HEALTH CARE

ETHICS
(BIOETHICS)
Jan Kyle S. Oteda
BSN 2-1
Instruction: Do A Literature Research on the 4 Key Ethical Principles Namely: Autonomy,
Beneficence, Nonmaleficence, And Justice. In Essay Form.

Answer the Following:

1. Explain Each One of The Ethical Principles

There are four key ethical principles that we derived the rules found in our professional code of
ethics, these are namely: Autonomy, Beneficence, Nonmaleficence, And Justice. The Principle of
Autonomy comes from the Greek word ‘autos’ which means ‘self’ and ‘nomos’ which means
‘governance or rule’. In autonomy, a person should be free to perform whatever action he/she
wishes, regardless of risk of foolishness as perceived by others provided it does not impinge on
the autonomy of others. Three basic elements seem to be involved in the process of autonomy:
the ability to decide, the power to act on your decisions and a respect for the individual autonomy
of others. The term self-determination is often used synonymously with autonomy. There are two
conditions that are ordinarily required before a decision can be regarded as autonomous. The
individual has to have the relevant internal capacities for self-government, and the individual has
to also be free from external constraints. In a medical context an patient’s decision is ordinarily
regarded as autonomous when the individual has the capacity to make the relevant decision, has
sufficient information to make the decision and does so voluntarily. The Principle of Beneficence
serves as a guide to the individual to do what is good and this priority to “do good” creates an
ethical perspective and possible solution to an ethical dilemma acceptable. The common English
usage of the term beneficence suggests an act of mercy and charity, although it may also be
expanded to include any action that benefits another. Persons are treated in an ethical manner not
only by respecting their decisions and protecting them from harm, but also by making efforts to
secure their well-being. Two general rules have been formulated as complementary expressions
of beneficent actions in this sense: (1) Do not harm and (2) maximize possible benefits and
minimize possible harms. The Principle of Nonmaleficence holds that there is an obligation not
to inflict any harm on others. It is closely associated with the maxim “primum non nocere” which
means ‘first do no harm’. This principle requires an intention to avoid needless harm or injury that
can arise through acts of commission or omission. In common language, it can be considered
“negligence” if you impose a careless or unreasonable risk of harm upon another. The Principle
of Justice looks at the concepts of fairness, just deserts, and entitlements. In a just society, we
require procedural justice or due process in cases of disputes between individuals. In health care,
we deal with distributive justice as we struggle with the distribution of scarce resources. The most
 famous formulation is that stated by Aristotle that “equals must be treated equally and un-equals
must be treated unequally."

2. What Are the Implications of These Principles to The Nursing Practice

Autonomy requires that the patient have the autonomy of thought, intention, and action when
making decisions regarding health care procedures. Therefore, the decision-making process of a
patient must be free of coercion or coaxing. In order for a patient to make a fully informed decision,
she/he must understand all risks and benefits of the procedure to be given and its likelihood of
success. From this principle, we have derived the rules involved in ‘informed consent’, which
generally contain the elements of disclosure, understanding, voluntariness, competence, and
permission giving. Autonomy and patient self-determination are emphasized by the nurse or
healthcare provider when he/she accepts the client as a unique person who has the innate right to
express their own opinions, perspectives, values and beliefs. Nurses must encourage patients to
make their own decision without any judgments or coercion from the nurse. The patient also has the
right to reject or accept all treatments. A patient’s choice and autonomy are considered key in
palliative care. Part of the nurse’s role, wherever possible, is to advocate for a competent patient’s
right to decide their own course of action, whether it is something that the nurse feels is appropriate
or not. Beneficence is an ethical principle that addresses the idea that a nurse's actions should
promote good. Doing good is also thought of as doing what is best for the patient. This principle acts
as an obligation for nurses to protect their patients from harm by removing and preventing bad
situations and promoting good ones. This is a valuable principle because this encourages a superior
standard of nursing performance. It also emphasizes compassionate care and advocates for
continual striving toward excellence. Nurses must be wary, however, of the downside of this principle,
as it can lead to paternalism (the intentional limitation of the autonomy of one person by another, in
which the person who limits autonomy appeals exclusively to grounds of benefit to the other person)
when executed improperly. When a patient’s autonomy is sacrificed for providing care that is deemed
“right,” acting in the name of beneficence can be damaging rather than helpful. To ensure
beneficence, nurses must develop and maintain a high level of skill and knowledge, make sure that
they are trained in the most current and best nursing practices, and must consider their patients’
individual circumstances; what is good for one patient will not necessary benefit another.
Nonmaleficence is doing no harm to the patient, as stated in the historical Hippocratic Oath. Harm
can be intentional or unintentional. This principle is also intended to be the end goal for all of
healthcare practitioner’s decisions, and means that healthcare providers must consider whether other
people or society could be harmed by a decision made, even if it is made for the benefit of an
individual patient. The nurse is responsible to provide a standard of care which avoids risks or
minimizing it, as it relates to medical competence. An example of nurses demonstrating this principle
includes avoiding negligent care of a patient. Justice means to be impartial and fair. A nurse making
impartial medical decisions demonstrate this, whether it relates to limited resources or new
treatments regardless of economic status, ethnicity, sexual orientation, etc.

3. Cite Hypothetical Situations Involving Nurse – Client Relationship Applying Each One of
The Ethical Principles.

An example of a hypothetical situation involving the nurse-client relationship regarding

Autonomy is when “A female Jehovah’s witness patient is in need of a potentially life-saving
operation but refuses due to her religious beliefs, so the nurse decides to respect the patient’s
decision while still informing her about the possible risks and then proceeds to inform the patient's
primary health care provider about her refusal.”

An example of Beneficence is when “A nurse provides vaccination to a child despite knowing

that it will cause discomfort to the child during administration, because you know that its benefits of
protection from a disease will outweighs its discomforts.”

An example for Nonmaleficence is “When a nurse is providing patient teaching for a patient
undergoing chemotherapy. The nurse explained that the chemotherapy will cause some unpleasant
side effects, such as nausea and hair loss. Although the patient will experience nausea and hair loss
(harm), the treatment will eventually produce good for the patient.”

Lastly, an example for Justice is “On a medical unit, several patients are being treated for Hepatitis B
infection. One of the patients contracted Hepatitis B through using infected needles associated with
heroin use. Another patient contracted Hepatitis B through a blood transfusion following a car
accident. Several of the employees on the unit treat the patient who used heroin rudely and delay
their attention to the patient's requests. The nurse intervenes and reminds the staffs that they should
still treat both the patients fairly and should not discriminate between the two individuals because it
will only worsen their situation.’

References:

Edge R. and Groves J. (2006). Ethics of Health Care: A Guide for Clinical Practice 3 rd Edition. C and E
Publishing Inc.

Carino J. (2018). Fundamentals of Ethics. C and E Publishing Inc.

Burke A. (2019). Ethical Practice: NCLEX-RN. Retrieved from https://www.registerednursing.org/nclex/ethical-

practice/
Kemparaj V. (2018). Understanding the principles of ethics in health care.
https://www.researchgate.net/publication/323386719_Understanding_the_principles_of_ethics_in_health_care
_a_systematic_analysis_of_qualitative_information