1. Introduction to Bioethics,
Nursing Ethics, and Ethical
Decision Making

2. Bioethics
• Bioethics is a specific domain of ethics
that is focused on moral issues in the
field of health care
• “Who lives? Who dies? and Who
decides?”

3. Ethical Principles
• Belmont Report
– Respect for persons
• includes the rule to do good, and to do no harm
– Beneficence
– Justice

4. Ethical Principles
• Principles of Biomedical Ethics
– four bioethical principles—autonomy,
nonmaleficence, beneficence, and justice

5. Ethical Principles
• Ethical Principlism
– provides guidelines that can be used to
make justified moral decisions and to
evaluate the morality of actions
– one of the most popular tools used today
for analyzing and resolving bioethical
problems

6. Autonomy
• The freedom and ability to act in a
self-determined manner

7. Autonomy
– Informed consent is respecting a person’s
autonomy to make personal choices based on the
appropriate appraisal of information about the
actual and/or potential circumstances of a
situation
• Receipt of information
• Consent for the treatment must be voluntary
• Persons must be competent

8. Autonomy
– Patient Self Determination Act
• The first federal statute designed to facilitate a
patient’s autonomy through the knowledge and
use of advance directives

9. Ethical Principles
• Nonmaleficence is the principle used to
communicate the obligation to “do no harm”;
the maxim or norm that “one ought not to
inflict evil or harm”
– slippery slope argument is a metaphor that is
used as a “beware the Ides of March” warning with
no justification or formal, logical evidence to back
it up; a situation that could hypothetically slip
toward a morally unacceptable situation

10. Ethical Principles
• The principle of beneficence consists of
deeds of “mercy, kindness, and charity”;
people take actions to benefit and to promote
the welfare of other people
– paternalism is the deliberate overriding of a
patient’s opportunity to exercise autonomy
because of a perceived obligation of beneficence

11. Ethical Principles
• Justice refers to fairness, treating people
equally and without prejudice, and the
equitable distribution of benefits and burdens
– Social justice is usually thought of in terms of
how benefits and burdens should be distributed
fairly among members of a society, or ideally, how
all people in a society should have the same
rights, benefits, and opportunities

12. Ethical Dilemmas
• Ethical dilemma is a situation in which
an individual is compelled to make a
choice between two actions that will
affect the well-being of a sentient being,
and both actions can be reasonably
justified as being good, neither action is
readily justifiable as good, or the
goodness of the actions is uncertain

13. Introduction to Nursing Ethics
• Nursing ethics is relationship-based and
specifically refers to ethical issues as
they directly relate to and affect nurses
and their patients (individuals, families,
communities, or populations) in nurses’
daily work, whatever that work may be

14. Relationships
• Moral suffering occurs when nurses
experience a disquieting feeling of
anguish, uneasiness, or angst

15. Relationships
• Moral Anguish can be experienced
when nurses attempt to sort out their
emotions when they find themselves in
imperfect situations that are morally
unsatisfactory or when forces beyond
their control prevent them from
positively influencing or changing
unsatisfactory moral situations

16. Relationships
• Nurse-Patient-Family Relationships
– Unavoidable Trust-Patients, in most cases, have
no option but to trust nurses and other health care
professionals when the patient is at the point of
needing care

17. Relationships
• Nurse-Patient-Family Relationships
– Human Dignity-Patients, in most cases, have no
option but to trust nurses and other health care
professionals when the patient is at the point of
needing care

18. Relationships
• Nurse-Patient-Family Relationships
– Patient Advocacy-Nurses try to identify unmet
patient needs and then follow up to address the
needs appropriately

19. Relationships
• Nurse-Physician Relationships
– Nurses and physicians, as members of the
health care community, must work together
for the health and well-being of patients,
whether those patients are individuals,
families, groups, communities, or
populations

20. Relationships
• Nurse-Nurse Relationships
– exist together within communities and use
similar moral language.
– they “share a moral narrative and
commitments [and] common
understandings of the foundations of
morality, moral reason, and justification”

21. Introduction to Critical Thinking and
Ethical Decision Making
• In health care and nursing practice,
ethical dilemmas and moral matters are
so ever-present that nurses often do not
even realize that they are making
minute-to-minute moral decisions

22. Introduction to Critical Thinking and
Ethical Decision Making
• Critical Thinking
– “self-directed, self-disciplined, self-
monitored, and self-corrective thinking
[that] requires rigorous standards of
excellence and mindful command of their
use”

23. Introduction to Critical Thinking and
Ethical Decision Making
• Moral Imagination
– moral decision making through reflection
that involves “empathetic projection” and
“creatively tapping a situation’s
possibilities”

24. Introduction to Critical Thinking and
Ethical Decision Making
• Moral Imagination
– involves moral awareness and decision
making that goes beyond the mere
application of standardized ethical
meanings, decision-making models, and
bioethical principles to real life situations

25. Introduction to Critical Thinking and
Ethical Decision Making
• Reflection in Nursing Practice
– reflection in action involves stopping to
think about what one is choosing and doing
before and during one’s actions
– since ethics is an active process of doing,
reflection in any form is crucial to the
practice of ethics

26. Introduction to Critical Thinking and
Ethical Decision Making
• The Moral Ground Model: A Virtue-
Based Nursing Model
– implies that nurses may start at a
groundless, uneducated state of moral
functioning
– the nurse can move toward flourishing
moral ground by traveling along a path of
intellectual and moral virtues

27. The Moral Ground Model: A
Virtue-Based Nursing Model
• Moral Ground Model Virtues
– Moral Virtues
• truthfulness, gentleness, compassion, loving
kindness, just generosity, courage, sympathetic
joy, equanimity
– Intellectual
• insight, practical wisdom

28. Introduction to Critical Thinking and
Ethical Decision Making
• Nurse as Part of a Health Care Team
– many problematic bioethical decisions will not be
made unilaterally
– an ethics committee usually consists of
physicians, nurses, an on-staff chaplain, a social
worker, a representative of the organization’s
administrative staff, possibly a legal representative
and community representatives, and others
drafted by the team.

29. Introduction to Critical Thinking and
Ethical Decision Making
• Nurse as Part of a Health Care Team
– also, the involved patient, the patient’s family, or a
surrogate decision maker may meet with one or
more committee members

30. Introduction to Critical Thinking and
Ethical Decision Making
• The Four Topics Approach to Ethical
Decision Making
– Case-based approach allows nurses and
other health care professionals to construct
the facts of a case in a structured format
that facilitates critical thinking about ethical
problems.

31. Introduction to Critical Thinking and
Ethical Decision Making
• The Four Topics Approach to Ethical
Decision Making
– Cases are analyzed according to four
topics: “medical indications, patient
preferences, quality of life, and contextual
features”