ETHICS
Ethics
is the study of human values in relation to the under-
standing and utilisation of concepts such as right and wrong,
good and evil. It is formalised through a branch of philoso-
phy referred to as moral philosophy and is divided into three
primary theoretical areas:
meta-ethics
(the study of the
concept of ethics),
normative ethics
(the study of how to
determine ethical values), and
applied ethics
(the study of
the use of ethical values). As with other values, these con-
cepts are developed from childhood, and the ability to make
ethical decisions and to act in an ethically justified manner
develops gradually. See Chapter 21 for a description of
moral development as developed by Kohlberg.
Many people use the term ‘ethics’ when describing the
systematic ethics incorporated into a code of professional
conduct, such as nursing codes of ethics. The term
morals
is
similar in meaning to ethics and the two words are often
used in an interchangeable way.
Morals
usually refer to per-
sonal or communal standards of right and wrong.
It is important to distinguish ethics from religion, law,
custom and institutional practices. For example, the fact that
an action is legal or customary does not in itself make the
action ethically or morally right. A principle-based frame-
work provides a critical, defensible, systematic and
intellectual approach to determining ethically what is right
or best in a complex or problematic situation.
Theories of ethics
Ethical theories
are systems of thought that attempt to
explain how we ought to live and why. As defined above,
these theories may be broadly categorised as meta-ethics,
normative ethics and applied ethics.
Meta-ethics
Meta-ethics
can be defined as the study of the origin and
meaning of ethical concepts and focuses on the extent to
which judgements are reasonable or otherwise justifiable.
This includes the foundation of ethical principles and their
meaning; that is, the issues of universal truths and how such
commonly held beliefs underpin actions which may or may
not be ethically defensible. Meta-ethics also explores the
psychological basis of moral judgements and conduct, par-
ticularly in relation to what motivates individuals to act in
ways that are classified as ‘morally correct’.
Normative ethics
Normative ethics
has a more practical purpose, focusing on
the determination of moral standards and ethical values reg-
ulating right and wrong conduct. It examines questions
about societal as well as family values associated with col-
lective and individual actions and outcomes. Normative
ethics identifies the general rules and principles that guide
most people’s actions. An example of normative ethics that
guides nurses’ actions is the provision of thoughtful care to
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Chapter 11 Values, ethics and advocacy
older people prompted by wanting that level of respect and
caring for their own parents or relatives.
Applied ethics
Applied ethics
is the use of ethical values to examine spe-
cific controversial issues, such as abortion or euthanasia.
The conceptual tools of meta-ethics and normative ethics
are used as a framework for discussion and resolution in
applied ethics, although the lines of distinction between
these three classifications of ethical theories are often
blurred. For example, the issue of abortion is an applied
ethical topic since it involves a specific type of controversial
behaviour. But it also depends on more general normative
principles, such as the right of self-rule and the right to life,
which in themselves arise from meta-ethics issues such as
the origin of people’s rights.
Applied ethics has been subdivided into groups, and
those of particular concern to the nurse and midwife are
bioethics
,
clinical ethics
and
nursing ethics
. Issues in
bioethics
include responsible research conduct, genetic
enhancement, environmental ethics and sustainable
healthcare.
Clinical ethics
is that branch of bioethics literally con-
cerned with ethical problems ‘at the bedside’; that is, ethical
concerns that arise within the context of caring for an actual
person, such as rights and responsibilities in relation to
informed patient consent to treatment. Clinical ethics have
developed in response to three criticisms of bioethics:
1. The need for a contextual approach to ethical inquiry that
takes a more careful account of the variety of contexts in
clinical care and the special needs of ill and suffering
people.
2. The need to emphasise the relevance of clinical experi-
ence that draws on the knowledge available only through
the intimacy of the clinician–patient relationship when
doing clinical ethics.
3. The need for an orientation towards service in clinical
ethics that addresses ethics education, policy making to
address ethical issues in patient care, ethics consultation
and clinical ethics research (Fletcher et al., 1997, p. 4).
Nursing ethics
has been defined broadly by Johnstone
(2009, p. 16) as the ‘examination of all kinds of ethical
and bioethical issues from the perspective of nursing
theory and practice which, in turn, rest on the agreed core
concepts of nursing, namely: person, culture care, health
healing environment and nursing itself’. As nurses
assume increasing responsibility for managing care, it is
critical they be prepared to recognise the ethical dimen-
sions of nursing practice and to participate competently in
ethical decision making. Common ethical issues encoun-
tered by nurses in daily practice include cost-containment
issues that jeopardise patient welfare, end-of-life deci-
sions, breaches of patient confidentiality, and the
incompetent, unethical or illegal practices of colleagues.
In the following scenario, explore all these dimensions of
ethical practice.
