ETHICS Ethics involves determining the best course of action in a certain situation.

Ethical reasoning is the analysis of what is morally right and reasonable. Bioethics is the application of ethics to health care. Ethical behavior for nurses is discussed in codes such as the American Nurses Association Code for Nurses. Ethical issues have become more complex as technology has created more options in health care. These issues are controversial because agreement over what is right or best does not exist and because moral support is possible for more than one course of action. Ethical Dilemmas An ethical dilemma is a situation in which no solution seems completely satisfactory. Opposing courses of action may seem equally desirable, or all possible solutions may seem undesirable. Ethical dilemmas are among the most difficult situations in nursing practice. To find solutions, nurses must apply ethical theories and principles and determine the burdens and benefits of any course of action. ETHICAL THEORIES Two major theories guide ethical decision making: deontologic and utilitarian. DEONTOLOGIC THEORY. The deontologic approach determines what is right by applying ethical principles and moral rules. It does not vary the solution according to individual situations. One example is the rule, Life must be maintained at all costs and in all circumstances. Strictly used, the deontologic approach would not consider the quality of life or weigh the use of scarce resources against the likelihood that the life maintained would be near normal. UTILITARIAN THEORY. The utilitarian theory approaches ethical dilemmas by analyzing the benefits and burdens of any course of action to find one that will result in the greatest amount of good. With this theory, appropriate actions may vary according to the situation. This practical approach is concerned more with the consequences of actions than the actions themselves. In its simplest form the utilitarian approach is The end justifies the means. If the outcome is positive, the method of arriving at that outcome is less important. ETHICAL PRINCIPLES Ethical principles are also important for solving ethical dilemmas. Four of the most important principles are beneficence, nonmaleficence, respect for autonomy, and justice. Other important ethical rules, such as accountability and confidentiality, are derived from these four basic principles. These principles guide decision making, but in some situations the application of one principle conflicts with another principle. In such cases, one principle may outweigh another in importance. Treatments designed to do good may also cause harm. For example, a cesarean birth may prevent permanent

harm to a fetus in jeopardy. However, the surgery that saves the fetus also harms the mother, causing pain, temporary disability, and possible financial hardship. Both mother and health care providers may decide that the principle of beneficence outweighs the principle of nonmaleficence. If the mother does not want surgery, the principles of autonomy and justice also must be considered.