Bioethics: Understanding Ethical Theories in Nursing | Summaries Bioethics

BIOETHICS

BIOETHICS – SECOND SEMESTER

MODULE 2 ETHICAL THEORIES

ETHICAL THEORIES

A human person act based on reason and

will. With will, he chooses to do something that is

determined by his reason that is ought to be done. With

reason, he makes use of his mind and embark on

seeking for knowledge. For nurses, we study the broad

base of knowledge and use this knowledge as basis of

our nursing actions. We try to aim for objective facts,

tested and tried to be sound and effective to ensure

correctness and safety of our nursing care plan. We

justify and rationalize our judgments, decisions and

actions based on this objective notion of what is good.

By objective, we mean it is not based on feelings or

personal motivations and instead a product of careful

reflections and rigorous scientific evidence-based

study.

In ethics, there are ethical theories that guide

us also in ethical decision-making. However, some of

these theories oppose one another i.e. ethical egoism

and virtue ethics etc, leaving the person unable to

decide on which theory he can make use as anchor of

any ethical decisions.

As a teacher in ethics for several years and

upon observing of the world and reality around me, I

have come to the conclusion that some people choose

a framework based on what suits his or her needs.

Which in itself it truly subjective.

However, Ethics must be objective, otherwise

it fails to set a standard that will guide human

character. Nevertheless, for purposes of scholarly

study, we discuss the different ethical theories to have

a wider perspective of the several ethical theories. A

separate discussion will be dedicated to attempt a

discussion on how to do ethical decision-making and

how to determine the goodness and badness of a

human act in simple terms.

Summary of Ethical Theories

1. Teleological Ethical Theories – rightness and

wrongness solely depend on the consequence

2. Deontological Ethical Theories – actions are

morally right independent of their consequences

3. Virtue Ethical Theories – ethical value is

determined by his character which refers to virtues,

inclinations and intentions that dispose of a person to

be ready to act ethically. Character builds a substantive

moral foundation for one’s actions. A person with the

strong character has imbibed emotional, intellectual,

moral and social virtues to achieve the self-discipline

to do what is right and good. Whereas a person with

weak character finds himself doing the wrong things

and doing what is harmful to him and makes excuses

for all his actions.

4. System Development Ethical Theories – the

extent to which organization system is sensitive to the

need to develop a work culture supportive of ethical

conduct determine the ethical values of actions. If the

organization do not implement morally supportive

systems then the organization is exposed to future

ethical risks.

Types of Teleological Ethical Theories.

1. Ethical Egoism – It posits that an action is good is

it produces or is likely to produce results that maximize

the person’s self-interest which the person himself

defines. Even at the expense of others. It is based on

the notion that it is always right to promote one’s own

good.

2. Utilitarianism – posits that an action is good if it

results in maximum satisfaction for a large number of

people who are likely to get affected by the action.

3. Eudaimonism – It posits that an action is good if it

results in the fulfillment of goals along with the welfare

of the human beings. The actions are said to be fruitful

if it promotes or tends to promote the fulfillment of goals

that constitute human nature and its happiness.

Types of Deontological Ethical theories:

1. Negative and Positive Rights Theories – asserts

that an action is right if it protects the individual from

harm or unwarranted interference from other people or

the government while exercising his right. The

Example: selling your property without the

interference of others. The positive right theory posits

that an action is right if it provides an individual with

anything that he needs to exist. Example, right to

adequate health care.

2. Social Contract Theories – posits that people

contract with each other to abide by the moral and

political obligations towards the society in which they

live. This theory is based on the notion that if there is

no order and law in the society, then people will have

unlimited freedoms like killing another because of too

much hatred, stealing money and property because

one needs it etc. What chaotic world it would be, thus,

people enter into an agreement with each other to give

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MODULE 2 ETHICAL THEORIES

ETHICAL THEORIES

A human person act based on reason and will. With will, he chooses to do something that is determined by his reason that is ought to be done. With reason, he makes use of his mind and embark on seeking for knowledge. For nurses, we study the broad base of knowledge and use this knowledge as basis of our nursing actions. We try to aim for objective facts, tested and tried to be sound and effective to ensure correctness and safety of our nursing care plan. We justify and rationalize our judgments, decisions and actions based on this objective notion of what is good. By objective, we mean it is not based on feelings or personal motivations and instead a product of careful reflections and rigorous scientific evidence-based study. In ethics, there are ethical theories that guide us also in ethical decision-making. However, some of these theories oppose one another i.e. ethical egoism and virtue ethics etc, leaving the person unable to decide on which theory he can make use as anchor of any ethical decisions. As a teacher in ethics for several years and upon observing of the world and reality around me, I have come to the conclusion that some people choose a framework based on what suits his or her needs. Which in itself it truly subjective. However, Ethics must be objective, otherwise it fails to set a standard that will guide human character. Nevertheless, for purposes of scholarly study, we discuss the different ethical theories to have a wider perspective of the several ethical theories. A separate discussion will be dedicated to attempt a discussion on how to do ethical decision-making and how to determine the goodness and badness of a human act in simple terms. Summary of Ethical Theories

Teleological Ethical Theories – rightness and wrongness solely depend on the consequence
Deontological Ethical Theories – actions are morally right independent of their consequences
Virtue Ethical Theories – ethical value is determined by his character which refers to virtues, inclinations and intentions that dispose of a person to be ready to act ethically. Character builds a substantive moral foundation for one’s actions. A person with the strong character has imbibed emotional, intellectual, moral and social virtues to achieve the self-discipline to do what is right and good. Whereas a person with weak character finds himself doing the wrong things and doing what is harmful to him and makes excuses for all his actions.
1. System Development Ethical Theories – the extent to which organization system is sensitive to the need to develop a work culture supportive of ethical conduct determine the ethical values of actions. If the organization do not implement morally supportive systems then the organization is exposed to future ethical risks. Types of Teleological Ethical Theories.
2. Ethical Egoism – It posits that an action is good is it produces or is likely to produce results that maximize the person’s self-interest which the person himself defines. Even at the expense of others. It is based on the notion that it is always right to promote one’s own good.
3. Utilitarianism – posits that an action is good if it results in maximum satisfaction for a large number of people who are likely to get affected by the action.
4. Eudaimonism – It posits that an action is good if it results in the fulfillment of goals along with the welfare of the human beings. The actions are said to be fruitful if it promotes or tends to promote the fulfillment of goals that constitute human nature and its happiness. Types of Deontological Ethical theories:
5. Negative and Positive Rights Theories – asserts that an action is right if it protects the individual from harm or unwarranted interference from other people or the government while exercising his right. The Example: selling your property without the interference of others. The positive right theory posits that an action is right if it provides an individual with anything that he needs to exist. Example , right to adequate health care.
6. Social Contract Theories – posits that people contract with each other to abide by the moral and political obligations towards the society in which they live. This theory is based on the notion that if there is no order and law in the society, then people will have unlimited freedoms like killing another because of too much hatred, stealing money and property because one needs it etc. What chaotic world it would be, thus, people enter into an agreement with each other to give

MODULE 2 ETHICAL THEORIES

up some of their freedoms and accept the obligation to respect and safeguard the rights of others. The individual then gains a civil rights that constitute the social benefits that he is entitled to the extent he fulfills his due obligations towards society.

Social Justice Theories – it asserts that the action is right if it confirms the fairness in the distributive, retributive dimensions of cost and rewards. The distributive dimension means the perceived fairness in the distribution of social benefits and burden among the group members. The retributive dimension considers the punishment proportionate to the extent of the crime while the compensatory dimension is the way people are compensated in relation to the injuries inflicted upon them. Types of Virtue Ethical Theories:
Individual Character Ethics – it holds that the identification and development of noble human traits help in determining both the instrumental an intrinsic value of ethical interactions. These noble traits are courage, self-discipline, prudence, gratitude, wisdom sincerity, understanding, benevolence etc.
Work Character Ethics – The identification and development of reflective practitioner noble traits at work such as creativity, honesty, loyalty, honor, trustworthiness, civility, dependability, shared work pride, empathy, etc. which determine the intrinsic and instrumental ethical quality of work life.
Professional Character Ethics – holds that self- regulation, loyalty, impartial judgments, altruism, truthfulness, public service determine the intrinsic and instrumental ethical quality of an individual associated with communities. Types of System Development Ethical Theories:
Personal Improvement Ethics – the action is good if it is intended to promote the individual’s personal responsibility for the continuous learning, improvement, holistic development and moral excellence. Example: continuing education program
Organizational Ethics – action is right if it confirms the development of the formal and informal organizational processes which in turn enhances the procedural outcomes, respectful caring, innovation in ethical work culture and systematic justice.
Extraorganizational Ethics – the action is right if it promotes collaborative partnerships and respect the global and domestic constituencies representing the diverse political, economic, legal, social, ecological and philanthropic concerns that affect the organization. Other ethical theories Subjective Relativism: Relativism: § No Universal norms of right and wrong. § One can be wrong or right based on relative views. o Subjective Relativism: § Right and wrong for each person are decided by themselves. § What’s wrong for someone may be right for someone else. Case for subjective relativism: § There can be disagreements on moral issues. (example: abortion) § Ethical debates are disagreeable and pointless. o Case against subjective relativism: § Blurs line between doing what one thinks is right and what they want to do. § Makes no moral distinction between actions of people. § Decisions may not be based on reason. § Subjective relativism and tolerance are two different things. Cultural Relativism: o In A Nutshell: § “Right” and “wrong” depends on a society’s moral guidelines. § Guidelines vary from a place to place and from time to time. § An action can be right in a certain society at one time and wrong in another society or at another time. o Case for cultural relativism: § Different social contexts demand different moral guidelines. § It is arrogant for one society to judge another. o Case against cultural relativism: § Two societies having different moral views doesn’t mean they’re ought to have different views. § Doesn’t explain how moral guidelines are determined. § Doesn’t account for evolution of moral guidelines. § Provides no way out for cultures in conflict § Existence of many acceptable practices doesn’t mean all practices are acceptable. § What if there are no cultural norms? § Societies share certain core values.

MODULE 2 ETHICAL THEORIES

Virtues in Bioethics Virtues are the character of the health care provider, which are morally praiseworthy traits. These characters are immeasurable, when these virtues are cultivated into a nurse. Personality; it is believed that that he/she can grow into a compassionate, humble, courageous health care professional with integrity. Professional Virtues Purity and holiness have religious overtones but these are embodied in The Hippocratic Oath. In nursing, to maintain purity and manifest a holy disposition is also important. The following Codes of Ethics for Nurses have implied statements: The nurse at all times maintains standards of personal conduct which reflects well on the profession and enhance public confidence” (International Code of Ethics for Nurses) The nurse owes the same duties to self as to others including the responsibility to preserve integrity and safety…” (American Nurses Associations Code of Ethics, approved June 30, 2001) “[Nurses must] perform their professional duties inconformity with existing laws, rules, regulations, measures, and generally acceptable principles of moral conduct and proper decorum.” (Code of Ethics for Filipino Registered Nurses) The above statements imply that virtues in nursing are important in order to act based on social values and needs, as they are applied to realities of health and nursing care in a changing society. Secular Virtues According to Plato, the four classical Greek virtues which are found to be praiseworthy are: justice, temperance, courage, and wisdom. These virtues enable the nurse to be firm in facing adversity, intactness of character, to be kind and optimistic, and to experience great joy in serving. Religious Virtues Roman Catholics tend to affirm both Greeks and Christian virtues, thus having a full list of seven virtues (namely prudence, justice, temperance, fortitude, faith, hope and love); while Protestants, being more prone to see tension between the Greeks and Christians, often limit their list to the three Pauline virtues such as faith, hope, and love (agape or charity). In addition to the Biblical Christian virtues, other major religions also put forward virtue lists such as contentedness, gratitude, generosity, and magnanimity from among the Muslims. The ancient Hindu Caraka Samhita lists care, attention, humility, and constant reflection. The famous Confucian virtues are humaneness, compassion, and filial piety. Filial piety is important in ancient Chinese medical ethics. It has been seen as implying that Chinese physicians are ideally like family member treating patients as brothers rather than the more distant “professional” relation that is the norm in Western culture. Virtue- Based Nursing Model The Moral Ground Model has its foundation in Aristotle’s approach to ‟virtue ethics with a proposed path to moral ground adapted from the Eightfold Path of Buddhism. Both the ethics of Aristotle and Buddhism are teleological philosophies, meaning that they both focus human morality on moving toward a final purpose or goal. The model implies that as nurses go about in their day-to-day activities, they are aware that this routine may give them dissatisfaction from their profession. But nurses are also aware that they have to focus less on their dissatisfaction instead, they need to carry on with their work. The following activities and attitudes will develop the nurses ‟intellectual and moral virtues which could facilitate growth in her character as a person and as a nurse in the profession: Insight (sophia) Sophia is translated as wisdom. This is the ability to think well about the nature of the world, and it involves careful deliberation of universal truths. The nurse’s sensitivity to the situations ‟of people around her can make her learn from their experiences. Remaining open to learning can educate nurses about intellectual virtues that provide insight into the nature of reality, which could shape them to become practically wise. Practical wisdom (Phronesis) Phronesis is sometimes translated as prudence. It is the capability to consider the mode of action in order to deliver change, especially to enhance the quality of life. It involves using one’s insight into reality in deliberatively

MODULE 2 ETHICAL THEORIES

reasoning and applying ‟the intellectual virtue of practical wisdom in directing ones ‟actions. It includes knowing how a person of virtue chooses to act. Nurses are expected to be prudent at all times. He/she could exercise prudence by careful analysis of the actions and the decisions that he/she makes especially in rendering care to clients. Inability to be prudent could lead to situations involving negligence or malpractice. Choice (prohairesis) Morality is achieved through choice (prohairesis), facilitated by insight, practical wisdom, and evenness of emotional states. Moral virtues and the excellence of the nurses ‟disposition, or character, are cultivated through habitual practice such as effective communication and compassionate caring. Goal or telos It embodies personal and professional excellence in nursing which is characterized as active happiness and well-being that is consistent with an enlightening awareness of the causes of moral suffering as well as the awareness of the sacredness of the day to day moral nature of nurse’s work. Virtues of the Health Care Provider Fidelity Refers to the obligation of a person to be faithful to agreements, responsibilities, and commitments that he has made to himself and to others. It is the main principle that supports the concept of accountability of nurses and other professionals. Honesty Being fair and just in character and behaviour, not cheating or stealing, free of deceit. This is synonymous with sincerity, integrity, truthful, uprightness, and just. Honesty to self and in the performance of duty is expected from the nurse. Humility This is defined as being modest in dealings, unpretentious, with simplicity, and submissive. Nurses are known for this virtue as they perform their role as a member of the health care team. Respect This is showing a deferential esteem felt or shown toward a person. Nurses do not only show this virtue to the patients but to the other members of the health team, community, and society, or in any setting that she is involved. Compassion This is a virtue that is important for the nurse because this enables her to serve others selflessly. Prudence This is described as acting with cautiousness, with foresight, and with discretion. A nurse is expected to be prudent in all that she does, especially in the performance of her duty. Courage This is the ability to disregard fear in acting out one’s convictions and belief. There are also times in a nurse’s career when he/she ‟becomes physically and emotionally exhausted and yet, somehow, finds the strength to go on. Nurses have to muster up strength and persevere to be able to perform their duties and responsibilities. Habits of the Health Care Provider The Good Habits Be Proactive - The proactive habit can be applied in multiple ways to foster healthcare interoperability. This is acting in a flexible manner in order to perform better and achieve more. This could be done in the communication of patient data through the use of information technology. Being proactive in healthcare results to:

Adaptability – being flexible to adapt to the various data requirements 2. Independence – removing total reliance to others to achieve your objectives
Satisfaction – delivering responsive clients service ‟With a proactive mindset and approach, there is interdependence among health care providers in health care delivery. Begin with the End in Mind Knowing what you want to achieve for your practice is important in deciding what integration approach should be taken. With better service as the vision, the health care delivery goals are better achieved. As a health care provider, the nurse’s involvement could ‟increase the efficiency of service. These could be through collaboration with the other members of the health care team, and the integration of technology in the different

Bioethics: Understanding Ethical Theories in Nursing, Summaries of Bioethics

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MODULE 2 ETHICAL THEORIES

ETHICAL THEORIES

MODULE 2 ETHICAL THEORIES

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MODULE 2 ETHICAL THEORIES