Fundamentals of Nursing and Midwifery 2e

Chapter 11 Values, ethics and advocacy

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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

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.