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____ and the _____ have established guidelines of patients’ rights. These are not legal documents, nurses and hospitals are considered responsible for upholding these rights of patients.

National League for Nursing & American Hospital Association


moral principle or a set of moral principles that can be used in assessing what is morally right or morally wrong. Theses principles provide different frameworks for ethical decision-making.

Ethical Theory


espouses that what is right and good is what is best for the individual making the decision. An individual’s actions are determined by what is to his or her own advantage. The action may not be best for anyone else involved, but consideration is only for the individual making the decision.

Ethical egoism


as fairness principle. Sometimes referred to as distributive ______, and its basic premise lies with the right of individuals to be treated equally regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious belief. _____ reflects a duty to treat all individuals equally and fairly. All resources within the society ought to be distributed evenly without respect to socioeconomic status. Thus, according to this principle, the vast disparity in the quality of care dispensed to the various classes within our society would be considered unjust. A more equitable distribution of care for the individuals would be favored.



an essential role for the psychiatric nurses. ____ means acting in another’s behalf – being a supporter or defender. Helping clients fulfill needs that, without assistance and because of their illness, may go unfulfilled. Individuals with mental illness are not always able to speak for themselves. Nurses serve in this manner to protect the clients’ rights and interests. Strategies include educating clients and their families about their legal rights, ensuring that decisions are to give informed consent, and assisting clients to consider alternatives and supporting them in the decisions they make. Additionally, nurses may act as ____ by speaking on behalf of individuals with mental illness to secure essential mental health services.



It is not the consequences or end results that make an action right or wrong; rather it is the principle or motivation on which the action is based that is the morally decisive factor. Our actions are bound by a sense of duty. Ethical decisions are made out of respect for moral law. For example, “I make this choice because it is morally right and my duty to do so” not because of consideration for a possible outcome.



Conduct that results from serious critical thinking about how individuals ought to treat others. __________ reflects the way a person interprets basic respect for other persons, such as the respect for autonomy, freedom, justice, honesty, and confidentiality.

Moral behavior


arises from Kantian duty of respect for persons as rational agents. This viewpoint emphasizes the status of persons as autonomous moral agents whose right to determine their destinies should always be respected. ____ presumes that individuals are always capable of making independent choices for themselves. Health care workers know this is not always the case. Children, comatose individuals, and the seriously mentally ill are examples of clients who are incapable of making informed choices. A representative of the individual is usually asked to intervene and give consent. Health care workers must ensure that respect for an individual’s ____ is not disregarded in favor of what another person may view as best for the client.



is a situation that requires an individual to make a choice between two equally unfavorable alternatives. Evidence exists to support both moral “rightness” and moral “wrongness” related to a certain action. The individual who must make the choice experiences conscious conflict regarding the decision.
Not all ethical issues are ____. An _____ arises when there is no clear reason to choose one action over another. Ethical dilemmas generally create a great deal of emotion. Often, the reasons supporting each side of the argument for action are logical and appropriate. The action associated with both sides are desirable in some respects and undesirable in others. In most situations, taking no action is considered an action taken.

ethical dilemmas


when there is no restriction whatsoever on the individual’s entitlement

Absolute Rights


approach to ethical decision making is focused on a way of life and teaching of Jesus Christ. It advances the importance of virtues such as love, forgiveness, and honesty. One basic principle often associated with Christian ethics is known as the Golden Rule: “Do unto others as you would have them do unto you”. All decisions about right and wrong should be centered in love for God and in treating others with the same respect and dignity with which we would expect to be treated.

Christian Ethics


a right on which the society has agreed and formalized into law

Legal rights


fundamental guidelines that influence decision-making. The _____ of autonomy, beneficence, nonmaleficence, veracity, and justice are helpful and used frequently by health-care workers to assist with ethical decision-making.

ethical principles


refers to one’s duty to benefit or promote the good of others. Health care workers who act in their clients interest are beneficent, provided their actions really do serve the clients best interest. In fact, some duties seem to take preference over other duties. For example, the duty to respect the autonomy of an individual may be overridden when that individual has been deemed harmful to self or others. The difficulty that sometimes arises in implementing the principle of _____ lies in determining what exactly is good for another and who can best make that decision.



Do no harm to clients, either intentionally or unintentionally. Some philosophers suggest that this principle is more important than beneficence; that is, they support the notion that it is more important to avoid doing harm than it is to do good. In the event, ethical dilemmas often arise when a conflict exists between an individual’s rights and what is thought to best represent the welfare of the individual. Conflict is when psychiatric client refuses antipsychotic medications (consistent with his or her rights), and the nurse must then decide how to maintain client safety while psychotic symptoms continue.



a valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service



one’s duty to always be truthful. Requires health-care providers tell the truth and not intentionally deceive or mislead clients. There are times when limitations must be placed on this principle, such as when the truth would knowingly produce harm or interfere with the recovery process. Being honest is not always easy, but rarely is lying justified. Clients have the right to know about their diagnosis, treatment, and prognosis.



are personal beliefs about what is important and desirable.



this process increases awareness through which individuals identify and rank their own personal values. The process increases awareness about why individuals behave in certain ways. _______ is important in nursing to increase understanding about why certain choices and decisions are made over others and how values affect nursing outcome

Values clarification


The greatest-happiness principle. This principle holds that actions are right to the degree that they tend to promote happiness and wrong as they tend to produce the reverse of happiness. The good is happiness and the right is that which promotes the good. The wrongness of an action is determined by its tendency to bring about unhappiness. An ethical decision based on ____ view looks at the end result of the decision. Action is taken on the basis of the end results that produce the most good (happiness) for the most people.



Clients have a right to whatever level of treatment is effective and least restricts their freedom. The restrictiveness of psychiatric therapy can be described in the context of a continuum based on severity of illness. Clients may be treated on an outpatient basis, in day hospitals, or through voluntary or involuntary hospitalization. Symptoms may be treated with verbal rehabilitative techniques and move successively to behavioral techniques, chemical interventions, mechanical restraints, or electroconvulsive therapy. However, ethical issues arise in selecting the least restrictive means among involuntary chemical interventions, seclusion, and mechanical restrains.

The right to the least restrictive treatment Alternative


based on the writings of St. Thomas Aquinas. It advances the idea that decisions about right versus wrong are self-evident and determined by human nature. The theory espouses that, as rational human beings, we inherently know the difference between good and evil (believed to be knowledge that is given to man from God), and this knowledge directs our decision-making.

Natural law theory


Ideas or concepts that give meaning to an individual’s life



Steps of making an ethical decision

1. Assessment
2. Problem Identification
3. Plan
4. Implementation
5. Evaluation


When making a decision about forced medications.
*The treatment team must determine that _____ criteria be met to force medications without client consent.

1. The client must exhibit behavior that is dangerous to self or others
2. The medication ordered by the physician must have a reasonable chance of providing help to the client
3. Clients who refuse medication must be judged incompetent to evaluate the benefits of the treatment in question.


requires healthcare facilities to provide clear written information for every patient concerning his/her legal rights to make healthcare decisions, including the right to accept or refuse treatment.

The Self-Determination Act


are passed by the state legislature and in general are concerned with such provisions as
1. Definition of important terms, including the definition of nursing and the various types of nurses recognized
2. A statement of the education and other training or requirements for licensure and reciprocity
3. Broad statements that describe the scope of practice for various levels of nursing.
4. Conditions under which a nurse’s license may be suspended or revoked, and instructions for appeal
5. The general authority and powers of the state board of nursing

The Nurse Practice Act


State/Country - Law created by a legislative body, such as county, city, state, or congress. Example of statutory law is the Nurse Practice Act.

Statutory law


Judge - Derived from decisions made in previous cases. These laws apply to a body of principles that evolve from court decisions resolving various controversies. Example is how different states deal with a nurse’s refusal to provide care for a specific client.

Common Law


protects the private and property rights of individuals and businesses. Private individuals or groups may bring a legal action to court for breach of ____. These legal actions are of two basic types: torts and contracts.

civil law