Three basic principles, among those generally accepted in our cultural tradition, are particularly relevant to the ethics of research involving human subjects: the principles of respect of persons, beneficence and justice.
These are based on the Belmont Report. Respect for Persons. The principle of respect for persons thus divides into two separate moral requirements: the requirement to acknowledge autonomy and the requirement to protect those with diminished autonomy.
In most cases of research involving human subjects, respect for persons demands that subjects enter into the research voluntarily and with adequate information. To respect autonomy is to give weight to autonomous persons' considered opinions and choices while refraining from obstructing their actions unless they are clearly detrimental to others.
Respect for the immature and the incapacitated may require protecting them as they mature or while they are incapacitated. Some persons are in need of extensive protection. It is at its core an element of respect for persons Gabard, Veracity is antithetical to the concept of medical paternalism, which assumes patients need to know only what their physicians choose to reveal. Obviously there has been a dramatic change in attitudes toward veracity because it forms the basis for the autonomy expected by patients today.
Informed consent , for example, is the ability to exercise autonomy with knowledge. Decisions about withholding information involve a conflict between veracity and deception. There are times when the legal system and professional ethics agree that deception is legitimate and legal. Therapeutic privilege is invoked when the healthcare team makes the decision to withhold information believed to be detrimental to the patient.
Such privilege is by its nature subject to challenge. Fidelity is faithfulness, or loyalty. It speaks to the special relationship developed between patients and their healthcare provider. Fidelity often results in a dilemma, because a commitment made to a patient may not result in the best outcome for that patient. At the root of fidelity is the importance of keeping a promise, or being true to your word. Individuals see this differently. Some are able to justify the importance of the promise at almost any cost, and others are able to set aside the promise if an action could be detrimental to the patient.
The moral conscience is a precursor to the development of legal rules for social order. Ethics has been described as beginning where the law ends. Ethics never stands alone, nor does the law. Some issues that have both ethical and legal components include:. The Affordable Care Act is an example of a set of laws developed with a number of ethical issues in mind.
Due to preexisting conditions or simple unavailability, tens of millions of people have been unable to purchase health insurance at any cost. The law addresses this inequity by requiring most U. The law also addresses insurances choices and costs, and puts into place certain rights and protections for consumers.
Recall the ethical concept of distributive justice discussed in the previous section, which addresses the degree to which healthcare services are distributed equitably throughout society. The Affordable Care Act also touches on the ethical principles of beneficence kindness and nonmaleficence do no harm by setting up affordable healthcare exchanges and plans.
The exchanges are an integral part of the complicated issue that is created when healthcare is mandated. It is based on the concept that mandating health insurance without addressing affordability would cause significant harm to individuals and families who are struggling financially Lachman, Although ethics attempts to identify all available options to a given problem and consider the implications of each option, the law often places limits on those options. This intersection of the law and ethic often creates conflict and raises these important questions Porter, :.
Ethical dilemmas arise when there are equally compelling reasons both for and against a particular course of action and a decision must be made. It is a dilemma because there is a conflict between the choices. Usually one action, though morally right, violates another ethical standard. A classic example is stealing to feed your family. Stealing is legally and ethically wrong, but if your family is starving it might be morally justified Noel-Weiss et al.
When evaluating the alternatives, both courses of action have positive and negative elements. Right vs. Working through an ethical dilemma until a satisfactory conclusion is reached, making decisions that lead to good actions, and avoiding negative consequences and regret are the foundational principles of ethical practice Noel-Weiss et al. Research suggests that ethical conflicts are on the rise in the nursing field, due both to the increasing complexity of care and to scientific and technological advances.
Several studies that sought to analyze ethical conflicts that arise in critical care units noted that the ethical conflicts experienced by critical care nurses stem from three main sources:. Situations that create ethical conflicts highlight the difficulty involved in making the right decision.
In a situation of moral uncertainty the professional is unsure whether or not an ethical problem exists, or recognizes that there is such a problem but is unclear about the ethical principles involved. Finally, moral distress is felt when the professional recognizes the ethical principles involved and knows the right thing to do but is constrained by something or somebody from acting accordingly. The primary function of a decision is to commit to some sort of action: a decision reduces to zero the uncertainty about what to do.
To arrive at a decision, called secondary uncertainty , the decision maker must be motivated by some sort of pressure and must work to reduce uncertainty about the pros and cons of a selected course of action. Secondary uncertainty includes uncertainty about the situation, goals to be achieved, and available options or courses of action. Once secondary uncertainty has been reduced, commitment to a chosen option can occur. Tim is fit and slim, walks well with good balance, and is able to do his activities of daily living with some supervision.
Three days after he was admitted Tim was found missing from his room when the nursing assistant brought dinner. On this particular cold, dark, and foggy evening there were three nursing assistants and one licensed vocational nurse on duty acting as the charge nurse.
The facility had 51 residents, some of whom had moderate to severe dementia, plus eight acute rehab patients. As soon as Tim was reported missing, a search was begun. Two of the nursing assistants refused to join the search outside because they were afraid of the dark. They also felt that they should not leave the rest of the residents alone.
The charge nurse, PT, and one nursing assistant began searching while the two remaining nursing assistants rummaged through drawers for flashlights. Five flashlights were found but all had dead batteries and no fresh batteries were available. The charge nurse and the PT agreed not to call or notify the facility administrator or the family.
It becomes limited if it infringes on the best interests of others. This duty also includes respect for confidentiality and privacy. Privacy is related not only to information, but also to freedom from unnecessary or unwanted interference by others.
Respect for autonomy also underlies both informed consent and the drive toward using advanced treatment directives. The duty always to act in the best interests of the patient, client, or resident; it must be distinguished from paternalism. The duty to do not harm, and to protect the others from harm. In the palliative care setting, possible violations of this duty include: - Insisting that patients confront the reality of their approach to death. Distributive justice.
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