Chapter 3 Ethical Decision Making PDF

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By nclexnursing

Ethical decision-making. As mentioned in the previous sections, ethical challenges in nursing practice are many and varied. Although the circumstances differ, and experience shows that there are no clear solutions to these difficulties, the essential philosophical ideas remain the same, and the process of moral inquiry will assist nurses in justifying their conduct. The steps of the nursing process can be used to guide ethical decision-making.

Ethical Nursing Care

We are surrounded by ethical issues in every aspect of our lives in today’s complex world. As a result, there has been a surge in interest in the topic of ethics, as people seek to better understand how these issues affect us. In health care, in particular, the attention on ethics has heightened in reaction to contentious developments such as improvements in technology and genetics, as well as dwindling healthcare and financial resources.

Today’s superior technology allows people to live far longer than they would have in the past. Expensive experimental treatments and pharmaceuticals are available to try to prolong life, even if such efforts are likely to fail. The advancement of technical assistance has had an impact on people at all phases of life. Genetic screening, in vitro fertilization, embryo harvesting and freezing, and prenatal surgery, for example, have all had an impact on the prenatal period. Premature infants are given a chance for survival by using technical support in their early stages of life.

Organ transplantation allows children and adults who would otherwise die from organ failure to live longer. The average life expectancy has also increased as a result of technological advancements. These technological advancements, on the other hand, have been a mixed benefit. Questions have been raised concerning whether and under what circumstances such technology should be used. While many people enjoy a higher quality of life, others suffer for a longer period of time as a result of efforts to extend life, which are frequently costly. Ethical concerns also surround procedures or policies that appear to unfairly distribute healthcare resources based on age, color, gender, disability, or societal mores.

The Inquiring Mind

A continual flow of questions evolves in the thinker’s head throughout the critical thinking process. Although the questions will differ depending on the clinical scenario, certain general inquiries can be used as a starting point for drawing conclusions and deciding on a course of action.

When confronted with a patient situation, it’s generally helpful to get answers to some or all of the following questions in order to figure out what steps to take:

  • What are the patient’s desired outcomes? Which is the most important? Is the patient in agreement with me on these issues?
  • What will be my initial course of action in this situation?
  • Have I obtained all of the necessary data (signs/symptoms, test results, medication history, emotional components, and mental status)? Is there anything you’re missing?
  • Is there anything urgent that needs to be reported? Is it necessary for me to seek more help?
  • Is there anything unusual about this patient? Which ones are the most important? What should I do to reduce these dangers?
  • What possible complications must I anticipate?
  • What are the most important problems in this situation? Do the patient and the patient’s family recognize the same problems?
  • What are the patient’s desired outcomes? Which is the most important? Is the patient in agreement with me on these issues?
  • What will be my initial course of action in this situation?

Domain In Nursing Ethics

In the medical-surgical field, a nurse’s ethical concerns can be numerous and varied. The nurse will be able to reason through these issues if she is aware of the underlying philosophical notions. This chapter covers the fundamentals of moral philosophy, such as ethics terminology, theories, and approaches. Understanding the role of the professional nurse in ethical decision-making will help nurses express their ethical positions and acquire the skills necessary to make ethical decisions.

Ethics Versus Morality

Ethics and morality are concepts used to describe opinions about what is good and wrong, as well as to recommend suitable action rules. Morality is the adherence to informal personal standards, whereas ethics is the formal, methodical examination of moral views. Because there is such a small difference between the two, they are frequently used interchangeably.

Ethics Theories

Teleologic theory, often known as consequentialism, is a classic ethical theory that focuses on the ends or repercussions of actions. Utilitarianism, the most well-known version of this theory, is founded on the concept of “the greatest benefit for the greatest number.” Under this perspective, the best course of action is the one that maximizes good over bad. When judging intrinsic qualities and determining whose good is the highest, the theory is difficult to apply. Furthermore, the question of whether beneficial outcomes justify any amoral behaviors taken to attain them must be considered.

Approaches to Ethics

Metaethics and applied ethics are two approaches to ethics. Analyzing the notion of informed consent is an example of metaethics (understanding the concepts and linguistic terms utilized in ethics) in the healthcare system. Patients must give consent before surgery, and nurses are aware of this, but there is sometimes doubt about whether the patient is genuinely informed. A metaethical investigation of the concept of informed consent might be interesting.

Common Ethical Principles


This word relates to self-rule and is derived from the Greek words autos (“self”) and nomos (“rule” or “law”). It has a wide range of implications in contemporary discourse, including individual rights, privacy, and choice. Autonomy refers to the ability to make decisions without being constrained by external factors.


The duty to do good and the active encouragement of benevolent deeds are referred to as beneficence (eg, goodness, kindness, charity). It could also contain a prohibition on inflicting injury (see nonmaleficence).


Confidentiality is a term that refers to a person’s right to privacy. Information obtained from one person will not be shared with another unless it is for the person’s advantage or there is a direct threat to the public good.

Double Effect

This is a moral theory that may justify some behaviors that have both beneficial and bad consequences. All four of the following requirements must be met:

  1. The action itself is good or morally neutral.
  2. The agent sincerely intends the good and not the evil effect
    (the evil effect may be foreseen but is not intended).
  3. The good effect is not achieved by means of the evil effect.
  4. There is a proportionate or favorable balance of good over evil.


Promise keeping is fidelity; it is the obligation to keep one’s promises. It encompasses both verbal and implicit promises made to another individual.


Justice, in a broad sense, states that similar cases should be treated similarly. Distributive justice is a more limited version of justice that refers to the distribution of societal advantages and costs depending on a variety of criteria, which may include the following:

  • Equality
  • Individual need
  • Individual effort
  • Societal contribution
  • Individual merit
  • Legal entitlement

The distribution of punishment is the focus of retributive justice.


This is the responsibility of not inflicting harm as well as preventing and removing it. Nonmaleficence could be incorporated into the principle of beneficence, making nonmaleficence more obligatory.


Paternalism is the deliberate restriction of another’s autonomy, justified by an appeal to beneficence or another’s welfare or needs. The prevention of ills or harm takes precedence over any prospective harms created by interfering with an individual’s autonomy or liberty under this notion.

Respect for Persons

The terms “respect for people” and “autonomy” are commonly used interchangeably.
It goes beyond embracing the idea or attitude that people have free will to treat others in a way that allows them to make their own decisions.

Sanctity of Life

This viewpoint holds that life is the greatest good. As a result, all forms of life, including mere biologic existence, should take precedence above external quality-of-life criteria.

Chapter 3 Critical Thinking PDF


The commitment to tell the truth and not to lie or deceive others is known as veracity.

Moral Situation

Types of Ethical Problems in Nursing



Trust Issues

Refusing to provide care

End of Life Issues

  • Pain control
  • Do not Resuscitate Order
  • Life Support
  • Food and Fluid

Advance Directives

Advance directives are legal documents that outline a patient’s preferences prior to hospitalization and provide useful information to help health care personnel make decisions. One sort of advance directive is a living will. Living wills are usually limited to instances where the patient’s medical condition is considered terminal. The living will is not usually followed since it is impossible to define “terminal” precisely. Another disadvantage of the living will is that it is typically drafted while the individual is in good health. As a person’s disease advances, it’s not uncommon for them to change their opinions. As a result, the patient retains the right to void the document.