3-ETHICAL PRINCIPLES & THEORIES kmu .ppt

education

1. UNIT-III: ETHICAL
PRINCIPLES AND
THEORIES
By: Farzana Kausar Khattak
Lecturer
KMU-INS

2. OBJECTIVES
At the end of the session learner will be able to:
• Discuss ethical principles in health care in the light of ethical
theories.
• Discuss the ethical dilemmas face by nurses and client.
• Discuss the strategies to resolve ethical dilemma in daily
nursing practice.
• List steps of ethical decision-making
FARZANA KHATTAK 203/06/25

3. ETHICAL PRINCIPLE AND
ETHICAL THEORIES
• Ethical principles are a set of ethical rules that provide the
framework/ tools which may facilitate individuals and society to
resolve conflict in a fair and moral manner.
• They are the foundations of ethical analysis because they are the
viewpoints from which guidance can be obtained along the
pathway to a decision.
• Each theory emphasizes different points such as predicting the
outcome and following one's duties to others in order to reach an
ethically correct decision.
FARZANA KHATTAK 303/06/25

4. ETHICAL PRINCIPLE AND
ETHICAL THEORIES
• However, in order for an ethical theory to be useful, the
theory must be directed towards a common set of goals.
• Ethical principles are the common goals that each
theory tries to achieve in order to be successful. These
goals include all principles of Ethics.
FARZANA KHATTAK 403/06/25

5. ETHICAL PRINCIPLES
• Autonomy: Right to make one’s own decisions and choices.
• Veracity: Refers to telling the truth.
• Confidentiality: Respect for a person’s privacy.
• Beneficence: The principle of doing good and benefits someone.
• Non-maleficence: The duty to do no harm (Prevent unintentional harm).
• Justice: The principle that deals with fairness, equity and equality.
• Fidelity: Means to be faithful to agreements and promises.
• Accountability: Answerable to oneself and others for one’s own
actions.
FARZANA KHATTAK 503/06/25

6. ETHICAL THEORIES
1.Consequence-based (teleological) theories.
2.Principle-based (deontological) theories.
3.Relationships-based (caring) theories.
FARZANA KHATTAK 603/06/25

7. 1.TELEOLOGICAL THEORIES

Teleological theories, also known as consequentialist
theories, are a category of ethical theories that focus on the
outcomes or consequences of actions to determine their
moral value.
 In teleological ethics, the rightness or wrongness of an
action is determined by the overall good or value it
produces. Here are some notable teleological ethical
theories:
•Utilitarianism
•Hedonism
•Egoism
FARZANA KHATTAK 703/06/25

8. UTILITARIANISM
Developed by philosophers like Jeremy Bentham
and John Stuart Mill.
The right action is the one that maximizes overall
happiness.
In utilitarianism, happiness is typically understood
as pleasure and the absence of pain.
Actions that promote the greatest happiness for the
greatest number of people are considered morally
right (even if its ethically wrong).
FARZANA KHATTAK 803/06/25

9. HEDONISM
 Hedonism specifically focuses on the pursuit of
pleasure and the avoidance of pain as the ultimate goal
of human life.
 Hedonistic theories argue that the right action is the one
that maximizes pleasure or minimizes suffering.
 Hedonism is based on the principle that actions are
morally right if they maximize pleasure or happiness and
minimize pain or suffering.
FARZANA KHATTAK 903/06/25

10. EGOISM
 Ethical egoism argues that individuals should act in
their own self-interest and seek to maximize their own
happiness.
 Egoism argues that individuals should act in their self-
interest to maximize their own well-being.
 It's a form of ethical egoism that focuses on the
personal consequences of actions.
03/06/25 FARZANA KHATTAK 10

11. 2.DEONTOLOGICAL THEORIES
Deontological ethics, often referred to as duty-based ethics, is
an ethical theory that emphasizes the intrinsic nature of actions
or duties as the basis for determining their moral value.
In deontological ethics, certain actions are considered
inherently right or wrong, regardless of their consequences.
Here are some notable deontological theories:
•Kantian Ethics (Deontology)
•Divine Command Theory
•Rights-Based Ethics
FARZANA KHATTAK 1103/06/25

12. KANTIAN ETHICS
 Developed by the philosopher Immanuel Kant.
 Kantian ethics states that individuals should act only
according to principles that could be universal laws
without contradiction.
 It emphasizes the importance of moral duties and the
inherent worth of individuals, asserting that we have a
duty to act morally regardless of the consequences.
03/06/25 FARZANA KHATTAK 12

13. DIVINE COMMAND
THEORY
 This theory asserts that the moral rightness or
wrongness of actions is determined by divine
commands or the will of a higher power, such as God.
 It relies on religious texts and authority for moral
guidance, where obedience to divine rules is
paramount.
03/06/25 FARZANA KHATTAK 13

14. RIGHTS-BASED ETHICS
 Rights-based ethics, influenced by the works of
philosophers like John Locke and Immanuel Kant,
emphasizes individual rights as a fundamental aspect of
morality.
 It argues that individuals have certain inherent rights, and
respecting these rights is a moral duty.
 Actions are considered morally wrong if they violate
someone's rights, and it is our moral duty to protect and
uphold these rights, regardless of the overall consequences.
03/06/25 FARZANA KHATTAK 14

15. 3. CARING THEORIES
Relationship-based caring theories emphasize the significance
of interpersonal relationships and human connection in
healthcare and caregiving.
These theories guide healthcare professionals in building
meaningful relationships with patients and providing care that is
both patient-centered and culturally sensitive. Here are some
relationship-based caring theories:
•Madeleine Leininger's Cultural Care Theory
•Swanson's Theory of Caring
•Travelbee's Human-to-Human Relationship Model
03/06/25 FARZANA KHATTAK 15

16. MADELEINE LININGER'S
CULTURAL CARE THEORY
Madeleine Lininger's theory highlights the
importance of culturally congruent care, where
healthcare providers understand and respect the
cultural beliefs and values of their patients.
03/06/25 FARZANA KHATTAK 16

17. SWANSON'S THEORY
OF CARING
 Developed by Kristen M. Swanson.
 This theory outlines five caring processes that guide the
nurse-patient relationship:
1.Maintaining Belief
2.Knowing
3.Being With
4.Doing For
5.Enabling
03/06/25 FARZANA KHATTAK 17

18. TRAVELBEE'S HUMAN-TO-
HUMAN RELATIONSHIP
MODEL
Joyce Travelbee's model focuses on the
interpersonal aspects of nursing care and
therapeutic relationship between the nurse and
patient, highlighting the significance of
communication, empathy, and understanding in
providing holistic care.
03/06/25 FARZANA KHATTAK 18

19. ETHICAL DILEMMAS IN
NURSING
 Nurses face ethical dilemmas on a daily basis
regardless of where they practice. No matter where
nurses function in their varied roles, they are faced
with ethical decisions that can impact them and their
patients.
 There is no “right” solution to an ethical dilemma.
FARZANA KHATTAK 1903/06/25

20. There are many ethical issues nurses can encounter in the
workplace. These include:
 Quality vs quantity of life
 Pro-choice (abortion) vs Pro-life (conception).
 Freedom vs control.
 Truth telling vs deception (trick or fraud).
 Distribution of resources.
 Empirical knowledge vs personal beliefs.
FARZANA KHATTAK 2003/06/25
ETHICAL DILEMMAS IN
NURSING

21. QUALITY VS QUANTITY OF
LIFE
Quantity may address how long a person lives or perhaps
how many people will be affected by the decision.
Quality pertains to how “good” a life a person may have and
this varies depending on how a person defines “good”.
So how does the nurse support a patient deciding between a
therapy that will prolong life but the quality of life will be
compromised? The person may live longer, but will likely
experience significant side effects from the therapy. What
should the nurse’s position be?
FARZANA KHATTAK 2103/06/25

22. PRO-CHOICE VS PRO-LIFE
 This issue affects nurses personally. Many of the positions nurses
assume in this dilemma are influenced by their own beliefs and
values.
 How does a nurse care for a patient who has had an abortion,
when the nurse considers abortion murder?
 Can that nurse with very opposing values support that patient’s
right to choose her autonomy?
FARZANA KHATTAK 2203/06/25

23. FREEDOM VS CONTROL
 Does a patient have the right to make choices for
one’s self that may result in harm, or should the nurse
prevent this choice?
 For example, a patient wants to stop eating, but the
nurse knows the consequences will harm the patient.
 Does the nurse have the “right” to force the patient to
eat?
FARZANA KHATTAK 2303/06/25

24. TRUTH TELLING VS
DECEPTION
 This is another issue that nurses may have to deal with,
especially when families want to deny telling the patient the
truth about the medical condition.
 What should a nurse do when a family insists telling the
patient the prognosis will cause harm?
 How can a nurse know if this is true?
 Does the patient have the right to know?
FARZANA KHATTAK 2403/06/25

25. DISTRIBUTION OF
RESOURCES
 A nurse may encounter a distribution of resources dilemma
when deciding how to allocate limited medical supplies like
ventilators during a healthcare crisis, such as a pandemic.
 They must determine which patients will benefit the most
from the available resources, balancing the need for fair
distribution while saving as many lives as possible.
FARZANA KHATTAK 2503/06/25

26. EMPIRICAL KNOWLEDGE VS
PERSONAL BELIEF
 In these dilemmas, research based knowledge in nursing
practice is contrasted to beliefs gained from such things as
religious beliefs.
 For example, what should a nurse do when a patient is
admitted to the hospital that desperately needs a transfusion to
live but has the belief that transfusions are unacceptable? The
nurse knows this patient will die without the transfusion.
FARZANA KHATTAK 2603/06/25

27. STRATEGIES TO ENHANCE
ETHICAL DECISION
The following strategies should be taken by a nurse to overcome the
moral distress on the job:
Become aware of your own values and ethical aspects of nursing.
Be familiar with nursing codes of ethics.
Seek continuing education opportunities to stay knowledgeable about
ethical issues in nursing.
Respect the values, opinions, and responsibilities of other health care
professional that may be different from your own.
Serve on institutional ethics committees.
Strive for collaborative practice in which nurses function effectively in
cooperation with other health care professionals.
FARZANA KHATTAK 2703/06/25

28. STEPS OF ETHICAL DECISION
MAKING
1.Gather the facts
2.Define the ethical issues
3.Identify the affected parties (stakeholders)
4.Identify the consequences
5.Identify the obligations (principles, rights, justice)
6.Consider your character and integrity (honest).
7.Think creatively about potential actions
8.Check your gut
9.Decide on the proper ethical action and be prepared to deal with
opposing arguments.
FARZANA KHATTAK 2803/06/25

29. 1.GATHER THE FACTS
The first step is to gather all relevant information and facts
related to the ethical dilemma.
This includes understanding the situation, the individuals
involved, and any contextual details.
Don’t jump to conclusions without the facts.
Questions to ask: Who, what, where, when, how, and why.
FARZANA KHATTAK 2903/06/25

30. 2.DEFINE THE ETHICAL
ISSUES
Identify and clarify the specific ethical problems or
dilemmas that exist within the given situation.
What are the conflicting values or principles at play?
Don’t jump to solutions without first identifying the
ethical issues in the situation.
Define the ethical basis for the issue you want to focus on.
There may be multiple ethical issues, focus on one major
one at a time.
FARZANA KHATTAK 3003/06/25

31. 3.IDENTIFY AFFECTED
PARTIES
Identify all of the stakeholders.
Determine who is impacted by the ethical decision.
Consider the various stakeholders and their interests in
the outcome.
FARZANA KHATTAK 3103/06/25

32. 4.IDENTIFY
CONSEQUENCES
Think about potential positive and negative
consequences for affected parties by the decision
(Focus on primary stakeholders to simplify analysis
until you become comfortable with the process).
What are the magnitude of the consequences and the
probability that the consequences will happen.
Short term vs. Long term consequences-will decision
be valid over time.
FARZANA KHATTAK 3203/06/25

33. 5.IDENTIFY THE RELEVANT
PRINCIPLES, RIGHTS, AND JUSTICE
ISSUES
 Consider ethical principles, rights, and notions of justice
that apply to the situation.
 What moral obligations do you or the organization have?
FARZANA KHATTAK 3303/06/25

34. 6.CONSIDER YOUR CHARACTER &
INTEGRITY
 Reflect on your own character and integrity. Are you being
honest with yourself about your motivations and values? How
do your actions reflect your character?
 Consider what your relevant community members would
consider to be the kind of decision that an individual of
integrity would make in this situation.
FARZANA KHATTAK 3403/06/25

35. 7.THINK CREATIVELY ABOUT
POTENTIAL ACTIONS
 Generate a list of possible actions or solutions to the ethical
dilemma.
 Be open to innovative approaches that may reconcile
conflicting values.
 If you have come up with solutions “a "and “b,” try to
brainstorm and come up with a “c” solution that might
satisfy the interests of the primary parties involved in the
situation.
FARZANA KHATTAK 3503/06/25

36. 8.CHECK YOUR GUT
Trust your intuition and emotions to some extent. Even
though the prior steps have argued for a highly rational
process, but it is always good to “check your gut.”
How do you feel about the potential solutions? Gut
feelings can sometimes provide valuable insights.
Particularly relevant if you have a lot of experience in the
area-expert decision making.
FARZANA KHATTAK 3603/06/25

37. 9.DECIDE ON YOUR COURSE OF
ACTION AND PREPARE RESPONSES
TO THOSE WHO MAY OPPOSE YOUR
POSITION
 Based on the previous steps, make a decision on
the most ethically sound course of action.
 Be ready to defend your decision and address
opposing arguments, as ethical dilemmas often
involve differing perspectives.
FARZANA KHATTAK 3703/06/25

38. SCENARIO
You are a nurse working in a hospital. A patient, Mr. Smith,
has been admitted with a severe illness. After a few days, he
tells you in confidence that he's been secretly taking an
experimental, unapproved drug he bought online because he
believed it would cure him. He's worried about the potential
side effects of this drug and asks you not to inform the
medical team or his family.
 Make a decision for this patient in light of Ethical
Decision-Making Steps.
03/06/25 FARZANA KHATTAK 38

39. ETHICAL DECISION-MAKING
STEPS
1.Gather the facts: You gather information by listening to Mr. Smith's
story and understanding the nature of the drug and his concerns.
2.Define the ethical issues: The primary ethical issue is patient
autonomy and informed consent. It's also about ensuring patient safety
and well-being.
3.Identify the affected parties (stakeholders): The affected parties
include Mr. Smith, his family, the medical team, and yourself.
4.Identify the consequences: If Mr. Smith's secret drug use is not
disclosed, there's a risk of potential harm due to drug interactions or
side effects. On the other hand, breaching his confidentiality might
harm the trust between the patient and healthcare professionals.
03/06/25 FARZANA KHATTAK 39

40. 5.Identify the obligations (principles, rights, justice): You have an
obligation to uphold patient confidentiality, but you also have an
ethical duty to protect Mr. Smith's well-being. The principles of
autonomy, beneficence, and non-maleficence come into play.
6.Consider your character and integrity (honest): Reflect on your
own integrity and values. Are you acting honestly and in the best
interest of the patient?
7.Think creatively about potential actions: Explore various options,
such as discussing the situation with Mr. Smith, seeking guidance
from a medical ethics committee, or informing his family while
respecting his autonomy.
03/06/25 FARZANA KHATTAK 40
ETHICAL DECISION-MAKING
STEPS

41. 8.Check your gut: Consider how you feel about each option. Your
intuition may guide you toward the most ethical action.
9.Decide on the proper ethical action and be prepared to deal with
opposing arguments: After careful consideration, you decide to
discuss the situation with Mr. Smith, emphasizing your concern for his
well-being. You're prepared to address his fears and explore the best
path forward.
In this example, the ethical decision-making process involves balancing
respect for patient autonomy and confidentiality with the
responsibility to ensure patient safety and well-being. The chosen
action prioritizes open communication and trust-building with the
patient while considering the potential consequences of the situation.
03/06/25 FARZANA KHATTAK 41
ETHICAL DECISION-MAKING
STEPS

42. ETHICAL DILEMMAS
 What should a health professional do when he/she sees a
colleague engaging in an unethical act?
 Because of the family’s wish, the terminal ill status has not been
told the patient but the nurse is sure he/she knows he/she is dying.
What should the nurse do ethically when this patient directly asks
her/him about his/her condition?
 Is lying to a patient ever ethical? What constitutes a lie? Is a
placebo a lie?
 Should the nurse follow a doctor’s order if she/he thinks there is a
potential problem with the order?
03/06/25 FARZANA KHATTAK 42

43.  Two ethical principles are ‘Do No Harm and Do Good’. What do
we mean by Harm and Good?
 Health professionals have two basic ethical obligations: (1) to
extend life & (2) to lessen pain and suffering. Can they do both in
this situation when Morphine may shorten patient’s life?
 How do you balance a patient's right to make their own medical
decisions (autonomy) with your duty to provide the best care
possible (beneficence) when they refuse a treatment that you
believe is in their best interest?
03/06/25 FARZANA KHATTAK 43
ETHICAL DILEMMAS

44. 03/06/25 FARZANA KHATTAK 44

45. REFERENCES
 American School Counselor Association. (2004). Ethical
standards for school counselors, Alexandria, VA: Author.
 Kushner, H. S. (2001). Living a life that matters. NY:
Anchor Books
 National Association of School Nurses (2010). Code of
ethics. Author.
 www.google.com
FARZANA KHATTAK 4503/06/25

46. FARZANA KHATTAK 4603/06/25