ETHICAL

PRESENTATION
Patients Autonomy Versus
Own Beliefs & Values
Spring 2015, N362

Sophia Soriano-Castillo, Veronica Alvarez,

Elizabeth Chang-Saito, Carissa Pekelo-Delgado,
and Susan Kim

Scenario

A 25 year old, pregnant single mother of two is

going in for her monthly check-up appointment at
22 weeks. An amniocentesis confirms that the fetus
will be born with Downs syndrome. The patient is
very concerned with her ability to care for the child
and pay for necessary medical expenses, given her
complex socioeconomic status and lack of family
support. She is considering abortion.
The patient is under the care of nurse Sally at her
current appointment. Nurse Jenny is walking by the
examination room when she overhears the patient
voice her plans for abortion to nurse Sally. Nurse
Sally responds that she shouldnt have an abortion
because it is wrong.
If you were nurse Jenny, what would you do?

Ethical Decision-Making
Model
Assess and
identify
ethical
dilemma

Collect
information

List possible
actions,
applying
ethical
principles

Make the
decision

Implementati
on of ethical
action

Reflect on /
evaluate
ethical
decision

Assess andSally:
identify:
Nurse
Violation of ethical
principles:

Autonomy:
Disregarding patients
interests
Fidelity: Putting her own
values before the
patients
Beneficence: Advice
given not in the clients
interest
Nonmaleficence:
Emotional harm to
patient

Values
Unethical
Unprofessional

Collect
information:

Laws

Registered nurses must

understand their ethical,
legal, and professional
rights and responsibilities
Hawaii
Administrative Rules
Section 16-89-59: Nursing
behavior which fails to
conform to legal standards
and accepted standards of
the nursing profession.

Nurse Jenny:
Assess and identify:
Ethical principles:

Autonomy
Beneficence
Nonmaleficence
Fidelity
Veracity

Rights
Protect the safety and
rights of the patients
Promote patients right to
make own decision

Collect
information:
Laws
Policies in regards to
reporting such situation
-

Hawaii Administrative
Rules
Section 16-89-60(6)(D):
Failing to take appropriate
action in safeguarding a
patient from incompetent
health care practices.

ANA
Code
of
Ethics
Provision 1
Respect for human
dignity
Relationships to patients
The nature of health
problems
Right to selfdetermination
Relationships with
colleagues

Provision 3
Acting on questionable
practice

Provision 2
Primacy of the patients
interests
Conflict of interest for
nurses
Professional boundaries

Provision 5
Moral self-respect
Wholeness of character
Preservation of integrity

Possible Actions

Inform nurse manager or appropriate authority

o Veracity: adherence
o Fidelity: adherence
o Nonmaleficence: adherence
o Facility policy: adherence
Intervene immediately by speaking with nurse
privately
o HIPPA: violation
o Client autonomy: possible adherence
o Veracity: adherence
o Beneficence: adherence
o Facility policy (chain of command): violation
Speak to the patient
o HIPPA: violation
o Client autonomy: adherence
o Veracity: adherence
o Beneficence: adherence

Decision and
Implementation
Plan of action and implementation are based on STANDARDS
OF

CARE:
State laws: Nurse Practice Act and Hawaii Administrative Rule
Published standards of nursing practice such as ANA
Health care facility policies & procedures

Implementation Focus:
What would nurse Jenny do to address nurse Sallys behavior?
Inform nurse manager
Speak to proper authority

Reflect and Evaluate Action

For the following key characters, how were they affected and was potential harm
minimized and good maximized?
Nurse Sally:
-

Unethical
behavior was
addressed by
the appropriate
supervisor
Minimized
potential harm
to future
patients having
same situations.

Nurse Jenny:
-

Maximized
good by
intervening
unnecessary
standard of
care by Nurse
Sally by
reporting to
supervisor.

Patient:
- Autonomy should
be promoted by
having all choices
presented rather
than being told
that she is wrong
because of one
decision
- Needs to take
into consideration
all possible
outcomes

Conclusion: Correcting nurse Sallys unethical behavior by

following the chain of command and directing the issue to
the charge nurse. In doing so, nurse Jenny is avoiding
conflict with nurse Sally and respecting patient privacy

References
American Nurses Association. (2011). Code of ethics. Retrieved from http://
www.nursingworld.org/Mobile/Code-of-Ethics
American Nurses Association. (2015). Code of Ethics for Nurses With Interpretive Statements.
Retrieved from
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-ofEthics-For-Nurses.html
American Nurses Association. (2015). Short Definitions of Ethical Principles and Theories
Familiar words, what do they mean? Retrieved from
http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethics-Definitions.pdf
Cherry, B. & Jacob, S. (2014). Contemporary nursing: issues, trends, & management. 6th Ed.
Louis, Elsevier Mosby
Find Law. Hawaii Abortion Laws. (2015). Retrieved from http://statelaws.findlaw.com/hawaiilaw/hawaii-abortion-laws.html
Prater, D. (2013). Nursing leadership and management (Edition 9.0). Assessment
Technologies Institute

St.