Ethical Theories in Nursing: A Comparative Overview

Introduction

Ethical theories in nursing represent the foundational ideas upon which guiding principles are based. This paper presents definitions and comparisons of several commonly used ethical theories in nursing practice: deontology, utilitarianism, justice ethics, care ethics, and rights ethics. Each theory is examined in terms of its core principles, relevance to the nursing profession, and key strengths and limitations.

Deontology

The word deontology derives from two Greek words: deon (duty) and logos (study or science). It is also understood as the study of binding duties (Moreland, J.P., n.d.). Deontology is a moral theory that directs us by examining what we ought to do, as opposed to other theories that focus on what kind of individuals we ought to be. In this respect, deontology stands in contrast to theories such as utilitarianism.

Scholars have identified three main characteristics of deontological ethics. First, moral obligations must be fulfilled without exception. An essential characteristic of any act is whether it is inherently right or wrong. Immoral acts such as lying, breaking promises, or murder are intrinsically wrong, and it is the duty of all people to avoid them regardless of the circumstances. That said, the consequences of an act cannot be entirely ignored — nurses, for example, are trained to recognize which actions harm or benefit a patient. While outcomes are not the sole basis for a moral decision, they help illuminate our duties even if they cannot determine those duties absolutely.

Second, human beings must be regarded as ends in themselves — that is, as beings with inherent ethical value, not merely as means to other ends. This principle reflects the view, associated with Kantian ethics, that humans possess integral moral worth that must be respected in every situation.

Third, deontology holds that a moral rule must be applicable to all persons in the same moral situation. Moral commands such as "tell the truth" or "keep your promises" apply universally and are not conditional upon particular circumstances.

Overall, deontology holds that the rightness of an action depends not on its consequences but on its conformity with a moral norm. For deontologists, the Right takes priority over the Good: if an act falls outside the moral norm, it should not be performed. Deontological theories account for strong, cross-cultural moral intuitions and provide a basis for individuals to demand justification when others breach their moral duties.

Despite these strengths, deontological theory has notable weaknesses. It requires that conflicts among duties and rights be resolved, yet Kant's bold assertion that "a conflict of duties is inconceivable" (Kant, 1780, p. 25) exposes the theory's vulnerability on this point. Although distinctions such as intention versus foresight, or doing versus allowing harm, can reduce some conflicts, whether such distinctions can eliminate all moral conflicts remains an open question.

Utilitarianism

Utilitarianism was developed by Jeremy Bentham (1748–1832) and John Stuart Mill (1806–1873). Bentham argued that every human being is governed by two masters throughout life: pain and pleasure. He therefore proposed the principle of utility — that the virtuous act is the one that produces the greatest happiness. Mill adopted Bentham's ethical framework while adding that pleasures derived from culture, education, and spiritual life are of greater importance than purely material pleasures. Both philosophers thus ground morality in the promotion of happiness and the reduction of suffering.

Both thinkers define happiness as the balance between sorrow and pleasure and hold that pain and pleasure carry their own moral weight. Utilitarians maintain that the natural values produced by two alternative actions can be compared, making it possible to estimate which action will have a better overall effect. This is why utilitarianism is also called a consequentialist moral theory: it evaluates the direct outcomes of an action rather than the action itself.

From a utilitarian standpoint, no act is inherently right or wrong; its moral status depends entirely on its consequences. A negative outcome makes an act wrong; a positive outcome makes it right. Utilitarianism therefore holds that ethical decisions are those whose consequences produce the greatest happiness for the greatest number of people (Nuffield, 2009). For example, utilitarianism could theoretically be used to justify punishing an innocent person if doing so maximized overall social happiness — yet such a conclusion reveals a serious flaw in the theory, since the action would clearly be unethical regardless of its aggregate benefits.

A further criticism is that utilitarianism focuses exclusively on outcomes and disregards the intentions or motives behind actions. Intentions matter to some degree: an action that unintentionally produces good results cannot straightforwardly be called morally good if the intent was to cause harm. Philosopher Karl Popper (1945) proposed that the utilitarian formula "Maximize happiness" should be replaced by "Minimize suffering," a position he termed negative utilitarianism. Popper argued that, from a moral standpoint, alleviating suffering is a more pressing obligation than promoting happiness.

The central rule of utilitarianism is that actions are right in proportion to their tendency to promote happiness, and wrong insofar as they promote the reverse. Happiness here means the presence of pleasure and the absence of pain; unhappiness means the presence of pain and the deprivation of pleasure. Despite its intuitive appeal, the theory's major drawback is that, if applied rigorously, it can justify clearly immoral acts as ethical and appropriate whenever they lead to happiness for the majority. Because of this deficiency, many thinkers have favored deontological ethics instead.