What are the core ethical principles of nursing practice?
A number of core ethical principles are recognised in the healthcare setting. These provide a basis for complex decision-making by weighing up multiple factors and consequences of the care process. The number of core principles varies; however, four key principles are generally recognised: non-maleficence, beneficence, autonomy, and justice.
Non-maleficence
Non-maleficence means ‘do no harm’. Any action should not cause unnecessary harm or suffering to the patient and should be justified by ethical and professional judgement and guidance. This includes both physical and psychological harm. Evidence-based practice is vital, as it can minimise the risk of harm. Nurses must be able to appraise the risk to the individual, and use interventions and treatments to minimise risk and maximise benefits.
Examples of non-maleficence include stopping a medication that is causing harmful side effects, or discontinuing a treatment strategy that is not effective and may be harmful.
Beneficence
Beneficence means ‘do good’, and promotes actions that benefit the patient. Nurses should support patients during their healing and recovery. This applies to all care processes, including administering medication and providing patients with information and education. There is often a need to balance the potential for a treatment to do good and do harm, particularly when administering drugs with side effects, or in patients with complex care needs. Balancing non-maleficence and beneficence is important, and requires careful consideration.
Beneficence can be frequently seen in practice, and includes the use of vaccines, providing patients with health advice and counselling, and providing emergency care.
Autonomy
Autonomy states that patients should be able to act independently and should be in control of their fate. Patients should make decisions regarding their care or act intentionally, without being controlled or excessively coerced. Nurses may try to influence patients to adopt a particular treatment strategy when that is the strategy with the strongest evidence base, but must not prevent patients making their own decisions. Preserving autonomy for patients can be achieved through patient-centred care and involving patients in their own care decisions.
An example of behaviours that promote autonomy is presenting all treatment options to a patient and providing them with sufficient information such that the patient can make an informed choice in concert with medical advice.
Justice
‘Justice’ entails obligations to act in a manner considered equitable, fair and consistent with the rights of the individual. Justice ensures fairness in the treatment of all patients; they have the right to be treated equally, regardless of their background or condition, and should not be discriminated against based on personal characteristics, beliefs or values.
Examples of justice in practice include offering the same treatment options to two patients, even where one may have a condition through no fault of their own and the other through personal behaviour (e.g. lung cancer and smoking), and allocating resources equally among members of the population.
Other ethical principles
Other ethical principles should also be considered. One is fidelity, which stands for dedication, advocacy and truthfulness towards patients and other professionals. Nurses should never attempt to deceive or manipulate patients, and should maintain the confidence of the patient and honour any commitments made. For instance, fidelity applies in a scenario where a patient asks a nurse to withhold a terminal diagnosis from their family. In this instance, the nurse should recognise the need to maintain confidential information for the patient, while also supporting the family.
Totality and integrity are additional ethical principles. Totality and integrity suggest that the entire patient should be considered when planning care. This is important where serious side effects may be associated with a treatment, despite the potential to relieve certain symptoms or alter the management course. Not all actions can be considered in terms of beneficence or non-maleficence, as many treatments may lead to adverse effects despite their effectiveness in other areas. Nurses need to balance the risks and benefits of the intervention in a holistic manner to justify their use.
The NMC code and nursing practice
The Nursing and Midwifery Council (NMC) is a key professional body that helps determine the professional and ethical values of the profession. The NMC Code covers the ethical requirements and also the professional and personal duties of nurses in the UK. Nurses must adopt the Code in order to be registered to practise in the UK.
The NMC Code focuses on the need for nurses to be proficient in knowledge, skills and conduct. Ethical patient management can only be achieved by meeting all of the demands of the profession. The Code serves as a key guideline for ethical patient management, with consideration of the core ethical principles of non-maleficence, beneficence, autonomy and justice. This is covered in greater detail in Chapter 2.
