Principles are basic ideas that are starting points for understanding and working through a problem. Ethical principles presuppose that nurses should respect the value and uniqueness of persons and consider others to be worthy of high regard. These principles are tents that are important to uphold in all situations. The major principles of health care ethics are: autonomy, beneficence, nonmaleficence, justice veracity fidelity and confidentiality
Autonomy is the promotion of independent choice, self determination and freedom of action. Autonomy means independence and ability to be self-directed in healthcare. Autonomy is the basis for the client's right to self-determination. It means clients are entitled to make decision about what will happen to their body. Autonomy of clients is more discussed in terms of larger issues such as: informed consent, paternalism, compliance and self-determination
i. Informed Consent: is a process by which patients are informed of the possible outcomes, alternative s and risks of treatments and are required to give their consent freely. It assures the legal protection of a patient's right to personal autonomy in regard to specific treatments and procedures. Informed consent will be discussed in detail in selected legal facts of nursing practice.
ii. Paternalism: Restricting others autonomy to protect from perceived or anticipated harm. The intentional limitation of another's autonomy justified by the needs of another. Thus, the prevention of any evil or harm is greater than any potential evils caused by the interference of the individual's autonomy or liberty.
Paternalism is appropriate when the patient is judged to be incompetent or to have diminished decision-making capacity.
iii. Non-compliance: Unwillingness of the patient to participate in health care activities. Lack of participation in a regimen that has been planned by the health care professionals to be carried out by the client. Noncompliance may result from two factors:
- When plans seem unreasonable to the patient
- Patients may be unable to comply with plans for a variety of reasons including resources, lack of knowledge, psychological and cultural factors that are not consistent with the proposed plan of care
Beneficence is doing or promoting good. This principle is the basis for all health care providers. Nurses take beneficent actions when they administer pain medication, perform a dressing to promote wound healing or providing emotional support to a client who is anxious or depressed.
This principle provides nursing's context and justification. It lays the groundwork for the trust that society places in the nursing profession and the trust that individuals place in particular nurses or health care agencies.
The principle of beneficence has three components:
- Promote good
- Prevent harm
- Remove evil or harm
Nonmaleficence is the converse of beneficence. It means to avoid doing harm. When working with clients, health care workers must not cause injury or suffering to clients. It is to avoid causing deliberate harm, risk of harm and harm that occurs during the performance of beneficial acts. E.g,, experimental research that have negative consequences on the client. Nonmaleficence also means avoiding harm as a consequence of good. In that cases the harm must be weighed against the expected benefit
Justice is fair, equitable and appropriate treatment. It is the basis for the obligation to treat all clients in an equal and fair way. Just decision is based on client need and fair distribution resources. It would be unjust to make such decision based on how much he or she likes each client.
Veracity means telling the truth, which is essential to the integrity of the client-provider relationship. Health care providers obliged to be honest with clients. The right to self-determination becomes meaningless if the client does not receive accurate, unbiased, and understandable information
Fidelity means being faithful to one's commitments and promises.
- Nurses' commitments to clients include providing safe care and maintaining competence in nursing practice.
- In some instances, a promise is made to a client in an over way
- Nurse must use good judgment when making promises to client. Fidelity means not only keeping commitment but also keeping or maintaining our obligation.
Confidentiality comes from Latin fide: trust. Confide as to "show trust by imparting secrets" "tell in assurance of secrecy" "entrust; commit to the charge, knowledge or good faith of another"; while confidential or in confidence is "a secret or private matter not to be divulged to others".
Confidentiality in the health care context is the requirement of health professionals to keep information obtained in the course of their work private.
Professional codes of ethics (and conduct) will often have statements about professions maintaining confidentiality, but confidentiality is often qualified. Confidentiality is non-disclosure of private or secret information with which one is entrusted. Legally, this requirement applies to health professionals and others, who have access to information about patients, and continues after the patient's death
Health professionals hold in confidence any information obtained in a professional capacity, and use professional judgment in sharing such information. Each health professionals will treat as confidential any personal information obtained in a professional capacity. The health professionals uses professional judgment, regarding the necessity to disclose particular details, giving due consideration to the interests, wellbeing and safety of the patient and recognizing that the nurse is required by law to disclose certain information.
Ethical Arguments for Maintaining Patient Confidentiality
(i) Utilitarian argument
Patients' assurance of confidentiality helps ensure they will seek treatment (e.g., for complaints that may be personally embarrassing, or related to socially denigrated, or illegal activities, etc.). This helps to ensure that patients will be properly diagnosed and treated. This in turn helps to minimize harm, and maximize good.
(ii) Respect for autonomy (may be a deontological or utilitarian justification)
Respect for autonomy requires allowing individuals to control any disclosure of information about them. Such control is essential for personal freedom (e.g., from coercion, or to pursue one's goals/values).
(iii) Promise keeping
There is an implicit promise between health professionals and patients that information will not be disclosed to third parties. Hence, breach of confidentiality breaks a promise.
The notion of confidentiality draws upon the principle of privacy, which may derive from the concept of autonomy or be conceptually separate
(1) Bodily privacy
An ethical concept of bodily privacy can be derived from respect for autonomy, where autonomy includes the freedom to decide what happens to one's body. Bodily privacy is recognized in law: actions in assault, battery and false imprisonment may be available to the person who does not consent to health care.
(2) Decisional privacy
Decisional privacy is distinguished as control over the intimate decisions one makes (e.g., about contraception, abortion, and perhaps health care at the end of one's life).
(3) Informational privacy
This type of privacy underlies the notion of confidentiality.
Arguments for Respecting Privacy
(i) Privacy and property
Personal information is regarded as a kind of property, something one owns.
(ii) Privacy and social relationships
Privacy is a necessary condition for the development and maintenance of relationships, including those between HPs and patients.
(iii) Privacy and the sense of self
The notion that one is a separate self includes the concept of one‘s body and experiences as one‘s own. Privacy is to be valued for its role in developing and maintaining our sense of individuation.
Limits of Confidentiality
Should the principles of confidentiality be honored in all instances? There are arguments that favor questioning the absolute obligation of confidentiality in certain situations. These arguments include theories related to the principles of harm and vulnerability.
The harm principle can be applied when the nurse or other professional recognizes that maintaining confidentiality will result in preventable wrongful harm to innocent others. Foresee ability is an important consideration in situations in which confidentiality conflicts with the duty to warn. The nurse or other health care professional should be able to reasonably foresee harm or injury to an innocent other in order to violate the principle of confidentiality in favor of a duty to warn. The harm principle is strengthened when one considers the vulnerability of the innocent. The duty to protect others from harm is stronger when the third party is dependent on others or in some way especially vulnerable. This duty is called the vulnerability principle.
Vulnerability implies risk or susceptibility to harm when vulnerable individuals have a relative inability to protect themselves.
Actions that are considered ethical are not always found to be legal. Though there is an ethical basis for subsuming the principle of confidentiality in special circumstances, and there is some legal precedent for doing so, there is legal risk to disclosing sensitive information. There is dynamic tension between the patient's right to confidentiality and the duty to warn innocent others. Health professionals need to recognize that careful consideration of the ethical implications of actions will not always be supported in legal systems.
Disclosure of Information
Disclosure of information is not necessarily an actionable breach of confidence. Disclosure may be allowed, under certain circumstances, when it is requested by: the patient, and where it applies, freedom of information can be used by patients to obtain health care information;
- Other health practitioners (with the patient's consent, and where the information is relevant to the patient's care);
- Relatives in limited circumstances (e.g., parents when it is in the interests of the child);
- Researchers with ethics committee approval (and where the approved process is followed);
- The court;
- The media, if the patient has consented; and
- The police, when the health professional has a duty to provide the information.
Unless there is a warrant or a serious crime has been committed, the information provided to the police is normally limited to the patient's identity, general condition and an outline of injuries. If in doubt, refer the issue to management and/or seek legal advice. When a patient has consented to the release of information to the media, management authorization is usually required.
Confidentiality is the ethical principle that requires non disclosure of private or secret information with which one is interested
The principles of health care ethics must be upheld in all situations. Rules are guidelines for the relationship between clients and health care Providers. They are the foundations for the ethical rules veracity, fidelity and confidentiality