What are the 4 main ethical principles in nursing

Throughout our nursing careers, we'll encounter ethical dilemmas in many challenging patient care situations. This can cause a great amount of stress as we struggle to identify what's the correct action for each unique situation. Utilizing the ethical principles of autonomy, beneficence, nonmaleficence, fidelity, justice, and paternalism as outlined by the American Nurses Association (ANA) provides us with a firm foundation for ethical decision making.

Autonomy allows healthcare teams to respect and support a patient's decision to accept or refuse life-sustaining treatments. As patient advocates, it's our duty to ensure that our patients receive all of the necessary information, such as potential risks, benefits, and complications, to make well-informed decisions. The healthcare team can then formulate care in compliance with the patient's wishes. Family members should refrain from making decisions for the patient or inflicting undue pressure to alter his or her decisions unless the patient is incapacitated or found to be legally incompetent. Many factors may influence a patient's acceptance or refusal of medical treatment, such as culture, age, general health, social support system, and previous exposure to individuals who received a similar treatment modality with negative clinical outcomes.

We use nonmaleficence by selecting interventions that will cause the least amount of harm to achieve a beneficial outcome. For example, if a patient verbalizes homicidal ideations with a plan, we may be torn between wanting to ensure patient privacy and our duty to escalate the patient's care to safeguard the public. The principle of nonmaleficence points us to place the safety of the patient and community first in all care delivery.

Beneficence is defined by the ANA as “actions guided by compassion.” We utilize beneficence daily as we administer pain medication or hold the hand of a grieving family member.

The ethical principle of fidelity directs us to model care delivery with altruism, loyalty, caring, and honesty. For example, when an older patient with intact cognitive function is diagnosed with a terminal illness and he or she doesn't want to share that information with immediate family, it can create an ethical dilemma. To maintain the trust established in the nurse-patient relationship, don't share any healthcare information without the patient's consent. Consult with other interdisciplinary team members, such as case managers, social workers, and clergy, to help identify supportive services that the patient may need as his or her disease progresses.

Justice leads us to ensure that care is provided on a fair and equal basis, regardless of patients' social or financial status. When we heavily advertise that our organization is providing free flu vaccine clinics to all of the local senior centers, we're using the ethical principle of justice.

Paternalism provides the power for healthcare professionals to make decisions to reveal or conceal a diagnosis, potential treatment modalities, or expected prognosis. An example of paternalism is when we admit an adolescent with multiple complete cervical spine fractures whose family is stating that the teen needs to participate in a state basketball championship in 3 months. The benefit of sharing the anticipated prognosis of quadriplegia at this time is far outweighed by the potential emotional trauma it may cause the family. We then schedule a family-interdisciplinary team meeting in a controlled environment to give them the prognosis.

As nurses, we may even face ethical dilemmas within our peer group if we witness a colleague exhibiting unsafe practices. When we see an immediate patient safety risk, we must act quickly and seek the guidance of our administrative teams and the collaborative expertise of our interdisciplinary team members. We may also need to notify our security teams and/or local police departments.

Nurses have been patient safety advocates for 165 years since Florence Nightingale assumed her first administrative position in 1853. We're known as the most trusted profession because of our dedication to providing patient-centered care in a holistic environment. As we tackle the ethical dilemmas of tomorrow, I encourage you to utilize the ANA's six principles as a compass to guide your decision making.

Working in the health care field can be both rewarding and challenging. Each shift you work is filled with new patients, sometimes unexpected experiences, and many choices that will have positive and negative consequences on someone’s health. 

Due to health care being such a dynamic environment, the four principles of health care ethics were created to support professionals as you navigate patient care. These principles are autonomy, beneficence, non-maleficence, and justice. 

Each of these principles has a unique objective, but the four come together to empower you as a health care professional and ensure that patients are receiving high quality and ethical health care.

#1 – Autonomy

The literal meaning of autonomy and the medical definition of autonomy have their differences and similarities.

At its base definition, autonomy is the control that you exercise when making individual decisions, especially regarding your well-being. In health care, autonomy is the right or freedom of the patient to maintain control of their body before and after treatment.

The practice of autonomy prevents health care professionals from potentially coercing or persuading the patient to take a specific action or treatment plan that might not be in their best interest. Ideally, autonomy aims to improve patient welfare by allowing the patient to be in full command of their treatment and care as much and as often as possible.

This principle is vital in the delivery of evidence-based care. Every individual has different beliefs and experiences that shape their opinions on a variety of topics, and the health care profession is no different. Not all medical professionals agree with certain treatment options and medication processes. 

As such, this principle addresses the clause of the best treatment option that the health care provider made independently. Health care professionals like nurses should not try to influence a patient’s decision based on that nurse’s own personal beliefs; however, it’s their responsibility to ensure that patients are educated and informed, so they can make the best decision for themselves. 

Patients and caregivers will often have contrasting beliefs, customs, and ideas. Additionally, the best course of action for one patient could be detrimental for another, even if they share the same signs and symptoms. So it’s a health care professional’s responsibility to help empower each patient to take control of their own health care. 

Autonomy fosters self-respect, self-knowledge, and self-worth.

#2 – Beneficence

Beneficence is the act of showing kindness or mercy. The actions of any health care provider should always bring positivity. 

Beneficence should not be confused with the closely related ethical principle of non-maleficence, which states that one should do no harm to patients. This principle acts as an obligation for nurses to protect their patients from harm by removing and preventing bad situations and promoting good ones.

At its core, beneficence is an essential principle of health care ethics and ethical selfishness. The principle encourages health care workers to consciously invest the time and effort to make sure that each patient benefits in each situation. 

Most people who choose health care as a profession do so because they want to help other people, and part of the profession is seeking out every way that you can help make a patient’s treatment experience a little bit better, safer, and more effective. Even the smallest positive change can have a big impact on a patient’s wellbeing. 

The difficulty with this principle often lies in defining what good means to each patient. Before acting with beneficence in mind, you have to learn and consider each patient’s specific wants, needs, and experiences. Being aware of a patient’s culture, religious beliefs, past experiences, and likes or dislikes can help guide you in determining what might be good for them. 

#3 – Non-Maleficence

Of the four principles of health care ethics, non-maleficence is the one that is generally the one most commonly prioritized. 

Non-maleficence means that you as a health care professional must do no harm. According to the ANA code of ethics, all health care workers should carefully evaluate each situation before making decisions. Whether knowingly or unknowingly, some decisions can cause harm to patients, the community, or even other health care workers, and it’s up to each health care professional to be aware of how each of their decisions can impact others.

Non-maleficence covers four factors. First, an act should not be truly wrong. Second, every action should have a positive benefit. Third, a good effect should never be a result of the wrong action. Lastly, good outcomes should always outweigh the bad. 

For example, a patient comes in with a health complication. There are several solutions to treat the complication, such as different prescription medications. The attending doctor chooses to prescribe one of those medications that has possible allergic effects without informing the patient. Later, the patient suffers from adverse drug effects.

Such a case is considered maleficence, because the physician had other better options. Additionally, each the health care professionals must inform the patient of any potential good or bad effects from any treatment, so the patient can make the best decision for themselves if able to.

On the other end of the spectrum, the goal of health care workers is to save the life of the patient by all means possible. An example of non-maleficence is a case where a patient needs surgical treatment. Though surgeons use anesthetics during surgery, a patient feels pain after the surgery. However, this particular instance is not maleficence, because the surgery was the only solution to save the life of the patient.

Keep in mind that the non-maleficence principle does not only apply to patients but also to fellow health care professional colleagues. Every health care provider should provide a comfortable working environment for other employees. Actions intended to harm other employees are considered maleficence.

Even verbal abuse at work is treated as maleficence. The non-maleficence principle was developed to protect health care workers and patients. 

#4 – Justice

The justice principle states that there should be fairness in all medical decisions. For instance, patients deserve advanced health care delivery regardless of their situation. There have been numerous cases where patients fail to get the necessary treatment due to economic status, ethnicity, sexual orientation, etc.

Following the ANA code of ethics, the top priority of all health care workers should be saving the lives of all patients. For example, say a patient comes into a hospital for emergency treatment. During the evaluation of the patient’s situation, the health care staff realize that the patient is an undocumented immigrant. A competent health care worker would proceed with the emergency treatment first to make sure that the patient receives the best care possible to help them with their emergency situation. 

Additionally, health care workers should listen to each patient’s interests before beginning medical procedures. For instance, if there are alternative treatments, a patient deserves to be given the information and the opportunity to make an informed decision for themselves. For individuals under the age of 18, their parents or guardians should approve the intended medical choices.

A current debate revolves around reproductive health technologies. Justice would call for equitable access to reproductive health services for all women. 

Justice does not only apply to patients; it also impacts health care providers. All physicians, nurses, and other health experts have a right to practice their profession in a pleasant environment. Each and every health care professional and member of a health care team deserve equal chances of assisting in the decision-making process. 

Health care professionals must hold strong to a moral compass. That’s why we only take the best nurses and healthcare professionals at Clipboard Health. Holding yourself to a high ethical standard will benefit the trust present between you and your patient. When ethical dilemmas arise, health care workers must consider the four principles of health care ethics when formatting the best response.