Nursing ethics involves rules and principles to guide right conduct in terms of moral duties and obligations to protect the rights of human beings. In nursing, ethical codes provide professional standards and formal guidelines for nursing activities to protect both the nurse and the client.

1. CODE OF ETHICS—serves as a frame of reference when judging priorities or possible courses of action. Purposes:
1. To provide a basis for regulating relationships between nurse, client, coworkers, society, and profession.
2. To provide a standard for excluding unscrupulous nursing practitioners and for defending nurses unjustly accused.
3. To serve as a basis for nursing curricula.
4. To orient new nurses and the public to ethical professional conduct.
2. ANA CODE OF ETHICS FOR NURSES incorporates the following key elements of what the nurse needs to do^*:
1. Demonstrate respect for human dignity and uniqueness of individual regardless of health problem or socioeconomic level
2. Maintain client's right to privacy and confidentiality
3. Protect the client from incompetent, unethical, or illegal behavior of others
4. Accept responsibility for informed individual nursing judgment and behavior
5. Maintain competence through ongoing professional development and consultation
6. Maintain responsibility when delegating nursing care, based on competence/qualification criteria
7. Work on maintaining/improving standards of care in employment setting
8. Protect consumer from misinformation/misrepresentation
3. BIOETHICS—a philosophical field that applies ethical reasoning process for achieving clear and convincing resolutions to issues and dilemmas (conflicts between two obligations) in health care.^†
1. Purpose of applying ethical reflection to nursing concerns:
1. Improve quality of professional nursing decisions.
2. Increase sensitivity to others.
3. Offer a sense of moral clarity and enlightenment.
2. Framework for analyzing an ethical issue:
1. Who are the relevant participants in the situation?
2. What is the required action?
3. What are the probable and possible benefits and consequences of the action?
4. What is the range of alternative actions or choices?
5. What is the intent or purpose of the action?
6. What is the context of the action?
3. Principles of bioethics:
1. Autonomy—the right to make one's own decisions.
2. Nonmalfeasance—the intention to do no harm.
3. Beneficence—the principle of attempting to do things that benefit others.
4. Justice—the distribution, as fairly as possible, of benefits, resources, and burdens.
5. Veracity—the intention to tell the truth.
6. Confidentiality—the social contract guaranteeing another's privacy.
7. Respect—acknowledge the rights of others.
8. Fidelity—keep promises and commitments.
4. CLIENT'S BILL OF RIGHTS^†
1. Right to appropriate treatment that is most supportive and least restrictive to personal freedom.
2. Right to individualized treatment plan, subject to review and reassessment.
3. Right to active participation in treatment, with the risk, side effects, and benefits of all medication and treatment (and alternatives) to be discussed.
4. Right to give and withhold consent (exceptions: emergencies and when under conservatorship).
1. Advance directives: legal, written, or oral statements made by a person who is mentally competent about treatment preferences. In the event the person is unable to make these determinations, a designated surrogate decision maker can do so. Each state has own specific laws with restrictions.
1. Living will: legal document that specifically identifies treatment desires and states that the person does not wish to have extraordinary lifesaving measures (e.g., DNR) when not able to make decisions about own care.
2. Durable power of attorney (health care proxy): legal document giving designated person authority to make health-care decisions on client's behalf when client is unable to do so.
5. Right to be free of experimentation unless following recommendations of the National Commission on Protection of Human Subjects (with informed, voluntary, written consent).
6. Right to be free of restraints and seclusion except in an emergency.
7. Right to humane environment with reasonable protection from harm and appropriate privacy.
8. Right to confidentiality of medical records.
9. Right of access to personal treatment record.
10. Right to as much freedom as possible to exercise constitutional rights of association (e.g., use of telephone, personal mail, having visitors) and expression.
11. Right to information about these rights in both written and oral form, presented in an understandable manner at outset and periodically thereafter.
12. Right to assert grievances through a grievance mechanism that includes the power to go to court.
13. Right to obtain advocacyassistance.
1. Definition: an advocate is a person who pleads for a cause or who acts on a client's behalf.
2. Goals: help client gain greater self-determination and encourage freedom of choices; increase sensitivity and responsiveness of the health-care, social, political systems to the needs of the client.
3. Characteristics: assertiveness; willingness to speak out for or in support of client; ability to negotiate and obtain resources for positive outcomes; willingness to take risks, and take necessary measures in instances of incompetent, unethical, or illegal practice by others that may jeopardize client's rights.
14. Right to criticize or complain about conditions or services without fear of retaliatory punishment or other reprisals.
15. Right to referral to complement the discharge plan.
5. CONFLICTS AND PROBLEMS—ETHICAL DILEMMAS
1. Personal values versus professional duty—nurses have the right to refuse to participate in those areas of nursing practice that are against their personal values, as long as a client's welfare is not jeopardized. Example: therapeutic abortions.
2. Nurse versus agency—conflict may arise regarding whether or not to give out needed information to a client or to follow agency policy, which does not allow it. Example: a teenager who is emotionally upset asks a nurse about how to get an abortion, a discussion that is against agency policy.
3. Nurse versus colleagues—conflict may arise when determining whether to ignore or report others' behavior. Examples: you see another nurse steal medications; you know that a peer is giving a false reason when requesting time off; or you observe a colleague who is intoxicated.
4. Nurse versus client/family—conflict may stem from knowledge of confidential information. Should you tell? Example: client or family member relates a vital secret to the nurse.
5. Conflicting responsibilities—to whom is the nurse primarily responsible when needs of the agency and the client differ? Example: a physician asks a nurse not to list all supplies used for client care, because the client cannot afford to pay the bill.
6. Ethical dilemmas—stigma of diagnostic label (e.g., AIDS, schizophrenia, addict); involuntary psychiatric confinement; right to control individual freedom; right to suicide; right to privacy and confidentiality.

^* Adapted from recording at JONA and Nurse Educator's Joint Leadership Conference, 1981, A. J. Davis, "Ethical Dilemmas in Nursing."

^† Adapted from AAA Code of Ethics on Nurses, Washington, DC.