ETHICAL PRINCIPLES

AUTONOMY
-is the state or condition of self-governance, or leading one’s life according to reasons,
values, or desires that are authentically one’s own. In medical practice, autonomy is usually
expressed as the right of competent adults to make informed decisions about their own
medical care.
Ex: A 26-year-old male has been involved in a high-speed collision, in which he sustained
blunt force trauma to his head as his head hit the front windscreen of his car. He did not lose
consciousness, he is fully responsive and has no indications of neurological damage. He does,
however, have a significant head wound that is bleeding continuously. This patient has
refused treatment on the grounds that he feels “fine” and is refusing to have sutures to close
his head wound. He would like to leave the Department.

Respect for autonomy is a principle frequently associated with a number of different concepts
including:
 Privacy
 Voluntariness
 Self-mastery
 Free choice
 Choosing one’s own moral position
 Accepting responsibility for one’s own choice
The three types of autonomy:
 Autonomy of thought
 Autonomy of will
 Autonomy of action
PATIENT CONFIDENTIALITY!

The American Nurses Association (ANA) believes that protection of privacy and
confidentiality is essential to maintaining the trusting relationship between health care
providers and patients and integral to professional practice (ANA, 2015a).

Confidentiality is a fundamental principle in healthcare, and nurses must understand how this
applies to their practice. Confidentiality pertains to restricting the sharing of sensitive patient
information and only sharing information when it is necessary either by law or professional
duty. Patients should be allowed to choose when their information is shared with others.
Therefore, nurses need to respect the wishes of patients and seek their permission before
sharing potentially sensitive information.

EXAMPLE: Your 36-year-old patient has just tested positive for HIV. He asks that you not
inform his wife of the results and claims he is not ready to tell her yet. What would you say
to your patient?

Because the patient's wife is at serious risk for being infected with HIV, you have a duty to
ensure that she knows of the risk. While public health law requires reporting both your
patient and any known sexual partners to local health officers, it is generally advisable to
encourage the patient to share this information with his wife on his own, giving him a bit
more time if necessary. 
VERACITY (Truth-Telling)

Veracity is defined as being honest and telling the truth. It is what binds the patient and the
healthcare provider as they seek to establish mutual treatment goals. Patients are expected to
be truthful about their medical history, treatment expectations, and other relevant facts.
Healthcare providers, for their part, must be truthful about the diagnosis, treatment options,
benefits and disadvantages of each treatment option, cost of treatment, and the longevity
afforded by the various treatment options.
Situational Example:
Honesty vs. withholding information. Family members may want to withhold medical
information from sick patients to protect their emotions. However, patients have the right to
know about their medical conditions. Deciding how to share this information, especially if it
goes against the family’s beliefs, can be a touchy situation. The interactive health care
relationship between patient and healthcare provider functions most effectively when both
parties are truthful and adhere to all promises made in the process.
FIDELITY

Fidelity is the research principle concerned with the building of trust between the researcher
and the participant (Parahoo 1997).

The research participant will entrust him- or herself to the researcher, who subsequently must
safeguard the participants and their welfare in the research situation (Garity 1995). It is
important to gain the participant's trust by being open and honest (Alderson 1995).
Example:
Disclosing Medical Conditions
A patient begs that his fatal disease not be revealed to his family by a nurse. The patient
explains that, regardless of the circumstances, his family would most likely completely ignore
his wishes and keep him alive. The nurse must be aware of the need to keep this information
private while yet assisting the patient's family. It can be tough to go against the wishes of a
dying patient, but the patient's rights must always take priority. The patient has the right to
keep that information private. The nurse's primary responsibility is to the patient, who must
have his or her wishes respected. Failure to keeping your patient's wishes violates the nurse's
ethical principle of fidelity.
Justice

 This research principle requires the researcher to be “fair, equitable, and appropriate
treatment to the person/participants.
 The main problem with this ethical principle is the selection of population (Garity,
1995).
 Vulnerable groups (older people, mentally ill, the military or prisoner, should not be
used merely for their convenience.)

2 types of. Justice:

1. Distributive justice- addresses the degree to which healthcare services are
distributed equitably throughout society.

6 Principles of Justice
-To each person
1. An equal share
2.according to need
3.according to too effort
4.according to contribution
5.according to merit
6.according to free market exchanges
EXAMPLE:
-An example would be when an insurance company has exhausted its
allocated and contracted funds to care for a hospitalized patient. The insurance company can
then demand that the patient be transferred to another facility of lesser cost
 2. Comparative justice- determines how healthcare is delivered at the individual
level.
- It looks at disparate treatment of patients based on age, disability, gender,
race, ethnicity, and religion.

EXAMPLE:
-Currently those age 65 and older receive disproportionate levels of funding in
healthcare because the number of individuals in that cohort continues to increase
and because people tend to need more healthcare services when they are older.
Equitable allocation of resources is an ever-increasing challenge as lives are
extended through natural and technological means.

REFERENCES:
Gelling, L. (1999). Ethical principle in healthcare research. Nursing Standard, 13(36) , 39-42.
https://www.researchgate.net/publication/12801905_Ethical_principles_in_health_care/link/
5d70b3eca6fdcc9961afa11a/download
Diamond, et.al (2021). Ethics for Professional Case Managers. 3. The Principles of
Healthcare Ethics, 3. The Principles of Healthcare Ethics | ATrain Education (atrainceu.com)
Beneficence
 is the requirement to benefit the patient.

Nurses must adhere to the Code of Professional Conduct (UKCC 1992), which states that the
nurse must: …act always in such a manner as to promote and safeguard the interests and
well-being of patients and clients’ (UKCC 1992).

Elements of Beneficence
One ought not to inflict evil or harm
One ought to prevent evil or harm
One ought to remove evil or harm
One ought to promote good

Beneficence obliges the nurse to weigh or balance the potential benefits against the potential
risks (Faden and Beauchamp 1986,
Garity 1995)

Examples:
-Resuscitating a drowning victim
-Providing vaccinations
-Educating the community about disease prevention

The goal is to do what is in the PATIENT'S best interest.

Non-Maleficence
•Comes from a Latin words: ‘non’ to mean ‘not’; malos’ from which ‘male’ is taken
to mean ‘bad/evil’ and ‘faceo’ from which ‘fic’ which means ‘do/make’.
•no harm should come to the patient or research participant as aresult of taking part in a study
(Faden andBeauchamp 1986, Garity 1995).

Five categories according to the level of harm or discomfort (Reynolds 1972):

1. No anticipated effects.
 No contact with the research participant
 frequently entail the review of medical notes or documentation.
 researchers should be aware that they are invading the person’s privacy
therefore it is important to acquire informed consent to the participant.
2. Temporary discomfort
 the discomfort to the participant is temporary and it ceases when their
involvement in the study ceases.
 involve questionnaires and interviews that involve minimal risks such as
fatigue, anxiety, embarrassment and time commitment
 researcher should be aware that these risks may occur and have strategies for
managing them.
3. Unusual levels of temporary discomfort.
 Participants experience discomfort during and after completion of the study
which include interviews about psychologically stressful experiences that may
continue to distress participants for some time after their contact with the
researcher has ended.
 researcher should be aware of the risks and be prepared, if necessary refer the
participants to a trained counsellor.
4. Risk of permanent damage.
 most common in biomedical research involving drug studies, where some of
the adverse effects is unknown. Some drugs undergo an extensive period of
research, sometimes lasting many years before they are administered to
humans.
 some uncertainty remains, so the researcher should have strategies to manage
adverse events.
5. Certainty of permanent damage.
 highly questionable regardless of the benefits that may be gained. These
studies violate the fifth principle of the Nuremberg Code, the Hippocratic Oath
and the Code of Professional Conduct.
 No studies that fall into this category should be allowed to proceed.

Key Points:
•The ethical principle of non-maleficence should go a long way to protecting research
participants
from harm as a result of research or any interventions.
•Equipoise should exist between the potential risks and benefits.
•The risks should never outweigh the benefits and the researcher should be aware that there
are potential risks with all research or interventions.

Example:
A 52-year-old man collapses in the street complaining of severe acute pain in his right
abdomen. A surgeon happens to be passing and examines the man, suspecting that he is on
the brink of rupturing his appendix. The surgeon decides the best course of action is to
remove the appendix in situ, using his trusty pen-knife.

From a beneficence perspective, successful removal of the appendix in situ would certainly
improve the patient’s life. But from a non-maleficence perspective, there is many risks
associated with the procedures that outweigh the benefit such as;

 The environment is unlikely to be sterile and so the risk of infection is extremely high
 The surgeon has no other clinical staff available or surgical equipment, meaning that
the chances of a successful operation are already lower than in normal circumstances
 Assuming that the surgeon has performed an appendectomy before, they have almost
certainly never done it at the roadside and so their experience is decontextualized and
therefore not wholly appropriate
 Unless there isn’t a hospital around for miles, this is an incredibly disproportionate
intervention.