# Nursing Ethics --- **Nursing ethics** is a subset of **bioethics** that pertains to [[nursing]] care. Nursing is an ethical profession, and there are certain **ethical principals** that are the foundation upon which the prefession is based. The American Nursing Association (ANA) defines the nursing Code of Ethics to include: - **Autonomy** is the principal that says one has the *right to self-determination*. This is why patient advocacy, and making sure the patient has a voice and a hand in their own care is so important. - Includes the concept of **shared decision making**, based on the three pillars of a) the scientific evidence, b) us as the clinicians, c) the patient's goals. - Includes the concept of [[patient rights and responsibilities|informed consent]], which includes the right to refuse care. - **Beneficence** is the principle to *do the right thing*. - **Nonmaleficence** is the principle to *do no harm*. Harm prevention is a huge conversation in nursing and medicine in general. - **Justice** is the principle of *equity and fairness*. This is why it's important to not only reflect and work to counter one's one [[implicit biases]], but also to understand the impacts of [[social determinants of health]] on our population. - Advocacy for the patients - Breaking down barriers, providing equitible care. - **Fidelity** is the principle to *keep promises*. Nurses take the nursing pledge and honor an implicit promise to the public to maintain competency. - **Veracity** is the principle to *tell the truth*. This fosters trust, and is why it is so important to establish and maintain a [[just culture]]. ## Frameworks You can use frameworks to guide decision making, like the Utilitarian or Deontological theory - Utilitarian Framework - the rightness or wrongness of an action depends on the consequences of the action - actions themselves have no morality except for how they affect people - actions that promote happiness are good - actions that reverse happiness are bad - directly opposed to a deontological framework >[!quote] >The needs of the many outweigh the needs of the few. >—Vulcan axiom - Deontological or Kantian framework - an action is right or wrong independent of its consequences - called Kantianism after the philosopher Immanuel Kant - directly opposed to a utilitarian framework - natural law theory - a human is a rational being and deep-down knows the difference between right and wrong - this predates Socrates i think, but sometimes attributed to St Thomas Aquinas for Christocentric reasons - ethical egoism - right and wrong is determined based on what benefit it has for the individual making the decision has ## Ethical Dilemma An **ethical dilemma** is a situation where there are two valid, conflicting courses of actions. If the answer were straightforward, it wouldn't be a dilemma. Ethical dilemmas are by nature [[moral distress|morally distressing]] and difficult to navigate. Hospitals often have formal committees to analyze and determine a course of action in an ethical dilemma. ## ANA Code of Ethics 1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. 2. The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. 3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. 4. The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care. 5. The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, reserve the wholeness of character and integrity, maintain competence, and continue personal and professional growth. 6. The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality, health care. 7. The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standard development, and the generation of both nursing and health policy. 8. The nurse collaborates with other health professionals and the public to protect human lights, promote health diplomacy, and reduce health disparities. 9. The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy. ### Ethical Principals ## Legal considerations [[the law]] [[patient rights and responsibilities|HIPAA]] [[patient rights and responsibilities|EMTALA]] ___