- Explain at least two ethical principles involved (from Ethical Principles in the Ethics folder) and how the principles apply to the case
This principle asserts that individuals have the right to determine their own actions and the freedom to make their own decisions. Autonomous decisions are based on the individual’s values, adequate information, freedom from coercion, and reason and deliberation.
Beneficence is the doing of good, and it is a critical ethical principle in health care. Actions motivated by the principle of beneficence may, however, conflict with other principles, particularly patient autonomy.
This is defined as the duty to do no harm. It is enshrined in the medical profession’s Hippocratic Oath and is likewise critical to the nursing profession. The nurse must not intentionally harm the patient. Chemotherapy is an example of a procedure that does short-term harm to the patient in hopes of producing great long-term good, and illustrates the “double effect principle.” Four conditions must be fulfilled to justify the use of the double effect principle: (1) the action must be good or at least morally indifferent; (2) the health care provider must intend only the good effects; (3) the undesired effects cannot be a means to the end or good effect; (4) there is a favorable balance between desirable and undesirable effects.
Justice requires that equals should be treated the same, and unequals should be treated differently. In the health care context, this means that patients with the same diagnosis and health care needs should receive the same care, while those with greater or lesser needs should receive care that is appropriate to their needs. Wealth, however, buys better health care regardless of the specific need of the patient. Given vast wealth disparity, it is unclear how the principle of justice can properly be applied. This problem is compounded by systemic wealth disparities that closely track racial and ethnic background, leading to racial and ethnic disparities in health care access, treatment options, and outcomes.
Fidelity refers to honoring one’s commitments or promises. For nurses, this specifically refers to fidelity to their patients. When a nurse is licensed, she or he accepts responsibility to respect all individuals, to uphold the Code of Ethics for Nurses, to practice within the scope of nursing practice, to keep skills current, to abide by an employer’s policies, and to keep promises to patients.
This consists in telling the truth. Truth-telling is fundamental to the development and maintenance of trust among people. The nurse-patient relationship assumes that the nurse will deal honestly with his or her patient. Some rare instances provide narrow exceptions to the nurse general duty to tell her or his patient the truth. Deceiving a patient “for their own good” amounts to paternalism, which denies the patient’s autonomy.