Deontological ethics and duty-based nursing care principles

Health Nursing

Healthcare Perspectives

Deontology

Deontology decides what one should and should not do based on what is fundamentally right and wrong. It basis ethical theory on what is morally required by duty, what is forbidden or wrong according to societal standard, and what is permitted or allowed based on normative ethical standard. Effect has nothing to do with choices; one simply obeys based on moral standards and duty. Moral right takes priority over everything else, in some case even over what one may consider the "good" of a matter. Moral agents have obligations that they must take certain actions, because it is their duty to do so; therefore they must do so.

Deontological theories are those suggesting that one's actions are right when they accord with what is ethically correct, according to certain ethical maxims, rights, rules, or duties (Cherry & Jacob, 2005; Chitty, 2005). Deontology states that actions might be morally obligated, or assumed to be allowed, or that they may be prohibited and that the consequences of such actions therefore do not matter (Cherry & Jacob, 2005). The intent behind one's actions in deontology do not matter because a person acting using the philosophy of deontology is always correct provided that there actions are ethically moral and correct, as per their duty (Cowen & Moorhead, 2006). With regard to the field of nursing then, one's actions are always correct provided they are ethically correct and in accordance with their duty to care with the lives of their patients. A nurse would have to follow the patient's Bill of Rights, and do what is ethically right with regard to their duty as a caregiver of patient's, and what is ethically right with regard to the duty of the ethics written in the hospital.

Some examples of deontological law include ethical theories provided by Kant, the Golden Rule, and principles of non-aggression. These are very basic principles one would expect from someone providing care to another human being. One would expect that a nurse would provide care that would not harm another human being, and that they would do everything possible to ensure the good health of another.

There are deontological principles that are followed and dilemmas that come up that are addressed in the nursing profession; these include the principle of autonomy, where the nursing professional has a duty to respect the right to determine his or her own medical care or plan. Also important is the principles of beneficence, where a nurse must act to ensure the benefits of the individuals cared for and prevent harm to the individuals cared for. The principle of no maleficence is the idea that health professionals should not inflict harm or risk harm on the one's they care form.

Utilitarian principles on the other hand deals with the consequences of one's actions; this is a normative ethical theory that is based on the outcome or the consequence of one's action or the policies one hold true (Cowen & Moorehead, 2006). Utilitarianism is also known as consequentialism, a theory refined by individuals including Bentham and John Stuart Mill; it implies that there is no act that is inherently right or wrong, but rather, moral duty is something that is "instrumental, not intrinsic" and that morality is a way to an end, not and end in itself (Moreland, n.d.).

The utilitarian principle comes into play with the idea of withholding treatment, or refraining treatment say, withholding use of a respirator, or withdrawing treatment, as in the case of when a treatment is no longer useful. This is a case of examining the consequences of one's actions. This is very different from the idea of what is right and wrong, and exploring one's duty, which is to inflict no harm. By withdrawing the use of a respirator, the consequences may include to facilitate the death of a patient, but this may not be ethically wrong in the case of a patient, if one is utilizing the utilitarian vantage point in nursing. The utilitarian view of morality and ethics carries with it much more weight than the deontological view. This consequentialist view offers more burdens, and with it more questions must be placed on the burden-bearer. At the same time, the person considering the consequences must take into consideration the same obligations, such as the duty of the caregivers, the duty of the person receiving care, the confidentiality of the individual or individuals involved, the legalities of the subjects considered, the rights, ethics and standards involved, and how all of these factors will affect the effects engendered when a decision is made. Ultimately the consequences will result in a consequence that is either good, or bad, rather than what one might consider morally "right" or "wrong." Whether this is much different from the deontological perspective may depend on the individual providing or receiving care in the end.

Moral Development -- Justice Ethics

Just ethics has to do with the legalities or legalism of ethical decision-making. How well ethics and morals attune to the rights of individuals as they ascribe to legal criteria and standards as they are outlined and governed by certain morals that dictate what justice is and should be according to human standards. This describes moral choices as made by examining the rights of people particularly the rights of the people involved with decision making, solution, and making decisions that will involve damage to the least number of people if that is a consideration in the issue involved (McFadden, 1996).

This theory suggests that humans by nature, may be good, or at least should lean toward their awareness of the good that exists within them, instead of inspiring toward evil (McFadden, 1996). This also suggests that human nature can self-realize and self-perfect, and human beings have a moral understanding and aspiration, more than practice. Moral ethics stems from development of this principle and foundation. One's ethical principle should be based on a foundation of making decisions with regard to what is good vs. what is wrong or in principle with one's rights and respect toward one's rights and with what is in accord with what is just. Human beings have a tendency to distinguish between what is just and right, and separate this with what is wrong and what is incorrect or in just (McFadden, 1996). With regard to nursing, moral ethics may involve making decisions that take into consideration the legal rights of the individual patient involved.

Take into consideration end-of-life decisions; if there is an advanced directive in place, one that is detailed and involves a decision-maker, then chances are making legal decisions will be much less complicated than if there is nothing in place to assist with decision-making. However, even in situations where there are legal documents in place to assist with decision-making, there can be difficult moral and ethical problems to face. For example, even with an advance directive in place, it may fail to deal with all situations. There may be people that challenge the advance directive. Legal considerations also consider the patient Bill of Rights, and moral and ethical duties of the caregivers in a hospital. A corporate body has a duty to the people it serves as much as the people themselves have a moral duty and ethical responsibility to each other (Chitty, 2005). Moral decisions are made by corporate entities as much as they are made by individuals. Nurses may be individual decision-makers as much as they may be made by the corporate body.

Rights Ethics

Rights ethics involves one's basic rights to ethical and standard treatment, including one's basic rights to confidentiality, autonomy, independence, decision-making, and right treatment (Cowen & Moorhead, 2006). This includes one's rights to basic care and legal representation where warranted and appropriate. Rights ethics in nursing has to do more with medical ethics and topics including beneficence, non-maleficence and respect for the autonomy of patients; rights ethics has to do with these basic "rights" of the patient (Cowen & Moorhead, 2006).

Rights ethics generally has to do with maintaining the rights of individuals; including their basic rights to their individual autonomy, their right to no-harm, and their right to justice. Basic rights assert the attempts of the nurse to exercise a relationship with a patient where the nurse attempts to build a working relationship with a patient. This relationship should be one where the nurse establishes the autonomy of the patient, and asserts the patient's right to dignity (Cherry & Jacob, 2005).

This can occur only where the patient has the ability to make certain choices regarding their care, and where the patient feels that they have control or as much control as possible over their environment when possible. In cases where this is not possible, the patient should have a right to assign who will or does have control over these factors (Cherry & Jacob, 2005). The nurse's role in these cases is to enforce, and sometimes reinforce these matters. There are many general rights that accompany ethics, including the right to informed consent. This includes the approval or agreement of the person or patient in the case of nursing, to certain standards or appreciation of the implication of certain treatments, or consequences of certain actions or non-action in certain circumstances. To provide informed consent it is necessary that the person consenting have reasonable skills to provide consent; meaning they must be of reasonable or sound mind to provide consent, or have appointed someone to provide such assent as necessary to provide informed consent to care or other treatment protocols.

Confidentiality is another common issue that arises with regarding to rights ethics, that a patient or other individual have rights regarding the information about them; and that information should not be shared without prior written permission unless there is a duty that involves the saving of said person's life. Observing such principles are critical to the preservation of right's ethics, and blend into other ethical standards observed in nursing care today.

Rights ethics are perhaps the most basic ethics and simplest ethics from which all other ethical standards are derived. If a patient is provided with basic rights, then one can expect that all their other needs will be provided. The key to understanding ethics is first to understand and undertake to define what one's basic rights are. This is something that has been continually argued since the dawn of time. This goes back to the very first argument or philosophical discussion regarding deontological and consequentialist theories, or the question of what is "right" vs. what is "good." What is a right? Is it one's moral independence or autonomy? Is it one's given "right" to decide their healthcare ability or choices? Even that in many cases is not guaranteed, as evidenced time and again. There are documents that one may sign, a bill of "rights" that patients are provided with when they enter a hospital, but this does not assert that what they want will always be carried out. So what is right's ethics? What are rights? Undoubtedly these are questions that will continue to plague men and continue to plague philosophers, theorists and caregivers, the people that care for the injured, sick and needy. The patients receiving care will also have to ask these questions as they continue to receive care, because rights are perhaps, not something that one or all can easily define. They are a question that remains uncertain.

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McFadden, E.A. 1996. Moral development and reproductive health decisions. J. Obstet Gynecol

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