Ethics is the branch of philosophy that examines the differences between right and wrong. Morality is behavior in accordance with custom or tradition and usually reflects personal or religious beliefs. Bioethics refers to the application of general ethical principles to health care, providing a structure to examine the care of clients and the allocation of resources. The field of ethics is rooted in the legal system. However, ethical opinions reflect individual differences and deal with the complexities of human behavior and motivation. Laws change according to social and political influences. The legal system judges action rather than intention.

Ethical theories are used to analyze ethical problems. Teleology is the ethical theory stating that the value of a situation is determined by its consequences. Teleological theory, also known as the “consequentialist” theory, was advocated by the philosopher John Stuart Mill. One principle of teleology is the principle of utility, which states that an act must result in the greatest amount of good for the greatest number of people involved in a situation.

Deontology is the ethical theory that considers the intrinsic significance of the act itself, or the motive of the person doing the act, as the criterion for determination of good. The deontological theory, also known as “formalism,” was advocated by the philosopher Immanuel Kant. Kant established the concept of the categorical imperative, which states that one should act only if the action is based on a principle that is universal, or in a way that everyone would act in a similar situation.

Ethical principles are tenets that direct or govern actions. The major ethical principles affecting health care are (1) autonomy, the individual’s right to choose and ability to act on that choice; (2) nonmaleficence, the duty to cause no harm to others; (3) beneficence, the duty to do good to others and to maintain a balance between benefits and harms; (4) justice, the equitable distribution of potential benefits and risks; (5) veracity, the obligation to tell the truth; and (6) fidelity, the duty to do what one has promised.

A link exists between ethics and values. In order to practice ethically, nurses must understand their own values. Values affect behavior indirectly because they influence the development of beliefs and attitudes. Nurses can understand their values better through values clarification. Values form the base for ethical decision making.

Nursing organizations have developed codes as guidelines for ethical conduct. The first was the 1973 Code for Nurses, developed by the International Council of Nurses (ICN), which urges nurses to respect the values, customs, and spiritual beliefs of individuals. The Canadian Nurses Association (CNA) developed a code of ethics in 1980, revising it in 1991, that is a guide to professional nursing actions. The 1985 American Nurses Association (ANA) Code of Ethics delineates the nurse’s obligations to clients and society at large. In most states, the Board of Nursing has authority to reprimand nurses for unprofessional conduct if they violate this ethical code. The American Hospital Association established a Patient Bill of Rights in 1972, and revised it in 1992. Generally, clients have the right to make decisions about their own care, be actively involved in their treatment, and be treated with dignity and respect.

Nurses use ethical reasoning when faced with an ethical dilemma (a conflict between two or more ethical principles). Ethical reasoning is the process of thinking through what needs to be done, in an orderly manner, and using ethical principles. A basic framework can be used for ethical decision making: Which ethical theories are applicable, which ethical principles are involved, who will be affected, what are the consequences of ethical options, and what does the client desire.

Three situations requiring ethical reasoning are euthanasia, refusal of treatment, and the use of scarce resources. Two types of euthanasia are possible: active euthanasia, taking deliberate action to hasten a client’s death, and passive euthanasia, cooperating with a client’s dying process. Assisted suicide is a form of active euthanasia. Both euthanasia and refusal of treatment present ethical dilemmas for nurses, who must balance their own values with the desires of clients and families. Nurses are client advocates, and their primary ethical responsibility is to protect clients’ rights to make their own decisions.