nurses

As nurses, we are put in many different situations in the workplace. Sometimes, we are assigned to care for a patient that we may have different beliefs or values from. Other times, we may be put in a difficult situation and have to make a difficult decision that seems impossible. When we are put in these positions, we can use ethical theories and principles to help guide us to make the best decisions. This paper looks at the importance of the ethical theory utilitarianism and the ethical principles of justice and autonomy in making healthcare decisions.

Ethical Theory

Butts & Rich (2016) define utilitarianism as the “attempt to promote the greatest good…and to produce the least amount of harm” (p. 17). In other words, while there is a chance of bad things happening, there is a greater chance of something good occurring. This ethical theory can come into place in a variety of different situations in a healthcare setting. It can help make decisions about healthcare when there isn’t an obvious right or wrong option. For example, if a patient needs to undergo a major surgery, such as open-heart surgery, there is always the possibility of complications occurring, such as blood loss or death. However, there are also many benefits to having the surgery, such as reducing the risk of a heart attack due to coronary artery disease or replacing the valves of the heart in order to allow blood to flow through it. In this case, the good the surgery would do outweighs the possible complications of having the surgery. Therefore, according to the utilitarianism theory, it is ethical to proceed with the procedure.

Ethical Principle

St. Joseph’s University defines the ethical principle of justice as providing fairness in all medical decisions. This can include fairness in the distribution of scarce resources or fairness in the treatment provided (“How the Four Principles”, 2017). This ethical principle is important to all nurses in order to provide the same and best care for all their patients.

In an article written by Pope, Hough, & Chase (2016), the discuss the importance of ethics in a community nursing setting. They bring up that an aspect of justice is that there are the same opportunities for everyone to have healthcare access. As nurses, we can use justice in our practice by providing this care for everyone, regardless of their economic class or income. For example, you have a patient that comes in seeking help for chest pain that he has been experiencing. While working with him, he informs you that he does not have insurance to cover the cost of the visit. According to the principle of justice, you would treat this patient the same as any other patient that came in with the same problem, regardless of their ability to pay for the services provided.

Ethical Principle and Confidentiality

If patient confidentiality were to be breached, then the ethical principle of autonomy would be in conflict. Autonomy, as defined by Blais & Hayes (2016), is a person’s right to make decisions for themselves (p. 60).  This means that a patient has the right to make decisions about the care that they will receive. According to Shahriari, Mohammadi, Abbaszadeh, & Bahrami (2013), in order to patients to be autonomous in making these decisions, the nurse must first give them all the pertinent information that they need in order to make an educated decision (p. 7). However, another aspect of autonomy is that they patient has the right to choose what information that they want to share with others. When information is shared without the patient first giving permission, you take away that decision from them. In other words, their autonomy is taken away.

One example of this is portrayed by a nurse in New York. This nurse was working one day in the clinic when her sister-in-law’s boyfriend showed up. The boyfriend was diagnosed with an STD and once the nurse found out, she immediately texted the sister-in-law in order to let her know what was going on. She failed to get permission from the boyfriend, making it a breach of confidentiality. When the boyfriend found out about the texts, he contacted the clinic, and then proceeded to sue them. The nurse of course was fired (Guglielmo, 2013). When this nurse decided to share that information without permission from the patient, she took away the patient’s decision, which in turn took away his autonomy.

Application to Course Content

As a new nurse, this course has taught me a lot about my role and all of the different areas that I need to be competent in. Ethics is one of those areas. It is important to learn about ethics when it comes to nursing because, as nurses, we make a variety of decisions that affect a lot of different people. We need to base these decisions off of ethical theories and principles, not only to save ourselves from legal trouble, but also to help our patients have the best outcomes possible.

Conclusion

In conclusion, ethical theories and principles can help us make decisions in the healthcare field. By using the theory of utilitarianism, we can make difficult decisions that do not seem to have a right or wrong answer. Through using the principles of justice and autonomy, we can ensure that our patients are getting the best care possible and that we are also respecting their wishes, beliefs and values.

References

• Blais, K. K., & Hayes, J. S. (2016). Professional nursing practice: Concepts and perspectives. Boston: Pearson.
• Butts, J. B., & Rich, K. L. (2016). Nursing ethics: Across the curriculum and into practice. Burlington, MA: Jones & Bartlett Learning.
• Guglielmo, W. J. (2013, May 13). Nurse Reveals STD Patient to Girlfriend, Man Sues; and More. Retrieved from https://www.medscape.com/viewarticle/803758
• How the Four Principles of Health Care Ethics Improve Patient Care. (2017, February 24). Retrieved from https://online.sju.edu/graduate/masters-health-administration/resources/articles/four-principles-of-health-care-ethics-improve-patient-care
• Pope, B., Hough, M. C., & Chase, S. (2016). Ethics in community nursing. Online Journal of Health Ethics, 12(2), 20–29. https://doi.org/10.18785/ojhe.1202.03
• Shahriari, M., Mohammadi, E., Abbaszadeh, A., & Bahrami, M. (2013). Nursing ethical values and definitions: A literature review. Iranian Journal of Nursing & Midwifery Research, 18(1), 1–8. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=asn&AN=93879340&site=ehost-live