Values, Ethics, and Advocacy in Health Professions

Values, Ethics, and Advocacy

Values

Values are beliefs about the worth of something, guiding behavior and decision-making. They influence health behaviors, responses to illness, and professional conduct.

• Definition: Values are standards that guide one’s behavior and choices.

• Value System: An organized ranking of values, forming a personal code of conduct.

• Influence: Values affect beliefs about health, illness, and human needs.

• Example: Valuing honesty may lead to transparent communication with patients.

Common Modes of Value Transmission

• Modeling: Learning values by observing others.

• Moralizing: Teaching values through instruction and rules.

• Laissez-faire: Allowing individuals to develop their own values.

• Rewarding and Punishing: Reinforcing values through consequences.

• Responsible Choice: Encouraging informed and autonomous value selection.

Professional Values in Health Professions

Professional values guide ethical conduct and decision-making in health care.

• Altruism: Concern for the welfare and well-being of others.

• Autonomy: Right to self-determination.

• Human Dignity: Respect for the inherent worth and uniqueness of individuals.

• Integrity: Acting according to ethical codes and standards.

• Social Justice: Upholding moral, legal, and humanistic rights.

The Valuing Process

• Choosing: Selecting values freely after considering alternatives and consequences.

• Prizing (Treasuring): Taking pride in and affirming chosen values.

• Acting: Consistently integrating values into behavior.

Ethics and Morals

Ethics is the systematic study of right and wrong conduct, while morals are personal or communal standards.

• Ethics: Principles of right and wrong, virtue and vice, good and evil.

• Bioethics: Ethical questions related to life and health care.

• Nursing Ethics: Subset of bioethics focusing on ethical issues in nursing practice.

• Morals: Standards of right and wrong held by individuals or communities.

Ethical Theories

• Utilitarian: Rightness or wrongness depends on consequences.

• Deontologic: Actions are right or wrong independent of consequences.

Principle-Based Approach to Bioethics (Beauchamp and Childress)

• Autonomy: Respect for patient decision-making.

• Nonmaleficence: Avoid causing harm.

• Beneficence: Promote patient benefit.

• Justice: Fairness and equitable treatment.

• Additional Nursing Principles: Fidelity, veracity, accountability, privacy, confidentiality.

Care-Based Approach to Bioethics

• Emphasizes caring relationships.

• Promotes dignity and respect for patients.

• Focuses on individual patient needs and responsiveness.

• Redefines moral skills to include virtues.

Ethical Conduct in Health Professions

Ethical conduct is based on professional standards and values. Health professionals must cultivate virtues and understand ethical theories.

• Moral Agency: Capacity to act ethically for the right reasons.

• Nurse Virtues: Competence, compassionate caring, self-effacement, trustworthiness, conscientiousness, intelligence, practical wisdom, humility, courage, integrity.

Code of Ethics for Nurses

• Succinct statement of ethical obligations and duties.

• Nonnegotiable ethical standard for the profession.

• Expression of commitment to society.

ICN Guidelines for Code of Ethics

• Study and reflect on standards.

• Discuss with colleagues.

• Use examples to identify dilemmas.

• Work in groups for consensus.

• Collaborate across disciplines.

Bill of Rights for Registered Nurses

Right	Description
Practice Obligations	Fulfill obligations to society and patients
Professional Standards	Work in environments supporting ethical practice
Advocacy	Freely advocate for self and patients
Fair Compensation	Receive compensation consistent with responsibilities
Safe Environment	Work in safe environments
Employment Negotiation	Negotiate employment conditions

Moral Distress and Resilience

Moral distress occurs when one knows the right action but cannot act due to constraints. Moral resilience is the ability to recover and respond well to such situations.

• Ways to Build Resilience:

  • Cultivate good relationships

  • Accept change as part of life

  • Refuse to view crises as insurmountable

  • Nurture a positive self-view

  • Keep perspective

Ethical Decision-Making Using the Nursing Process

The nursing process can be applied to ethical decision-making:

• Assess: Gather relevant data

• Diagnose: Identify the ethical problem

• Plan: Identify and weigh alternatives

• Implement: Carry out the decision

• Evaluate: Review the outcome

Ethically Relevant Considerations

• Balance between benefits and harms

• Disclosure, informed consent, shared decision-making

• Family norms

• Clinician-patient relationships

• Professional integrity

• Cost effectiveness and resource allocation

• Cultural and religious variation

• Power dynamics

Examples of Ethical Problems

Type	Description
Paternalism	Acting for a patient without consent to secure good or prevent harm
Deception	Deceiving a person for perceived benefit
Privacy & Social Media	Issues with patient privacy in digital contexts
Confidentiality	Protecting patient information
Resource Allocation	Distributing limited nursing resources
Consent/Refusal	Validating patient choices
New Technologies	Ethical conflicts with emerging medical technologies
Unprofessional Practice	Addressing unethical or illegal conduct by health professionals
Staffing Issues	Ethical concerns with short staffing
Beginning/End-of-Life Issues	Ethical dilemmas at life’s boundaries

Ethics Committees

• Functions:

  • Education

  • Policy making

  • Case review

  • Consultation

  • Quality assurance

  • Occasionally research

Conflicts of Commitment

• Primary commitment is to the patient (individual, family, group, or community)

• Nurses owe duties to self as well as others (integrity, competence, growth)

• Self-care is essential for effective patient care

Advocacy in Nursing Practice

• Primary commitment to the patient

• Prioritize individual patient good over societal interests

• Evaluate competing claims of autonomy and well-being

Areas of Concern for Patient Advocates

• Representing patients

• Promoting self-determination

• Whistle-blowing

• Political activism