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Ethics in Nursing

Enie Novieastari, SKp.,MSN

List of contents

z Definition of key terms

z Ethics in nursing care
z Nurses’ codes of ethics
z Accountability and responsibility
z Moral reasoning and theories
z Ethical principles
z Methodology for ethical decision making
z Institutional ethics committee
What is ethics?
z A term with many meaning
z Simply stated, it is concerned with how people
ought to act and how they ought to be in
relationship with others
z Concerned with establishing norms and
standards for human life and conduct should be
z Good and bad, right and wrong, character or
z Moral and ethics, used interchangeably
z Etika: asal kata “ethos” (Yunani kuno)
dalam bentuk tunggal yang berarti:
kebiasaan, adat; akhlak, watak; perasaan,
sikap, cara berpikir. Dalam bentuk jamak
“etha” yang berarti adat kebiasaan
(Bertens, 2007)
z Etika ~ moral dalam bahasa
Latin berarti kebiasaan, adat
Secara etimologi etika dan moral sama arti
Menurut KBBI (1999)
z Etika berarti: ilmu tentang apa yang baik dan apa yang
buruk dan tentang hak dan
kewajiban moral (akhlak)
z Etik berarti:
1. kumpulan asas atau nilai yang
berkenaan dengan akhlak
2. nilai mengenai benar dan salah yang
dianut suatu golongan atau masyarakat
z Etiket berarti:
1. secarik kertas yang ditempelkan pada kemasan
2. tatacara (adat, sopan santun dsb) dalam masyarakat
z Values and ethics are related
z Values: building blocks for personal and
professional morality, influence one’s ethical
decision making, relationship and conduct
z Values are based on experience, religion,
education, and culture
z A person’s ethic flows from his/her values
z Ethics is a study of good conduct, character, and
motives, and concerned with determining what
is good or valuable for all people
Ethics in nursing care
z In nursing, specific values and moral
requirements are necessary to maintain
integrity of the profession
z An ethical nurse will act and treat others
in specific ways that are consistent with
the nursing norms and will be guided by
more than personal preferences or values
An ethic of care
z Care: an action, a virtue, an affect, an ethical
principle, or a way of being in the world
z Care as an ethic for nursing is concerned not
only with the resolution of ethical dilemmas, but
also with the ways people behave towards one
z An ethic of care is concerned with relationship
between people and with a nurse’s character
and attitude toward others.
Nurses Code of Ethics
z Nursing has developed code of ethics that
describe ideals for professional conduct
z Codes reflect ethical principles widely accepted
by members of the professions
z See Kode Etik Keperawatan Indonesia:
- Perawat dan klien
- Perawat dan praktek
- Perawat dan masyarakat
- Perawat dan teman sejawat
- Perawat dan profesi
Accountability and responsibility
z Nurse assumes responsibility and accountability for
nursing care provided
z Responsibility: execution of duties associated with the
nurse’s particular role
Example: when administering the meds, the nurse is
responsible for assessing the client’s need for the drug,
giving them safely and correctly, and evaluating the
z A nurse who acts in a responsible manner gains the trust
of client and other professionals
z A responsible nurse: competent in knowledge and skills
and demonstrates a willingness to perform within the
ethical guidelines of the professions
z Accountability means being answerable for one’s
own actions
z A nurse is accountable to self, the client, the
profession, the employer, and society
z If a wrong dose of meds given, the nurse is
accountable to the client who receive it, the
physician who ordered it, the nursing service
that set standard of expected performance, and
the society, which demands professional
z To be accountable, the nurse acts according to
the professional code of ethics
The purpose of professional accountability:,
z To evaluate new professional practices
and reassess existing ones
z To maintain standards of health care
z To facilitate personal reflection, ethical
thought, and personal growth on the part
of health care professionals
z To provide a basis for ethical decision
Moral reasoning
z “Doing ethics” involves participating in a critical
thought process about right and wrong, good
and bad, or thinking about situations
z A process that occurs in many client-nurse
z Developing an understanding of the complex
thought process (moral reasoning) involved in
processing ethical situations helps nurses
participate more fully in the discussions
z Most moral reasoning happens after an ethical
situation has been recognized and before one
acts on the situation
z Emotions play an important role in ethical
z People feelings or emotions are different and
change in the same person from day to day or
hour to hour
z Feelings should be honored, acknowledged, and
used as a consideration in moral reasoning
without making ethics simply a discussion about
the validity and sincerity of individual’s feeling
z Ethics is concerned with developing a system of
shared values in a pluralistic society
z Legal considerations also affect moral reasoning
z It is important to consider the law, the policies,
or the guidelines of policy and procedure in
moral thinking
z Ethics and laws are often in harmony, but not
z Relying on law as the primary consideration of
moral standards is a form of legalism
z For example: refuse to act the request a
terminally ill, competent client to stop treatment,
because of practitioners are afraid of being sued
Ethical principles
z The most fundamental principle: respect
for persons
z The 4 other primary principles stem from
this basic principle:
1. respect for autonomy
2. beneficence
3. nonmaleficence
4. justice
z Autonomy: individual should have freedom
to choose their own life plan and ways of
being moral
z The principles of nonmaleficence and
beneficence are viewed on a continuum
ranging from not inflicting harm
(nonmaleficence) to benefiting others by
doing good (beneficence)
z Justice: treating others fairly and giving
persons their due
z The secondary principles:
- veracity: the duty to tell the truth
- confidentiality; the duty to protect privileged
- fidelity: the duty to keep promises
z Informed consent: promotes and respects
autonomy by expanding the client’s knowledge
of his/her opinions
z Advance directives: a form of communication in
which the persons can give direction on how
they would like to be treated when they cannot
speak for themselves
Kerangka pemecahan masalah etik
z Mengembangkan data dasar
z Mengidentifikasi konflik
z Membuat tindakan alternatif
z Menentukan siapa yang terlibat dan siapa
pengambil keputusan
z Mengidentifikasi kewajiabn perawat
z Membuat keputusan
Pengambilan keputusan etis
z Menunjukkan maksud baikng relevan
z Mengidentifikasi semua orang yang
z Mengumpulkan informasi yang relevan
z Mengidentifikasi prinsip etis yang penting
z Mengusulkan tindakan alternatif
z Melakukan tindakan
z Aiken, T.D. (2004). Legal, Ethical, and Political
Issues in Nursing. 2nd Ed. Philadelphia: F.A.
Davis Company.
z Potter, P.A. & Perry, A.G. (2005). undamentals
of Nursing: Conceps, Process and Practice. 6th
Ed.St.Louis,MI: Elsevier Mosby.
z Kozier, B., Erb, G.,Berwan, A.J., & Burke,K.
(2004). Fundamentals of Nursing:Concepts,
Process, and Practice. 6th Ed. New Jersey:
Prentice Hall Health.
z Buku Kode Etik Keperawatan Indonesia (PPNI).