Ethical Principles used in Disaster
Nursing
Morals
• An individual’s own code
for acceptable behavior
• They arise from an
individual’s conscience
• They act as a guide for
individual behavior
• They are Learned
• Ethics is the study of values in human
conduct or the study of right
conduct.
• Ethics offers a critical, rational,
defensible, systematic and
intellectual approach to determining
what is right or best in a difficult
situation.
Ethics
• Ethics deals with the “rightness”
or “wrongness” of human
behavior
• is the application of these
principles to life-and-death
issues
• the ethical obligations of
nurses, is nonnegotiable in
nature, and expresses the
profession’s commitment to
society (ANA, 2001)
The two major classifications of ethical
principles and ethical thought :
• 1. Deontology (Duty)
• is the ethical school of thought that requires
that both the means and the end goal must be
moral and ethical.
• 2. Utilitarianism
• a school of ethical thought states that the end
goal justifies the means even when the means
are not moral.
Ethical Principles
• Autonomy
• Nonmaleficence
• Beneficence
• Justice
• Fidelity
• Confidentiality
• Veracity
• Accountability
Autonomy
• The freedom to make decisions
about oneself
• The right to self-determination
• Healthcare providers need to
respect client/patient’s rights to
make choices about healthcare,
even if the healthcare providers do
not agree with the patient’s
decision.
Are there limits to a patient’s
autonomy in making health care
decisions?
• autonomy is limited:
• when its exercise causes
harm to someone else or
may harm the patient.
• When harm to others is
sufficiently grave, it
overrides the principle of
autonomy.
Nonmaleficence- do no harm
• Requires that no harm be
caused to an individual,
either unintentionally or
deliberately
• This principle requires
nurses to protect
individuals who are
unable to protect
themselves
Who Will Be There?
Ethics, the law, and a nurse’s duty to
respond in a disaster
• When disaster strikes, nurses are
needed:
• But do registered nurses have a
contractual “duty” to answer a call
to help in disaster situations?
• Do they have an ethical obligation to
respond?
• Can the law require them to
respond?
Accdg to ANA Code of Ethics for
Nurses
• A nurse’s duty to care is an ethical component of the
nurse-patient relationship that can be inferred from
Provision 2 of the ANA Code of Ethics for Nurses with
Interpretive Statements which states that :
• “the nurse’s primary commitment is to the patient.”
However, nurses not only have an ethical obligation to
care for others but also to care for themselves.
• Provision 5 of the Code states that the nurse owes the
same duty to self as to others.
Beneficence- Do Good
• This principle means “doing good”
for others (The Good Samaritan
Law)
• Nurses need to assist clients in
meeting all their needs
• Biological
• Psychological
• Social
ANA Code of Ethics for Nurses
• During the times of pandemics
or natural catastrophes, nurses
and other health care
providers must decide how
much high quality care they
can provide to others while
also taking care of
themselves.
Guidance for Establishing Crisis Standards
of Care for use in Disaster Situations: A
Letter Report. (ANA, 2017) it says:
• A Protocol designed to protect
medical professionals operating
in extreme conditions and
scarcities,
• and to ensure that the public
receives the most adequate
medical services possible in the
situation.
• Article 25 of HUMAN RIGHTS
• Everyone has the right to a standard of
living adequate for the health and well-
being of himself and of his family,
including food, clothing, housing and
medical care and necessary social
services, and the right to security in the
event of unemployment, sickness,
disability, widowhood, old age or other
lack of livelihood in circumstances beyond
his control.
Justice
• Every individual must be treated
equally
• This requires nurses to be
nonjudgmental
• Article 7 of HUMAN RIGHTS
• All are equal before the law and
are entitled without any
discrimination to equal protection
of the law
• Article 21 of HUMAN RIGHTS
• Everyone has the right of equal access
to public service in his country.
Fidelity
• Loyalty
• The promise to fulfill all
commitments
• The basis of accountability
• Includes the professionals
faithfulness or loyalty to
agreements & responsibilities
accepted as part of the practice
of the profession
• This ethical principle is the
foundation of the nurse-patient
relationship.
• Fidelity comes into play when we
uphold our commitment to provide
adequate pain control, when we
provide quality of care, comfort and
support when needed, when we
represent the interests of our clients
and we tell the truth.
Confidentiality
• Anything stated to nurses or health-
care providers by patients must
remain confidential
• The only times this principle may be
violated are:
• If patients may indicate harm to
themselves or others
• If the patient gives permission
for the information to be shared
Veracity
• This principle implies “truthfulness”
• Nurses need to be truthful to their
clients
• Veracity is an important component of
building trusting relationships
Accountability
• Individuals need to be responsible
for their own actions
• Nurses are accountable to
themselves and to their colleagues
Ethical Dilemmas
• Occur when a problem exists
between ethical principles
• Deciding in favor of one
principle usually violates
another
• Both sides have “goodness”
and “badness” associated
with them
Why call an Ethics Consultant?
• Ethics Consultant can help:
• Discover and understand the issues
• Serves as a forum for sharing of
concerns and questions
• Identifies possible treatmen,
solutions, alternatives
• Provides guidance to the staff,
patient, and family members
• Resolves conflicts
Using the Nursing Process
• Assessment
• Planning
• Implementation
• Evaluation
Approach to Ethical Dilemma
Approach
Assessment Planning Implementation Evaluation
Am I involved Determine goals Work towards Determine
of treatment a mutually whether desired
acceptable decision outcomes have been
reached
Collect Identify Use of Re-evaluate as necessary
the facts Decision-Makers discussion and
negotiation
What Values are in conflict List and
Rank the options
Ethical Decision Making Process
• Describe the problem
• Gather the facts
• Clarify values
• Note reactions
• Identify ethical Principles
• Clarify legal rules
• Explore options and alternatives
• Decide on a recommendation
• Develop an action plan
• Evaluate the plan
Salient Points: ANA, 2017
• Nurses must be professionally and
personally prepared.
• Registered nurses need to be aware
of the ethical situations they may
encounter, especially in times of
scarce resources and supplies when
they may face unimaginable patient
care decisions.
Salient Points: ANA, 2017
• They need to advocate for systems
and protocols that protect their
ethical obligations as nurses, as well
as ensure equity and fairness in
disaster medical care planning.
• Provision 8 of the Code obligates
nurses to always “stress human rights
protection under all conditions, with
particular attention to:
• preserving the human rights of
vulnerable groups such as
women,children, the elderly,
prisoners, refugees and socially
stigmatized groups.”
THANK YOU…..
