10 Application of ethical theory to clinical practice
Ethical theories have been applied to explore and understand elements of clinical practice. In this chapter, we will review some of the common ethical theories considered in the context of healthcare.
1. Utilitarianism
Utilitarianism focuses on promoting the greatest overall happiness or minimising harm for the greatest number of people. In nursing, this could be applied in situations where limited resources are available. For example, during a pandemic, a nurse may have to decide how to allocate scarce medical supplies (e.g., ventilators) among several critically ill patients. Utilitarianism would suggest that the nurse should prioritise the patient with the best chance of survival, even if it means withdrawing care from someone with a lower chance.
2. Deontology
Deontological ethics emphasises the importance of following moral rules and duties, regardless of the consequences. In nursing or midwifery, this might manifest in respecting patient autonomy and informed consent. For instance, if a patient with a terminal illness refuses a specific treatment, the nurse must honor their decision and not attempt to persuade or coerce them into accepting the treatment.
3. Virtue ethics
Virtue ethics concentrates on cultivating moral character traits and behaviors. In nursing and midwifery, this theory can be exemplified through the development of compassionate and empathetic care. In action, a nurse or midwife may demonstrate the virtue of compassion by providing emotional support to a patient who is anxious about an upcoming procedure, even though it might not be explicitly required in their job description.
4. Feminist ethics
Feminist ethics highlights the importance of recognising and challenging power imbalances, advocating for equality, and considering the unique experiences of individuals. In nursing, this theory could be applied by addressing issues related to gender bias in healthcare. For example, advocating for equal pay and opportunities for female nurses or ensuring that female patients’ health concerns are taken seriously and not dismissed.
5. Ethics of care
The ethics of care emphasises the significance of nurturing and maintaining relationships, especially in caregiving roles. In nursing, this could be exemplified through the consistent and attentive care provided to a patient with chronic illnesses. For instance, a nurse caring for an elderly patient with dementia may need to prioritise building trust and rapport to ensure the patient feels safe and comfortable during their care.
6. Principle-based ethics
Principle-based ethics involve using a set of moral principles to guide decision-making. In nursing, four main principles are commonly employed: autonomy, beneficence, non-maleficence, and justice. For example, when a patient is diagnosed with a life-threatening illness, the nurse must balance respecting the patient’s autonomy (by discussing treatment options), promoting beneficence (by providing appropriate care), avoiding harm (non-maleficence), and ensuring fair distribution of resources (justice). These examples demonstrate how ethical theories can be applied in nursing to guide decision-making and ensure ethical care delivery. However, it is essential to remember that real-life ethical situations can be complex and multifaceted, often requiring careful consideration and collaboration with healthcare teams and patients to reach the most ethical outcomes.
Clinical scenario
The application of deontological ethics, specifically drawing from Immanuel Kant’s moral philosophy.
Scenario
A nurse is caring for a patient who has been diagnosed with a severe form of dementia. The patient is unable to make informed decisions and lacks the capacity to give consent for medical treatments. The patient requires immediate surgery to address a life-threatening condition.
Kantian Deontological Approach
According to Kantian ethics, moral actions are those guided by duty and moral rules, irrespective of the consequences. In this case, the nurse must consider the patient’s lack of autonomy and inability to provide informed consent. Instead of focusing on the potential benefits of the surgery, the nurse would adhere to their duty to respect the dignity and autonomy of the patient.
Application
- Respect for autonomy: Kantian ethics upholds the principle of treating individuals as ends in themselves, not merely as a means to an end. The nurse must recognise the patient’s inherent worth and dignity, even in their vulnerable state, and not treat them solely as a medical case.
- Informed consent: In the absence of the patient’s ability to provide informed consent, the nurse should seek a surrogate decision-maker, such as a legally appointed healthcare proxy or a family member, to make decisions on behalf of the patient. This decision-making process aligns with the principles of autonomy and rationality, as advocated by Kant.
- Universality: Kant proposed the concept of the “categorical imperative,” which states that moral actions should be universally applicable. The nurse’s duty to respect patient autonomy applies to all patients in similar situations, regardless of the specific medical condition or prognosis.
- Honouring duty: Kantian ethics would encourage the nurse to uphold their professional duty to provide the best care possible for the patient, even when the patient cannot actively participate in decision-making. The nurse should prioritise the patient’s well-being, ensure their safety, and advocate for their best interests while respecting their autonomy.
In this scenario, the nurse’s adherence to Kantian deontological principles would lead them to prioritise respect for the patient’s autonomy and dignity while seeking to involve appropriate surrogate decision-makers in the treatment decision-making process. By acting according to their moral duty, the nurse ensures that ethical considerations guide their actions, even in complex situations where the patient’s autonomy is compromised.
Activity: Informed consent
What do you think informed consent to participate in research requires?
Examples of what is not informed consent
