Lesson 1, Topic 1
In Progress

Development of Ethical Principles

July 10, 2022

Values are personal beliefs about the worth of an object, an idea, a custom, or an attitude. Values vary among people and cultures; they develop over time and undergo change in response to changing circumstances and necessity. Each individual adopts a value system that governs what is deemed as right or wrong (or good and bad) and influences behaviors in a given situation.

Values influence everyday decisions. Each person has many values and at times has to choose between competing or conflicting values. Some values are more important than others, and the choices made are based on the priority placed on each particular value. A person’s values are learned through experience, observation, and reasoning. Some values are consciously chosen; others are adopted unconsciously. As children, society has a strong influence on behaviors and values retained and learned. Acceptable behavior is rewarded, and unacceptable behavior is punished. The development of an individual value system occurs with maturity and largely reflects culture (see Cultural Considerations box).

Nurses must reflect on and assess the values held. Value clarification is the process of self-evaluation that helps gain insight into personal values. To clarify

Cultural Considerations: Culture and Ethics

People of different cultural backgrounds often define health and illness in different ways. Culture is learned as the individual grows up and is influenced (usually subconsciously) by the surrounding environment. The nurse must be aware of cultural differences and should avoid: (1) transferring personal expectations to patients; (2) making generalizations based on personal views; (3) assuming patients can understand what is being said just because they speak English; and (4) treating each patient the same. To meet the individual’s needs, respect for a patient’s cultural heritage is vital.

Box 2-8 Ethical Dilemmas: What Would You Do?

The following are scenarios with an ethical dilemma. What would you do or say in each one?

  1. You see a nursing assistant stealing the patient’s ring. She says she needs money to pay her house note or the bank will foreclose. What should you do?
  2. The patient has a do-not-resuscitate order and a living will. He has not designated a health care proxy or representative. The patient goes into arrest, and the daughter who has not seen her dad in 10 years yells, “Do something, or I will sue you if he dies!” Whose wishes should you follow?
  3. You know your friend at work is diverting drugs. You have confronted her, but she says it is not for her but for a friend. What should you do?
  4. You suspect elder abuse by a family member of one of your relatives. What should you do?
  5. You made a mistake, and your charge nurse tells you to just rewrite the nurse’s notes to protect the unit and the hospital. What should you do?

values, do the following: (1) select the belief or behavior and consciously examine it; (2) decide its value; and (3) incorporate the value into everyday responses and behaviors. These steps exercise freedom of choice and determine which values are of most importance. Nurses are in a unique position of having the ability to assist in value clarification as well, by encouraging the patient to express feelings and thoughts related to a situation, without contributing personal opinions. Patients need to act on their own values, not those of the nurse. Sometimes the patient may be referred to a clergy member or other professional who can help deal with ethical issues. Most health care institutions have an ethics committee to help resolve ethical questions that arise and to act as an advising body for issues encountered.

Ethical dilemmas are situations that do not have a clear right or wrong answer (Box 2-8). They are complex, confusing, and often frustrating situations that call for careful rational analysis. First, the problem needs to be identified as an ethical one. This means that the question presented cannot be answered by applying external laws, rules, policies, and procedures. Many situations present a combination of legal and ethical questions. It is important to sort out the questions and seek guidance as needed. The next step is complete assessment of the situation, with as much information as possible gathered to aid in the decision-making process. Before a decision is finalized, any ethical principles that might apply to the situation should be considered. Ethical principles are general in nature, but they provide a framework for decision making.