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Principles of Biomedical Ethics and their Relevance to Nursing Practice

Addressing Challenges in Biomedical Ethics

In the introduction to the seventh edition of their highly influential Principles of Biomedical Ethics (2009), Tom Beauchamp and James Childress observe that:

In the last third of the twentieth century, developments in the biological and health sciences and in biomedical technology presented a number of challenges to traditional professional ethics in medicine and nursing. Despite a remarkable continuity in medical ethics across millennia, the Hippocratic tradition was not well equipped to address problems such as informed consent, privacy, access to health care, communal and public health responsibilities, and research involving human subjects as these appeared in the modern context (Beauchamp & Childress, 2009).
This course will address the issues identified by Beauchamp and Childress and the moral theories and principles that have been developed to help healthcare providers respond to such challenges. It will also analyze how ethical theories and principles relate to both the traditional values that have characterized nursing practice for the last century and a half and to the more recent changes that have arisen as the result of increased autonomy and professionalization, the tendency for healthcare teams to become more interdisciplinary, the increase in emphasis on patient and healthcare provider rights, the challenges associated with providing healthcare in an increasingly litigious society, and scarcity of resources.
“Morality (i.e., doing good) is at the heart of traditional theoretical perspectives of nursing practice” (Keatings and Adams, 2019) and nurses may be “viewed as ‘moral agents’ charged with nurturing the humanity of those for whom they care” (Cloyes, as cited by Keatings and Adams, 2019). This perspective is enshrined in the Canadian Nurses Association Code of Ethics for
Registered Nurses, first published in 1980 and most recently updated in 2017.
As you are most likely already aware, Part I of the Code of Ethics is organized around seven primary values, namely:
• Providing safe, compassionate, competent and ethical care
• Promoting health and well-being
• Promoting and respecting informed decision making
• Honouring dignity
• Maintaining privacy and confidentiality
• Promoting justice
• Being accountable (CNA, 2017)
Part II, meanwhile, has to do with ethical endeavours, which include “a commitment to do good; sensitivity and receptiveness to ethical matters; and a willingness to enter into relationships with persons receiving care and with groups, populations and communities that have health-care needs and problems” (CNA, 2017).
One of the reasons why nurses must study ethics has to do with the responsibilities and social expectations that attach to any self-regulating profession. Like doctors or lawyers, “[n]urses enjoy a position of extraordinary responsibility in Canadian society” (Keatings and Adams, 2019).
The amount of time that they spend with patients and their families in the hospital setting or in the home means that they are entrusted with a great deal of responsibility and are naturally expected to do what is right. Because of this trust, “nurses must be able to understand, clarify, and justify their choices and actions to others: patients, clients, colleagues, the profession, employers, the justice system, and society. To do this effectively, nurses must have a strong grounding in ethics and the skills and tools to make and defend complex decisions” (Keatings and Adams, 2019). This entails the ability to think critically, offer evidence-based solutions, and to respectfully challenge fellow healthcare professionals when one has good reason to believe that the choices they have made or the treatments that have offered are not in accordance with the best interests of the patient.

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