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chapter 4 | Questions of Values and Ethics 45 CikguOnline
by alcohol or drugs is knowingly placing patients at 3. What information would you communicate to
risk. Other nurses who observe such behavior have the family members, and how can you assist
an ethical obligation to protect patients according them in dealing with their mother’s concerns?
to the principle of nonmaleficence.
Justice
Beneficence The principle of justice obliges nurses and other
The word “beneficence”also comes from Latin: bene, health-care professionals to treat every person
which means well, and facere, which means to do. equally regardless of gender, sexual orientation,
The principle of beneficence demands that good religion, ethnicity, disease, or social standing (Edge
be done for the benefit of others. For nurses, this & Groves, 2005). This principle also applies in the
means more than delivering competent physical or work and educational setting. Everyone should be
technical care. It requires helping patients meet all treated and judged by the same criteria according
their needs, whether physical, social, or emotional. to this principle. Here is an example:
Beneficence is caring in the truest sense, and caring Mr. Johnson, found on the street by the police, was
fuses thought, feeling, and action. It requires know- admitted through the emergency room to a medical
ing and being truly understanding of the situation unit. He was in deplorable condition: his clothes
and the thoughts and ideas of the individual were dirty and ragged, he was unshaven, and he
(Benner & Wrubel, 1989). was covered with blood. His diagnosis was chronic
Sometimes physicians, nurses, and families alcoholism, complicated by esophageal varices and
withhold information from patients for the sake of end-stage liver disease. Several nursing students
beneficence. The problem with doing this is that it overheard the staff discussing Mr. Johnson. The
does not allow competent individuals to make their essence of the conversation was that no one wanted
own decisions based on all available information. In to care for him because he was dirty and smelly and
an attempt to be beneficent, the principle of auton- brought this condition on himself. The students,
omy is violated. This is just one of many examples upset by what they heard, went to their instructor
of the ethical dilemmas encountered in nursing about the situation. The instructor explained that
practice. For instance: every individual has a right to good care despite

Mrs. Chung has just been admitted to the oncology his or her economic or social position. This is the
unit with ovarian cancer. She is scheduled to begin principle of justice.
chemotherapy treatment. Her two children and her The concept of distributive justice necessitates the
husband have requested that the physician ensure fair allocation of responsibilities and advantages,
that Mrs. Chung not be told her diagnosis because especially in a society where resources may be
they believe she would not be able to cope with it. limited (Davis, Arokar, Liaschenko, & Drought,
The information is communicated to the nursing 1997). Health-care costs have increased tremen-
staff. After the first treatment, Mrs. Chung becomes dously over the years, and access to care has become
very ill. She refuses the next treatment, stating that a social and political issue. In order to understand
she did not feel sick until she came to the hospital. distributive justice, certain concepts need to be
She asks the nurse what could possibly be wrong addressed: need, individual effort, ability to pay,
with her that she needs a medicine that makes her contribution to society, and age (Davis, et al., p. 53).
sick when she does not feel sick. Only people who get Age has become an extremely controversial issue
cancer medicine get this sick! Mrs. Chung then asks as it leads to quality-of-life questions, particularly
the nurse, “Do I have cancer?” technological care at the end of life.The other issue
regarding age revolves around technology in
As the nurse, you understand the order that the
neonatal care. How do health-care providers place
patient not be told her diagnosis. You also under-
value on one person’s quality of life over that of
stand your role as a patient advocate.
another? Should millions of dollars be spent pre-
1. To whom do you owe your duty: the family or serving the life of an 80-year-old man who volun-
the patient? teers in his community, plays golf twice a week, and
2. How do you think you may be able to be a teaches reading to underprivileged children, or
patient advocate in this situation? should that money be spent on a 26-week-old fetus