Lesson 3-4

• Ethical Principles

  • These are basic and obvious moral truths that guide deliberation and action
• There are 7 ethical principles involved:

  • Autonomy
  • Confidentiality
  • Veracity
  • Fidelity
  • Justice
  • Beneficence
  • Non-Maleficence
• Autonomy

  • Autos - self
  • Nomos - governance
• Informed Consent

  • The process by which patients are informed of the possible outcomes, alternatives, and risks of treatments and are required to give their consent freely.
• Major Elements of Informed Consent

  • Information: includes disclosure and understanding of the essential information.
  • Consent: implies the freedom to accept or reject it
• 4 Principles of Informed Consent

  • Decision-making capacity
  • Documentation of consent
  • Disclosure of information
  • Comprehension of information
• 3 Essential Conditions of Informed Consent

  • Decision is voluntary
  • Appropriate understanding
  • Patient’s choice is deliberate
• Assent Forms

  • The agreement by an individual not competent to give legally valid informed consent to participate in research
• Paternalism

  • it occurs when a physician or other healthcare professionals make decisions for a patient without the explicit consent of the patient
• Proxy Consent (Legally Acceptable)

  • Is the process by which people with the legal right to consent to medical treatment for themselves or for minors or wards delegate that right to another person
  • It indicates consent given by an authorized person before or after death.
• 3 Fundamental Constraints:

  • The person making the delegation has the right to consent.
  • Person must be legally and medically competent to delegate the right to consent.
  • The right to consent must be delegated to a legally and medically competent person/adult.
• 2 Types of Proxy Consent

  • Power of attorney: It is a legal authorization for a designated person to make decisions about another person’s property, finance, or medical care.
  • Living Will: Is a written, legal document prepared by a competent adult that spells out medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive.
• Non-Compliance

  • Denoting unwillingness of the patient to participate in health care activities like taking medications as scheduled, maintaining a weight loss diet, regular exercise, and quitting smoking. This represents the failure of the nurse and the patient
• Causes of Noncompliant Behavior

  • Denial
  • Depression
  • Dementia
  • Cultural Issues
  • Drug or Alcohol
  • Cost
• Confidentiality:

  • Requires non-disclosure of private or secret information with which one is entrusted.
• Privacy

  • Refers to the right of an individual to control the personal information or secrets that are disclosed to others
• Veracity

  • Relates to the practice of truth-telling and the right to information.
• Fidelity:

  • Related to concepts of faithfulness and the practice of keeping promises.
• Justice

  • Relates to fair, equitable, and appropriate treatment
• Beneficence

  • Do good
  • Beneficent acts are morally and legally demanded by our professional role.
• Non-Maleficence

  • Do No Harm
• Principle of Double Effect:

  • An act foreseen to have both good and bad effects.
• Principle of Legitimate Cooperation

  • To achieve a well-formed conscience, one should always judge it unethical to cooperate formally with an immoral act.
• Types of Cooperation

  • Formal
  • Implicit Formal
  • Immediate Material
  • Mediate Material
• Formal cooperation


  When a person or organization freely participates in the actions of a principal-agent
• Implicit Formal cooperation


  Occurs when even though the cooperator denies intending the object of the principal agent, the cooperator, participates in the action. "Yes, I'm happy to drive the getaway car because I want to be an accomplice."
• Immediate Material cooperation


  Occurs when the cooperator participates in circumstances that are essential to the commission of an act, such the act could not occur without this participation
• Mediate Material cooperation


  Occurs when the cooperator participates in circumstances that are not essential to the commission of the action, such that the action could occur even without cooperation
• Principle of Common Good and Subsidiarity

  • The term the “common good” has been used in various contexts to identify actions or outcomes that have some definable benefit that extends beyond individual gain.
• Nursing is viewed as promoting the common good.
• Nursing also addresses the need to balance the preservation of individual dignity and respect against societal integrity.