chapter 4 | Questions of Values and Ethics 43a supreme being, and technology, for example, is con-
sidered a gift that allows health-care personnel to
maintain the life of a loved one. Other religions, such
as certain branches of Judaism, focus on free choice
or free will, leaving such decisions in the hands of
humankind. Many Jewish leaders believe that if
genetic testing indicates, for instance, that an infant
will be born with a disease such as Tay-Sachs, which
causes severe suffering and ultimately death, an abor-
tion may be an acceptable option.
Belief systems often help survivors in making
decisions and living with them afterward. So far,
more questions than answers have emerged from
these technological advances. As science explains
more and more previously unexplainable phenom-
ena, people need beliefs and values to guide their
use of this new knowledge.
Morals and Ethics
Although the terms moralsand ethicsare often used
interchangeably,ethicsusually refers to a standard-
ized code as a guide to behaviors, whereas morals
usually refers to an individual’s own code for
acceptable behavior.
Morals
Moralsarise from an individual’s conscience. They
act as a guide for individual behavior and are learned
through instruction and socialization. You may find,
for example, that you and your patients disagree on
the acceptability of certain behaviors, such as pre-
marital sex, drug use, or gambling. Even in your
nursing class, you will probably encounter some dis-
agreements because each of you has developed a per-
sonal code that defines acceptable behavior.
Ethics
Ethicsis the part of philosophy that deals with the
rightness or wrongness of human behavior. It is
also concerned with the motives behind behaviors.
Bioethics,specifically, is the application of ethics to
issues that pertain to life and death. The implica-
tion is that judgments can be made about the right-
ness or goodness of health-care practices.
Ethical Theories
Several ethical theories have emerged to justify
moral principles (Guido, 2001).Deontological theo-
riestake their norms and rules from the duties that
individuals owe each other by the goodness of the
commitments they make and the roles they take
upon themselves. The term deontological comes
from the Greek word deon(duty). This theory is
attributed to the 18th-century philosopher
Immanuel Kant (Kant, 1949). Deontological ethics
considers the intention of the action, not the con-
sequences of the action. In other words, it is the
individual’s good intentions or goodwill (Kant,
1949) that determines the worthiness or goodness
of the action.
Teleological theoriestake their norms or rules for
behaviors from the consequences of the action.
This theory is also called utilitarianism. According
to this concept, what makes an action right or
wrong is its utility, or usefulness. Usefulness is con-
sidered to be the amount of happiness the action
carries. “Right” encompasses actions that have good
outcomes, whereas “wrong” is composed of actions
that result in bad outcomes. This theory had its ori-
gins with David Hume, a Scottish philosopher.
According to Hume, “Reason is and ought to be
the slave of the passions” (Hume, 1978, p. 212).
Based on this idea, ethics depends on what people
want and desire. The passions determine what is
right or wrong. However, individuals who follow
teleological theory disagree on how to decide on
the “rightness” or “wrongness” of an action (Guido,
2001) because individual passions differ.
Principalismis an arising theory receiving a
great deal of attention in the biomedical ethics
community. This theory integrates existing ethical
principles and tries to resolve conflicts by relating
one or more of these principles to a given situation.
Ethical principles actually influence professional
decision making more than ethical theories.Ethical Principles
Ethical codes are based on principles that can be
used to judge behavior. Ethical principles assist
decision making because they are a standard for
measuring actions. They may be the basis for laws,
but they themselves are not laws. Laws are rules
created by a governing body. Laws can operate
because the government has the power to enforce
them. They are usually quite specific, as are the
punishments for disobeying them. Ethical princi-
ples are not confined to specific behaviors. They act
as guides for appropriate behaviors. They also take
into account the situation in which a decision
must be made. Ethical principles speak to the
essence or fundamentals of the law rather than to