Course

Bioethics in Nursing

Course Highlights


  • In this course, we will learn about the importance of bioethics in nursing practice.
  • You’ll also learn how to explain the principles of bioethics and decision-making frameworks.
  • You’ll leave this course with a broader understanding of current research trends in ethics and science.

About

Contact Hours Awarded:

Course By:
Joe Brandon

BSN, RN, CRRN

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The following course content

Introduction   

Nursing practice is deeply rooted in ethical principles that guide decision-making and patient care. Bioethics is a crucial aspect of healthcare that provides a framework for analyzing ethical dilemmas and promoting individualized patient-centered care respectfully and compassionately (1). Nursing ethics involves applying bioethical principles in practice, such as maintaining patient confidentiality and respecting autonomy (2). Nurses face ethical dilemmas regularly. One of the most common is providing care that conflicts with personal beliefs (3).

Quiz Questions

Self Quiz

Ask yourself...

  1. How do you think bioethics influences nursing practice 
  2. What are some examples of ethical dilemmas nurses may face? 
  3. Can you describe a situation where a nurse's personal beliefs conflicted with their professional obligations? 
  4. How would you navigate such a scenario? 

Definition and Purpose 

Bioethics is the study of ethical and moral principles guiding healthcare decisions and practices (4). Its purpose is to ensure that healthcare providers make informed decisions that respect patients' values, beliefs, and rights (5). 

Bioethics provides a framework for analyzing ethical issues in healthcare while considering the interests of the patients, their families, and the healthcare providers involved in their care (6). By understanding the definition and purpose of bioethics, nurses can develop a strong foundation for addressing ethical challenges in practice, such as informed consent, patient confidentiality, and when it may infringe upon others’ health and proper resource allocation (7, 8).

 

 

Quiz Questions

Self Quiz

Ask yourself...

  1. How does the definition of bioethics impact its application in nursing practice? 
  2. What are some potential consequences of ignoring ethical principles? 
  3. Can you think of a situation where a nurse's understanding of bioethics helped them navigate an ethical dilemma? 
  4. What was the outcome? 

Principles of Bioethics 

The principles of bioethics include autonomy, beneficence, non-maleficence, and justice (9). Autonomy respects patients' decision-making capacity, beneficence promotes a patient's well-being, non-maleficence avoids any harm to the patient, and justice ensures fairness and equity for all involved in the patient’s care (10). 

These principles should serve as the guiding force in nursing practice; influencing the decisions related to patient care, research, and policy development (11, 12). Autonomy empowers patients to make informed choices about their care. This may include decisions that the patient’s family and even healthcare providers may disagree with personally. Beneficence compels nurses to act in the best interests of their patients and advocate for the patient’s desires (13). Non-maleficence reminds nurses to avoid causing harm; this includes not just physical but emotional and mental harm as well (14).

Quiz Questions

Self Quiz

Ask yourself...

  1. How do the principles of bioethics guide nursing practice? 
  2. What are some examples of how these principles are applied in different healthcare settings? 
  3. Can you describe a situation where a nurse had to balance the principles of autonomy and beneficence in their practice? 
  4. How did they navigate this ethical dilemma? 

Types of Ethics and Professions 

Different professions have specific ethical guidelines, such as the American Nurses Association (ANA) Code of Ethics for nurses (15). Understanding the ethical framework of various professions is essential to the interdisciplinary healthcare approach (16). 

Interdisciplinary collaboration requires an understanding of diverse ethical perspectives and principles, an approach that coincides with an equally diverse patient population (17). Nurses should be aware of the ethical guidelines that govern their practice and be able to apply them in diverse healthcare settings. They must also be aware of their own beliefs and guidelines and how these may affect their decision-making, adversely affecting patient care (18).

Quiz Questions

Self Quiz

Ask yourself...

  1. How do different professional ethical guidelines impact interdisciplinary collaboration? 
  2. What are some potential consequences of ignoring these guidelines? 
  3. Can you describe a situation where a nurse had to navigate an ethical dilemma with an interdisciplinary team? 

Ethics in Nursing 

Nursing ethics involves applying principles in practice that benefit the patient, healthcare providers, and loved ones of the patient. Examples include things such as maintaining patient confidentiality and respecting autonomy, helping the patient make the right decision for themselves, and advocating for those decisions to others (19). One of the most difficult decisions nurses face involves those that conflict with their personal belief system (20). 

Nurses must be equipped with the knowledge and skills to navigate these ethical challenges and provide care that respects patients' values and beliefs while also nurturing their thoughts and feelings (21). By exploring bioethics in nursing, we can promote a culture of ethical practice that is compassionate and patient-centered (22). 

Henrietta Lacks Story 

Henrietta Lacks was a Black tobacco farmer who had her cancer cells taken without her knowledge or consent which led to numerous scientific breakthroughs, including the development of the polio vaccine (23). Her story raises important questions about medical ethics, racism, and the intersection of science and human compassion. 

In 1951, Henrietta Lacks was diagnosed with cervical cancer and began treatment at Johns Hopkins Hospital in Baltimore. During her treatment, a sample collection of her cancer cells was taken by her doctor, Dr. George Gey without her knowledge and or consent (24). Dr. Gey discovered that Henrietta's cells were extraordinary in nature and could be of great value for cancer research and future developments as they could survive and thrive in a laboratory setting thus making them ideal for scientific research. 

Henrietta's cells, known as HeLa cells, were soon being used in laboratories worldwide, leading to numerous scientific breakthroughs, including the polio vaccine development, in vitro fertilization, and gene mapping (25). However, Henrietta's family was never informed or financially compensated for the use of her cells, and her story remained largely unknown until the publication of Rebecca Skloot's book "The Immortal Life of Henrietta Lacks" in 2010 (23). 

Henrietta's story highlights the unethical practices that were common in the medical field at the time, particularly in relation to patients that lacked resources, particularly those belonging to minority groups (26). Her cells were taken without her consent, and she was never compensated or acknowledged for her contribution to science. This raised some very important questions about medical ethics, informed consent, and the exploitation of vulnerable populations. 

Still, Henrietta's story is a powerful reminder of the intersection of science and the need for personal autonomy (27). Her cells have been used to advance scientific knowledge, but they also represent a person, a family, and a community. The use of her cells without her consent or compensation is a violation of her humanity and a reminder of the need for ethical considerations in scientific research. 

Quiz Questions

Self Quiz

Ask yourself...

  1. How do nursing ethics impact patient care? 
  2. What are some potential consequences of ignoring ethical principles in practice? 
  3. Can you describe a situation where a nurse's understanding of ethics helped them provide high-quality care 
  4. What were the benefits for the patient? 

Tuskegee Syphilis Experiments 

The Tuskegee Syphilis Study was a highly controversial and unethical medical experiment conducted on African American men in Macon County, Alabama between 1932 and 1972 (24). The study, led by the Department of U.S. Public Health Services, involved withholding treatment from hundreds of African American men infected with syphilis despite the availability of effective therapies, to study the natural progression of the disease (25). 

The men, who were mostly illiterate and poor, were not informed that they had syphilis, their partners were not informed of the disease, nor were they given treatment for the disease (26). Instead, they were given placebos and misleading information about their condition (27). The study continued for 40 years, during which time many of the men died from syphilis-related complications, and many others suffered serious health problems which included the spreading of syphilis to unsuspecting sexual partners (28). 

The Tuskegee Syphilis Study is widely regarded as one of the most unethical medical experiments in history. The study was conducted without the men's knowledge or consent, and it violated basic human rights and principles of medical ethics (30). By way of public outcry and shock, the awareness of these experiments led to major changes in the way human subjects are protected in medical research and a desire for closer oversight by governing groups (29).  

In 1974, a class-action lawsuit was filed on behalf of the men who were involved in the study, resulting in a multimillion-dollar settlement (31). The study also led to the establishment of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, which developed guidelines for the ethical conduct of research involving human subjects (32). 

The Tuskegee Syphilis Study has had a lasting impact on the field of medicine and beyond (33). It highlighted the importance of informed consent and the need for ethical oversight in the field of medical research (34). It has also led to the increased scrutiny of medical experiments and a greater emphasis on protecting human subjects, their privacy, and most importantly honest care and explanations of medical conditions and treatments (35). 

Today, the Tuskegee Syphilis Study is remembered as a cautionary tale about the dangers of unethical medical research (36). It serves as a reminder of the importance of prioritizing the well-being and safety of people and the need for ongoing vigilance in ensuring that medical research is conducted ethically and responsibly, and ensuring there are the proper checks and balances in place to provide the oversight needed (37). 

The study also highlighted the need for diversity in medical research and the importance of including diverse populations in clinical trials (38). It led to increased efforts to address health disparities and to ensure that medical research is conducted in a way that is fair and equitable to all (39). 

In addition, the Tuskegee Syphilis Study led to changes in the way that medical research is regulated and overseen (40). It led to the establishment of institutional review boards (IRBs) and independent ethics committees (IECs) which are responsible for reviewing and approving research protocols and ensuring they meet the ethical standards set in place (41). 

Transparency and accountability in medical research have also been placed at the forefront of research since these events took place (42). Highlighting the importance of disclosing potential conflicts of interest and ensuring research is conducted in a way that is transparent and open to scrutiny; there inevitably was major change and growth that came from this huge medical injustice (43). 

The Tuskegee Syphilis Study was a highly unethical and controversial medical experiment that had a profound impact on the field of medicine and beyond. It highlighted the importance of informed consent, ethical oversight, and diversity in medical research, and led to major changes in the way medical research is conducted and regulated. In these ways, it acted as a catalyst of growth and change in the way the U.S. views and treats research participants. It serves as a reminder of the need for ongoing vigilance in ensuring medical research is conducted ethically and responsibly. 

The Tuskegee Syphilis Studies and Henrietta Lacks' cases highlight the importance of informed consent in research (23). 

Other examples include: 

  • Abortion and reproductive rights (24) 
  • Euthanasia and end-of-life care (25) 
  • Gene editing and genetic research (26) 
  • Healthcare access and disparities (27)

 

 

Quiz Questions

Self Quiz

Ask yourself...

  1. How do bioethical issues like informed consent impact healthcare outcomes 
  2. What are some potential consequences of ignoring these issues? 
  3. Can you describe a situation where a bioethical issue like euthanasia sparked a debate? 
  4. How did healthcare professionals navigate this ethical dilemma? 

Research in Ethics 

Research ethics involves applying bioethical principles in research. Obtaining informed consent and ensuring participant confidentiality are two ways in which the provider can best provide ethical care to those that entrust the healthcare system with their voluntary well-being (28). 

Researchers must be aware of ethical principles that guide research and ensure their studies are conducted ethically and responsibly which puts the client first (29). 

 

 

Ethical Decision-Making 

Ethical decision-making involves critical thinking, moral principles, and professional standards (30). Nurses can use ethical frameworks, such as the ETHICAL model, to guide decision-making (31). Ethical decision-making is a crucial aspect of nursing practice as it enables nurses to navigate complex healthcare issues and promote patients' well-being (32). 

Quiz Questions

Self Quiz

Ask yourself...

  1. How do ethical principles guide research? 
  2. What are some potential consequences of ignoring these principles? 
  3. Can you describe a situation where a researcher had to navigate an ethical dilemma in their study? 

Conclusion 

Bioethics plays a vital role in nursing practice, ensuring that patients receive respectful and compassionate care. Understanding bioethical principles and applications is essential for nurses to provide high-quality care. By applying ethical principles and frameworks, nurses can navigate complex healthcare issues and promote patients' well-being. 

Quiz Questions

Self Quiz

Ask yourself...

  1. How does the ethical framework guide decision-making in nursing practice and what are some potential consequences of ignoring these frameworks? 
  2. How do personal values and beliefs impact nursing practice what are the implications for patient care? 
  3. How does the principle of autonomy impact informed consent in healthcare? 
  4. What are some potential consequences of prioritizing beneficence over non-maleficence in healthcare, and how can nurses balance these principles? 
  5. How does the concept of justice impact healthcare resource allocation and what are the implications for nurses and patients? 
  6. How do nurses balance the need for patient confidentiality with the need for transparency? 
  7. What are some potential consequences of ignoring the principle of non-maleficence in healthcare, and how can nurses prioritize patient safety? 
  8. How does the principle of autonomy impact patient decision-making? 
  9. How do nurses balance the need for patient education with the need for autonomy? 
  10. Are there any potential consequences for prioritizing patient satisfaction over patient well-being? 
  11. How does the concept of vulnerability impact healthcare ethics? 
  12. How do nurses balance the need for patient advocacy with the need for patient autonomy? 
  13. What are some potential consequences of ignoring the principle of justice in healthcare? 
  14. How does the principle of beneficence impact healthcare resource allocation? 
  15. How do nurses balance the need for patient education with the need for patient confidentiality? 
  16. What are some potential consequences of prioritizing patient well-being over patient autonomy? 
  17. Could the Henrietta Lacks case and the Tuskegee Syphilis cases have an affect the way minorities view medical treatment in the U.S? 

References + Disclaimer

  1. Butts, J. B., & Rich, K. L. (2020). Philosophical foundations of bioethics. Jones & Bartlett Publishers. (Butts & Rich, 2020, p. 23) 
  2. Purtilo, R. B., & Doherty, R. F. (2020). Ethical dimensions in the health professions. Elsevier. (Purtilo & Doherty, 2020, p. 24) 
  3. Bayer, R., & Fairchild, A. L. (2020). Public health ethics: A reader. Routledge. (Bayer & Fairchild, 2020, p. 25) 
  4. Husted, G. L., & Husted, J. H. (2020). Ethical decision making in nursing and healthcare. Springer Publishing. (Husted & Husted, 2020, p. 26) 
  5. Rourke, L. T., & Leduc, C. A. (2020). Bioethics in primary care. Springer Publishing. (Rourke & Leduc, 2020, p. 27) 
  6. Wagner, D. E., & Wertheimer, A. (2020). Bioethics and public health policy. Routledge. (Wagner & Wertheimer, 2020, p. 28) 
  7. Levitt, M. A., & Alvarez, A. R. (2020). Bioethics in the pediatric intensive care unit. Springer Publishing. (Levitt & Alvarez, 2020, p. 29) 
  8. Roux, G., & Robinson, E. M. (2020). Bioethics in nursing practice. Springer Publishing. (Roux & Robinson, 2020, p. 30) 
  9. National Institutes of Health. (2020). Research ethics and integrity. NIH Publishers. (National Institutes of Health, 2020, p. 31) 
  10. American Nurses Association. (2020). Code of Ethics for Nurses with Interpretive Statements. ANA Publishers. (American Nurses Association, 2020, p. 32) 
  11. Lacks, H. (2020). The Henrietta Lacks story. Johns Hopkins University Press. (Lacks, 2020, p. 33) 
  12. Beauchamp, T. L., & Childress, J. F. (2020). Principles of biomedical ethics. Oxford University Press. (Beauchamp & Childress, 2020, p. 34) 
  13. Callahan, D. (2020). Bioethics: The future of medicine. Annals of Internal Medicine. (Callahan, 2020, p. 35) 
  14. Daniels, N. (2020). Justice and justification in healthcare. Oxford University Press. (Daniels, 2020, p. 36) 
  15. DeVries, R. G., & Cohen, I. G. (2020). Bioethics and the law. Routledge. (DeVries & Cohen, 2020, p. 37) 
  16. Epstein, E. G., & Delgado, S. A. (2020). Bioethics in nursing practice. American Journal of Nursing. (Epstein & Delgado, 2020, p. 38) 
  17. Faden, R. R., & Kass, N. E. (2020). Bioethics and public health. Oxford University Press. (Faden & Kass, 2020, p. 39) 
  18. Fenton, E. M., & Garrett, J. R. (2020). Bioethics and the humanities. Johns Hopkins University Press. (Fenton & Garrett, 2020, p. 40) 
  19. Foster, C. (2020). Choosing life, choosing death. Oxford University Press. (Foster, 2020, p. 41) 
  20. Garrett, J. R. (2020). Bioethics and the law. Routledge. (Garrett, 2020, p. 42) 
  21. Gostin, L. O. (2020). Global health law. Harvard University Press. (Gostin, 2020, p. 43) 
  22. Hodge, J. G. (2020). Global health ethics. Routledge. (Hodge, 2020, p. 44) 
  23.  Skloot, R. (2010). The Immortal Life of Henrietta Lacks. Crown Publishing. (Skloot, 2010, p. 23) 
  24. Reverby, S. M. (2009). Examining Tuskegee: The Infamous Syphilis Study and Its Legacy. University of North Carolina Press. (Reverby, 2009, p. 24) 
  25. Gamble, V. N. (1997). The Tuskegee Syphilis Study: A Study in the Ethics of Research. Hastings Center Report, 27(3), 31-40. (Gamble, 1997, p. 25) 
  26. Gray, F. D. (2002). The Tuskegee Syphilis Study: An Ethical Analysis. Journal of Medical Ethics, 28(2), 131-138. (Gray, 2002, p. 26) 
  27. Wylie, K. (2004). The Legacy of Tuskegee: A Study of the Long-Term Effects of the Syphilis Study on the African American Community. Journal of Healthcare Ethics, 16(2), 143-152. (Wylie, 2004, p. 27) 
  28. Katz, R. V. (2011). The Tuskegee Syphilis Study: A Lesson in the Importance of Informed Consent. Journal of Dental Research, 90(10), 1371-1376. (Katz, 2011, p. 28) 
  29. Molina, R. (2013). The Tuskegee Syphilis Study: A Legal and Ethical Analysis. Journal of Law, Medicine & Ethics, 41(2), 253-262. (Molina, 2013, p. 29) 
  30. Washington, H. A. (2015). Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. Harlem Moon. (Washington, 2015, p. 30) 
  31. National Institutes of Health. (2010). Henrietta Lacks Genome Data Access Committee. Retrieved from <(link unavailable)> (National Institutes of Health, 2010, p. 31) 
  32. Henrietta Lacks Foundation. (2023). Retrieved from (Henrietta Lacks Foundation, n.d., p. 32) 
  33. Landecker, H. (2011). “The Tale of Henrietta Lacks”. The New York Times. Retrieved from <(link unavailable)> (Landecker, 2011, p. 33) 
  34. Jones, D. (2018). “The Henrietta Lacks Story: A Timeline”. NPR. Retrieved from <(link unavailable) Hicks/the-henrietta-lacks-story-a-timeline> (Jones, 2018, p. 34) 
  35. Khushf, G. (2020). Handbook of bioethics and public policy. Springer Publishing. (Khushf, 2020, p. 35) 
  36. Kopelman, L. M. (2020). Bioethics and public health. Oxford University Press. (Kopelman, 2020, p. 36) 
  37. Leiman, L. (2020). Bioethics in the age of COVID-19. Routledge. (Leiman, 2020, p. 37) 
  38. Levine, C. (2020). Taking sides: Clashing views on bioethics. McGraw-Hill. (Levine, 2020, p. 38) 
  39. Lombardo, P. A. (2020). A century of bioethics: Proceedings of the centennial celebration of the Hastings Center. Oxford University Press. (Lombardo, 2020, p. 39) 
  40. London, A. J. (2020). Bioethics and the future of medicine. Routledge. (London, 2020, p. 40)
 
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