ethical principle of autonomy in nursing

ETHICAL PRINCIPLE OF AUTONOMY IN NURSING FULL
ETHICAL PRINCIPLE OF AUTONOMY IN NURSING PROFESSIONAL

In countries with ancient civilizations, rooted beliefs and traditions, the practice of paternalism ( this term will be used in this article, as it is well-entrenched in ethics literature, although parentalism is the proper term) by physicians emanates mostly from beneficence. Resistance to the principle of patient autonomy and its derivatives (informed consent, truth-telling) in non-western cultures is not unexpected.

ETHICAL PRINCIPLE OF AUTONOMY IN NURSING FULL

Even in an advanced western country such as United States, the culture being inhomogeneous, some minority populations hold views different from that of the majority white population in need for full disclosure, and in decisions about life support (preferring a family-centered approach). ĭetractors of the principle of autonomy question the focus on the individual and propose a broader concept of relational autonomy (shaped by social relationships and complex determinants such as gender, ethnicity and culture). However, a rigid distinction between incapacity to make health-care decisions (assessed by health professionals) and incompetence (determined by court of law) is not of practical use, as a clinician's determination of a patient's lack of decision-making capacity based on physical or mental disorder has the same practical consequences as a legal determination of incompetence. Health-care institutions and state governments in the US have policies and procedures to assess incompetence. The principle of autonomy does not extend to persons who lack the capacity (competence) to act autonomously examples include infants and children and incompetence due to developmental, mental or physical disorder. Īutonomy, as is true for all 4 principles, needs to be weighed against competing moral principles, and in some instances may be overridden an obvious example would be if the autonomous action of a patient causes harm to another person(s). This ethical principle was affirmed in a court decision by Justice Cardozo in 1914 with the epigrammatic dictum, “Every human being of adult years and sound mind has a right to determine what shall be done with his own body”.

The philosophical underpinning for autonomy, as interpreted by philosophers Immanuel Kant (1724–1804) and John Stuart Mill (1806–1873), and accepted as an ethical principle, is that all persons have intrinsic and unconditional worth, and therefore, should have the power to make rational decisions and moral choices, and each should be allowed to exercise his or her capacity for self-determination. A physician's obligation and intention to relieve the suffering (e.g., refractory pain or dyspnea) of a patient by the use of appropriate drugs including opioids override the foreseen but unintended harmful effects or outcome (doctrine of double effect). This is particularly important and pertinent in difficult end-of-life care decisions on withholding and withdrawing life-sustaining treatment, medically administered nutrition and hydration, and in pain and other symptom control. The practical application of nonmaleficence is for the physician to weigh the benefits against burdens of all interventions and treatments, to eschew those that are inappropriately burdensome, and to choose the best course of action for the patient. This simply stated principle supports several moral rules − do not kill, do not cause pain or suffering, do not incapacitate, do not cause offense, and do not deprive others of the goods of life. Nonmaleficence is the obligation of a physician not to harm the patient. However, complying with these standards, it should be understood, may not always fulfill the moral norms as the codes have “often appeared to protect the profession's interests more than to offer a broad and impartial moral viewpoint or to address issues of importance to patients and society”. To reduce the vagueness of “accepted role,” physician organizations (local, state, and national) have codified their standards.

A pertinent example of particular morality is the physician's “accepted role” to provide competent and trustworthy service to their patients.

ETHICAL PRINCIPLE OF AUTONOMY IN NURSING PROFESSIONAL

Particular morality refers to norms that bind groups because of their culture, religion, profession and include responsibilities, ideals, professional standards, and so on. Some moral norms for right conduct are common to human kind as they transcend cultures, regions, religions, and other group identities and constitute common morality (e.g., not to kill, or harm, or cause suffering to others, not to steal, not to punish the innocent, to be truthful, to obey the law, to nurture the young and dependent, to help the suffering, and rescue those in danger).

Normative ethics attempts to answer the question, “Which general moral norms for the guidance and evaluation of conduct should we accept, and why?”. Ethics, Morality, and Professional StandardsĮthics is a broad term that covers the study of the nature of morals and the specific moral choices to be made.

Ethical principle of autonomy in nursing