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chapter 4 | Questions of Values and Ethics 47 CikguOnline
her father. However, it is available only through a The Code of Ethics for Nurses with Interpretive
research study being conducted at a nearby univer- Statements provides values, standards, and princi-
sity. To participate in the research, the patient must ples to help nursing function as a profession. The
be informed of the purpose of the study, the medica- original code was developed in 1985. In 1995 the
tion to be given and its side effects, and follow-up American Nurses Association Board of Directors
procedures. Ms. Allen continues to refuse to allow and the Congress on Nursing Practice initiated the
her father to be told his diagnosis because she is Code of Ethics Project (ANA,2002).The code may
certain he will commit suicide. be viewed online at nursingworld.org
Ethical codes are subject to change. They reflect
The nurse practitioner faces a dilemma: does he
the values of the profession and the society for which
abide by Ms. Allen’s wishes based on the principle
they were developed. Changes occur as society and
of beneficence, or does he abide by the principle of
technology evolve. For example, years ago no
veracity and inform his patient of the diagnosis.
thought was given to do not resuscitate (DNR)
What would you do?
orders or withholding food and fluids.Technological
advances have since made it possible to keep people
Accountability
in a kind of twilight life, comatose and unable to
Accountability is linked to fidelity and means
participate in living in any way, but nevertheless
accepting responsibility for one’s actions. Nurses
making DNR and withholding very important
are accountable to their patients and to their col-
issues in health care. Technology has increased
leagues. When providing care to patients, nurses
knowledge and skills, but the ability to make deci-
are responsible for their actions, good and poor. If
sions regarding care is still guided by the principles
something was not done, do not chart or tell a col-
of autonomy, nonmaleficence, beneficence, justice,
league that it was. An example of violating
confidentiality, fidelity, veracity, and accountability.
accountability is the story of Anna:
Virtue Ethics
Anna was a registered nurse who worked nights on
an acute care unit. She was an excellent nurse, but as Virtue ethics focuses on virtues, or moral character,
the acuity of the patients’ conditions increased, she rather than on duties or rules that emphasize the
was unable to keep up with both patients’ needs and consequences of actions.Take the following example:
the technology, particularly intravenous (IV) lines. Norman is driving along the road and finds a cry-
She began to chart that all the IVs were infusing as ing child sitting by a fallen bicycle. It is obvious that
they should,even when they were not.Each morning, the child needs assistance. From one ethical stand-
the day shift would find that the actual infused point (utilitarianism), helping the child will
amount did not agree with what the paperwork increase Norman’s personal feelings of “doing good.”
showed. One night, Anna allowed an entire liter to be The deontological stance states that by helping,
infused in 2 hours into a patient with congestive heart Norman is behaving in accordance with a moral
failure. When the day staff came on duty, they found rule such as “Do unto others....” Virtue ethics looks at
the patient expired, the bag empty, and the tubing the fact that helping the person would be charitable
filled with blood. Anna’s IV sheet showed 800 mL or benevolent.
left in the bag. It was not until a lawsuit was filed
that Anna took responsibility for her behavior. Plato and Aristotle are considered the founders
of virtue ethics. Its roots can be found in Chinese
The idea of a standard of care evolves from the philosophy. During the 1800s virtue ethics disap-
principle of accountability. Standards of care pro- peared, but in the late 1950s it reemerged as an
vide a rule for measuring nursing actions. Anglo-American philosophy. Neither deontology
nor utilitarianism considered the virtues of moral
Ethical Codes character and education and the question: “What
A code of ethics is a formal statement of the rules type of person should I be, and how should I live”
of ethical behavior for a particular group of individ- (Hooker, 2000; Driver, 2001). Virtues include such
uals. A code of ethics is one of the hallmarks of a qualities as honesty, generosity, altruism, and relia-
profession. This code makes clear the behavior bility. They are concerned with many other ele-
expected of its members. ments as well, such as emotions and emotional