. fundamental moral principles;
. the core values of:
± the individual
± the institution
± the profession
± society.
This list has no special order, as it is a matter of controversy which source of ethics
is most reliable, and which takes priority. However, most of us would agree that
nurses have a strong obligation to abide by, and work within, the law. The law does
not determine precisely what is ethical, for instance many actions are lawful but
possibly unethical, and some actions may be ethical without being lawful. Exam-
ples might include abortion and euthanasia ± many people who think abortion
ethical also think euthanasia ethical, while in law abortion is legal in many
circumstances and active euthanasia is unlawful. Conversely, many people who
think euthanasia is unethical also think that abortion is unethical.
The role of professional codes of ethics and conduct is in part to define the
nature of the profession they regulate. They identify certain actions which might be
permitted for lay people but are not permissible in nurses, and other actions which
are permissible in nurses but not permitted for lay people. Codes set out the higher
standards of competence, rights and duties which go along with being a nurse.
Many of these rights and duties have an ethical character, but many are more in the
nature of the requirements of professional etiquette.
In identifying the roles that the law, ethics and professional codes have for
nurses and others, we must turn eventually to the ethical foundations of these
codes ± the fundamental principles and values which are meant to underlie these
codes. An example of a fundamental moral principle is the principle of non-
maleficence: individuals have a duty to refrain from harming others. This principle
is particularly associated with the caring professions, but it is not specific to them
alone. Rather, it has special importance for the caring professions simply because
their patients or clients are particularly vulnerable, and thus at greater risk of being
harmed, and because the skills and tools of the caring professions are particularly
liable to being turned to harmful ends. However, saying that this principle is
fundamental is not to say that it is absolute. Thus, certain actions do cause harm
'e.g. venepuncture) but are justified by their being carried out with beneficent
intentions 'e.g. to provide pain relief). Hence, fundamental principles must be
balanced against each other; in this case, non-maleficence is balanced with
beneficence and with respect for autonomy 'the individual must be asked for his
or her consent).
The question of epistemology of values 'how we know them) has exercised
philosophers for generations. It appears in an interesting way in research ethics.
Firstly, research ethics, like health care ethics generally, is a field which has
experienced considerable historical evolution, as its principles have become more
clearly articulated and ramified over time. The key scandals in the ethics of
research always raise the question: did the responsible agents know that they were
acting wrongly? Was it possible for them to know? Even if we can show that they
did not and could not have known that they were in the wrong, we may perhaps
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