Chapter 6 Flashcards
What was considered to be the first code of ethics for nurses?
a. The Nightingale Pledge
b. American Code of Ethics for Professional Nurses
c. Code of Ethics for Nurses with Interpretive Statements
d. Canadian Nurses Association Code of Ethics
a. The Nightingale Pledge
A community health nurse (CHN) facing an ethical dilemma is not able to determine which option would have the best outcome. She talks to her supervisor and lets the supervisor decide which action to take. Into which ethical category does the CHN’s decision fall?
a. The decision is appropriate because the supervisor is responsible for the CHN’s choices.
b. The decision is intelligent because the supervisor has access to resource persons (spiritual leaders, physicians, administrators) who may know of options that the CHN has not considered.
c. The decision is advisable, but only as an opportunity to further discuss the issue, because ultimately the CHN is still responsible for her own choice.
d. The decision is smart because the supervisor would be more aware of community priorities.
c. The decision is advisable, but only as an opportunity to further discuss the issue, because ultimately the CHN is still responsible for her own choice.
A community health nurse (CHN) finds that a family has decided to refuse medical intervention for a particular health concern because the intervention could affect the family member’s ability to return to work, and consequently the family’s resources would be drastically reduced. Which of the following actions by the CHN would ethically be most appropriate in this situation?
a. The CHN should appreciate that the couple has made the decision that they feel is best for their family and take no further action if it is clear that they have made an informed choice.
b. The CHN should insist that every individual in society has a right to health care and that the family will have to find some way to raise funds for the needed treatment.
c. The CHN should talk to the social worker on the health care team to see if he or she can convince the couple to agree to the medical intervention.
d. The CHN should arrange a meeting with the family to discuss the consequences of the couple’s decision.
a. The CHN should appreciate that the couple has made the decision that they feel is best for their family and take no further action if it is clear that they have made an informed choice.
The family is choosing not to proceed with treatment because they’re weighing the economic survival of the household. And as long as they’ve made an informed decision, the nurse has to respect that.
No matter how medically irrational or financially heartbreaking it seems, if the family understands the risks and consequences, it’s not the nurse’s job to override them. The nurse’s role is to educate, support, and respect
A pregnant teenage client asks a community health nurse (CHN) to provide information on
abortions and a list of health care providers who offer abortion services. The CHN has very strong personal beliefs against abortion that would get in the way of helping the client. What should the CHN do?
a. Call in another CHN to care for this client.
b. Explain, from the personal perspective, all the reasons why abortion should be made illegal.
c. Offer the client a combination of oral contraceptives to induce spontaneous abortion.
d. Provide information on alternatives to abortion and give the client information on adoption agencies.
a. Call in another CHN to care for this client.
A team of community health nurses (CHNs) disagree about the appropriate action to take
in relation to a family with an ill family member who have chosen to continue working at
their jobs instead of taking time off to care for the ill family member. One CHN states, “It
is the wife’s responsibility to care for her ill husband.” What type of thinking is this CHN
applying?
a. Consequentialism
b. Deontological ethics
c. Principlism
d. Utilitarianism
b. Deontological ethics
This question is about ethical frameworks in nursing, specifically deontological ethics.
Why is the correct answer “b. Deontological ethics”?
• Deontological ethics (also known as duty-based ethics) focuses on following moral rules and duties regardless of the consequences.
• In this scenario, the CHN believes it is the wife’s duty to care for her ill husband, implying that roles and responsibilities should be followed as a moral rule.
• The CHN is not considering the consequences (such as financial burdens or emotional stress on the wife), but rather what they perceive as a duty or obligation.
Why not the other options?
• (a) Consequentialism – Focuses on the outcome or consequences of actions. The CHN in this scenario does not evaluate whether the outcome will be good or bad—they simply believe in a fixed duty.
• (c) Principlism – Involves four ethical principles (autonomy, beneficence, nonmaleficence, and justice). The CHN is not balancing multiple ethical principles but instead applying a rigid rule.
• (d) Utilitarianism – Focuses on maximizing overall happiness or benefits. The CHN is not considering the best outcome for everyone—they are applying a fixed rule of duty instead.
Key Takeaways
• Deontological ethics = duty-based thinking (e.g., “It is your responsibility, regardless of the situation.”)
• Consequentialism & Utilitarianism = results-based thinking (e.g., “What will have the best outcome for everyone?”)
• Principlism = balancing ethical principles (e.g., “What is fair, just, and respects autonomy?”)
A team of community health nurses (CHNs) disagree about the appropriate action to take
in relation to a family with an ill family member who have chosen to continue working at
their jobs instead of taking time off to care for the ill family member. One CHN states,
“The whole family is being affected and will fall apart if they don’t focus on the family’s
needs first.” What type of thinking is this CHN applying?
a. Communitarianism
b. Deontological ethics
c. Principlism
d. Utilitarianism
d. Utilitarianism
This question is about ethical frameworks in nursing, specifically utilitarianism.
Why is the correct answer “d. Utilitarianism”?
• Utilitarianism is an outcome-based (consequentialist) ethical theory that focuses on choosing actions that maximize overall benefit and minimize harm for the greatest number of people.
• The CHN in this scenario is prioritizing the well-being of the entire family rather than just the individual.
• The statement “The whole family is being affected and will fall apart if they don’t focus on the family’s needs first” suggests that the CHN is making a decision based on what will lead to the best overall outcome for the majority (the family as a whole).
Why not the other options?
• (a) Communitarianism – This ethical approach emphasizes the good of the community and shared values, but the CHN is focused specifically on maximizing benefit for the family unit, not the broader community.
• (b) Deontological ethics – This is a duty-based approach (e.g., “It is the wife’s obligation to care for the husband”), but the CHN here is thinking about outcomes rather than fixed duties.
• (c) Principlism – This approach balances four principles (autonomy, beneficence, nonmaleficence, and justice), but the CHN in this case is mainly focused on beneficence for the majority rather than balancing multiple ethical principles.
Key Takeaways
• Utilitarianism = “Greatest good for the greatest number.”
• The CHN is weighing the impact of decisions on the entire family rather than focusing on individual rights or duties.
• Utilitarianism is often used in public health and resource allocation (e.g., prioritizing vaccine distribution to reduce overall harm).
A team of community health nurses (CHNs) disagree about the appropriate action to take
in relation to a family with an ill family member who have chosen to continue working at
their jobs instead of taking time off to care for the ill family member. One CHN asks,
“What sort of example does this behaviour set for the community? What if everyone
always put their jobs before their families?” What type of thinking is this CHN applying?
a. Communitarianism
b. Deontological ethics
c. Principlism
d. Utilitarianism
a. Communitarianism
What is Communitarianism?
Communitarianism is an ethical and political philosophy that emphasizes the importance of the community and the common good over individual interests. It argues that people have moral responsibilities not just to themselves but also to their social groups, including families, neighborhoods, and broader communities.
Key Ideas of Communitarianism:
1. Community First:
• Individual actions should be evaluated based on their impact on the well-being of the community as a whole.
• People should act in ways that strengthen social cohesion and collective welfare.
2. Moral Responsibility:
• Individuals owe obligations to their community beyond personal freedoms and choices.
• Ethical decisions are not just about individual rights but also about social values and shared responsibilities.
3. Social Norms and Traditions:
• Encourages people to follow norms that promote social harmony and stability.
• Cultural values and traditions play a role in shaping what is considered ethically right or wrong.
How It Applies to the Question:
The CHN in the scenario is concerned about the broader impact of the family’s decision on the community, questioning:
“What if everyone always put their jobs before their families?”
This reflects communitarian thinking because:
✔ The CHN is focusing on the collective consequences of individual actions.
✔ The question implies that personal choices should align with community values and expectations.
✔ There is an underlying belief that family and caregiving responsibilities contribute to a healthy and stable society.
Why Not the Other Options?
• (b) Deontological Ethics – Focuses on duty and moral rules, regardless of consequences. The CHN is thinking about outcomes for the community, not just moral rules.
• (c) Principlism – Relies on four principles (autonomy, beneficence, non-maleficence, and justice). The CHN’s reasoning is more about social consequences than these individual principles.
• (d) Utilitarianism – Aims for the greatest good for the greatest number, but in a broader sense. Communitarianism is more focused on shared community values rather than just maximizing benefits.
Final Takeaway:
Communitarianism values collective well-being over individual autonomy and emphasizes the responsibilities individuals have toward their community. The CHN in this case is applying communitarian thinking by considering how personal choices shape social norms and impact collective health outcomes.
A team of community health nurses (CHNs) disagree about the appropriate action to take
in relation to a family with an ill family member who have chosen to continue working at
their jobs instead of taking time off to care for the ill family member. One CHN states,
“But it doesn’t have to be either–or. Perhaps the family members could take turns calling
in sick for just 2 or 3 days. That way, they could all help and yet not upset their employers.
Wouldn’t that be fair?” What type of thinking is this CHN applying?
a. Communitarianism
b. Deontological ethics
c. Principlism
d. Utilitarianism
c. Principlism
Why is “Principlism” the Correct Answer?
Principlism is an ethical framework that applies four key ethical principles to decision-making:
1. Autonomy – Respecting individuals’ right to make their own choices.
2. Beneficence – Promoting good and acting in the best interest of others.
3. Non-maleficence – Avoiding harm.
4. Justice – Ensuring fairness and equity.
How This Scenario Reflects Principlism:
• The CHN is trying to balance multiple ethical principles:
• Autonomy → Recognizing the family’s decision to continue working.
• Beneficence & Non-maleficence → Encouraging a caregiving solution that doesn’t overwhelm any single family member.
• Justice → Aiming for a fair approach that does not harm employment stability.
• The CHN proposes a compromise that distributes responsibility fairly, showing an ethical balancing act rather than a rigid moral rule.
Why the Other Options Are Incorrect:
• (a) Communitarianism
• Focuses on the greater good of the community rather than individual rights.
• This CHN is balancing individual and group needs, not prioritizing community norms.
• (b) Deontological Ethics
• Based on absolute moral duties and rules (e.g., “You must always put family before work”).
• The CHN is not applying strict rules, but rather seeking a flexible, fair approach.
• (d) Utilitarianism
• Focuses on maximizing overall happiness and minimizing suffering for the greatest number.
• The CHN is not just maximizing happiness but ensuring fairness and ethical balance.
Final Takeaway:
Principlism is correct because the CHN is weighing multiple ethical principles (autonomy, beneficence, non-maleficence, and justice) to find a fair and practical solution. It’s an ethical compromise rather than a strict moral rule or community-driven decision.
A team of community health nurses (CHNs) disagree about the appropriate action to take in relation to a family with an ill family member who have chosen to continue working at their jobs instead of taking time off to care for the ill family member. A CHN states, “It’s not up to us; it’s the family’s decision.” What type of thinking is this CHN applying?
a. Communitarianism
b. Deontological ethics
c. Principlism
d. Utilitarianism
c. Principlism (autonomy)
Core Principles of the Four Ethical Theories
Each of the ethical frameworks—Communitarianism, Deontological Ethics, Principlism, and Utilitarianism—has distinct guiding principles that shape decision-making. Here’s a breakdown:
- Communitarianism
Focus: Community well-being over individual interests
✔ Social Responsibility – Ethical decisions should benefit society as a whole.
✔ Collective Good – The well-being of the community takes priority over personal autonomy.
✔ Moral Traditions & Norms – Values are shaped by cultural, social, and historical contexts.
✔ Duties to Others – Individuals have obligations to contribute to the common good.
🔹 Example: Supporting a mandatory vaccination program because it protects public health, even if some individuals object.
- Deontological Ethics (Duty-Based Ethics)
Focus: Moral duties and rules, regardless of consequences
✔ Moral Absolutes – Some actions are always right or wrong, regardless of their outcomes.
✔ Duty & Obligation – Ethical behavior follows strict moral duties (e.g., honesty, keeping promises).
✔ Intrinsic Morality – The intent behind an action matters more than the consequences.
✔ Universalization – If an action is right, it should be a universal rule for everyone (Kant’s categorical imperative).
🔹 Example: A nurse refuses to lie to a patient about their prognosis, even if the truth might cause distress.
- Principlism
Focus: Balancing ethical principles in decision-making
✔ Autonomy – Respecting individuals’ rights to make their own choices.
✔ Beneficence – Promoting good and acting in the best interest of others.
✔ Non-Maleficence – Avoiding harm (“Do no harm”).
✔ Justice – Ensuring fairness and equitable distribution of resources.
🔹 Example: A CHN respects a family’s right to choose whether to take time off work to care for an ill relative while also considering what is fair and beneficial.
- Utilitarianism (Consequentialism)
Focus: Maximizing overall happiness and minimizing harm
✔ Greatest Good for the Greatest Number – Actions are ethical if they benefit the majority.
✔ Consequences Matter – Right and wrong are determined by the outcomes of actions, not intentions.
✔ Cost-Benefit Analysis – Ethical choices weigh harm vs. benefit to society.
✔ Impartiality – No one’s interests are inherently more important than another’s.
🔹 Example: Allocating limited ICU beds to patients with the highest survival chances instead of a first-come, first-served.
Final Takeaway:
• Communitarianism → Community-focused ethics.
• Deontology → Rule-based morality.
• Principlism → Balanced ethical reasoning.
• Utilitarianism → Outcome-driven decision-making.
Each approach has strengths and weaknesses, and healthcare professionals often use a mix depending on the situation. Would you like an example applied to a healthcare scenario?
A team of community health nurses (CHNs) disagree about the appropriate treatment for Mrs. Mehta, who is likely an excellent candidate for hospice care. The first CHN says that deciding on care, rather than cure, is up to Mrs. Mehta, and no one else can decide for her. The second CHN says that it is the responsibility of the health care team to do what is best for Mrs. Mehta, and if the physician thinks there is still a possibility of cure, then the CHNs should do everything they can to implement the treatment plan. The third CHN says it is not fair for the family to expend all their resources on Mrs. Mehta, who is probably going to die in spite of the care provided by the health care team. What conclusions can be drawn from this dispute?
a. Ethical principles can conflict with each other.
b. The first CHN is correct because autonomy demands that the patient herself decide.
c. The second CHN is correct because professional health care providers profess or promise to always do the best for those under their care.
d. The third CHN is correct because utility demands the maximization of benefit for the majority.
a. Ethical principles can conflict with each other.
After hearing the debates about an appropriate course of action for a specific client, a community health nurse (CHN) expresses a desire for a rule that would help with decision
making. What criteria could the CHN apply to this rule for his or her decision making?
a. The rule absolutely will not get the CHN in trouble with the employer.
b. The rule will gain the support of an expert, such as a spiritual leader.
c. The CHN would recommend the rule to anyone in a similar situation.
d. The supervisor would feel comfortable reporting the rule to the administration.
c. The CHN would recommend the rule to anyone in a similar situation.
This question is about ethical decision-making in nursing, specifically applying the universalizability test, which is a principle from deontological ethics (Kantian ethics).
Why is the correct answer “c. The CHN would recommend the rule to anyone in a similar situation”?
• This reflects universalizability, meaning that an ethical rule should be consistently applied to everyone in similar situations.
• If a rule is truly ethical, it should be something that anyone, anywhere, could follow without leading to contradictions or unfairness.
• This approach ensures that ethical decisions are fair, just, and non-discriminatory.
Why not the other options?
• (a) The rule absolutely will not get the CHN in trouble with the employer.
• This focuses on self-preservation rather than ethics.
• Just because something avoids trouble doesn’t mean it is ethical.
• (b) The rule will gain the support of an expert, such as a spiritual leader.
• Ethical decisions should be based on moral reasoning, not just seeking approval from authority figures.
• Experts may provide insight, but their opinion does not automatically make something ethical.
• (d) The supervisor would feel comfortable reporting the rule to the administration.
• While supervisor approval can indicate that an action is reasonable, ethics should not depend on administrative comfort.
• A rule can be ethically right but controversial or uncomfortable for leadership.
Key Takeaways
• The universalizability test asks, “Would this rule be acceptable if everyone followed it?”
• Ethical decisions should be fair, consistent, and applicable to all.
• Nursing ethics often use this test to ensure fairness and avoid bias in patient care.
A man, bleeding profusely and screaming, perhaps out of fear, cries out “I’ve got a right to see a doctor. I’m hurt. Someone has to take care of me!” What ethical premise could justify such a demand?
a. All hospitals receive provincial/territorial funding, and all employed adults pay taxes; so, all adults have a right to what their tax money has purchased.
b. Saving an individual’s life improves society and upholds tradition.
c. Our society believes that all persons should be treated equally and that basic needs, such as being saved from death, if possible, should be met.
d. The man has a property right to his own body, and government is responsible to ensure that property rights are protected.
c. Our society believes that all persons should be treated equally and that basic needs, such as being saved from death, if possible, should be met.
When working with a parent who will not vaccinate their child, what is the best way the public health nurse can work through this ethical dilemma?
a. Apply the Oberle and Raffin model
b. Discuss with colleagues at lunch table
c. Consult with a friend who also does not vaccinate
d. Start a qualitative research study on why parents do not vaccinate their children.
a. Apply the Oberle and Raffin model
The Oberle and Raffin Model is an ethical decision-making framework specifically designed for nurses to navigate complex ethical dilemmas in healthcare. It provides a structured way to analyze ethical issues, balance competing values, and guide decision-making.
Key Components of the Oberle and Raffin Model
The model consists of four interrelated components:
1. Context – Understanding the social, cultural, and personal factors that influence the ethical issue (e.g., why the parent refuses vaccination).
2. Relationships – Recognizing the nurse’s professional duty, the parent’s rights and beliefs, and the child’s best interest.
3. Reflection – Encouraging critical thinking about the ethical dilemma, including legal, professional, and ethical responsibilities.
4. Ethical Action – Determining the most ethical course of action while balancing respect for autonomy, beneficence, and public health.
Why is this model used in vaccine refusal cases?
• Considers the context of vaccine hesitancy (e.g., misinformation, religious beliefs, or distrust in healthcare).
• Acknowledges relationships between nurses, families, and public health responsibilities.
• Encourages ethical reflection on how to balance individual rights with public health concerns.
• Promotes ethical action through education, respectful communication, and evidence-based practice.
Why not the other options?
• (b) Discussing with colleagues at lunch – While peer discussion can be helpful, it doesn’t provide a structured ethical framework.
• (c) Consulting a friend who is also anti-vaccine – This introduces bias rather than an objective ethical approach.
• (d) Starting a qualitative research study – Research can provide insights but does not help resolve the immediate ethical issue.
Key Takeaway
The Oberle and Raffin Model helps nurses approach ethical dilemmas systematically, ensuring decisions are made thoughtfully and ethically rather than based on personal biases.
A physician refuses to order pain medication for a person with a substance use disorder who was severely injured in a car accident. When the community health nurse (CHN) requests medication to be used p.r.n., the physician states that the client’s suffering from the pain of his injuries will build character. What ethical theory is the physician using (or
misusing)?
a. Consequentialism
b. Communitarianism
c. Virtue ethics
d. Utilitarianism
c. Virtue ethics
This question is about virtue ethics, an ethical theory that focuses on moral character and personal virtues rather than rules or consequences.
Why is the correct answer “c. Virtue ethics”?
• Virtue ethics is based on the idea that ethical behavior stems from developing good character traits (virtues) such as courage, honesty, and compassion.
• In this scenario, the physician refuses to prescribe pain medication, believing that suffering will “build character”—this reflects a misapplication of virtue ethics, where the focus is on personal moral growth rather than the patient’s well-being.
• The ethical flaw in this case is that virtue ethics should be used to guide compassionate care, not justify unnecessary suffering.
Why not the other options?
• (a) Consequentialism – This focuses on the outcome of an action. The physician is not considering outcomes but rather the moral “virtue” of suffering.
• (b) Communitarianism – This is about what benefits the community as a whole rather than individual morality.
• (d) Utilitarianism – This seeks the greatest good for the greatest number; the physician’s reasoning is not based on maximizing benefit but on the belief that pain itself is a moral teacher.
Key Takeaways
• Virtue ethics = Focus on moral character rather than strict rules or outcomes.
• Misuse of virtue ethics can lead to neglect of patient well-being under the belief that suffering has value.
• In healthcare, ethical practice requires balancing virtue ethics with principles like beneficence (doing good) and nonmaleficence (avoiding harm).
What is the central, most important concept or action in nursing today?
a. Adapting to the use of computers and other technological advances
b. Caring
c. Distinguishing nursing care from medical care
d. Seeking evidence-based outcomes
b. Caring
Gilligan and Noddings both believe in the morality of responsibility in relationships. They emphasize connection. Which following term describes this belief?
a. A distributive justice approach
b. A feminist ethic of care
c. A principled approach
d. Virtue ethics
b. A feminist ethic of care
This question is about the feminist ethic of care, a moral philosophy developed by Carol Gilligan and Nel Noddings.
What is the Feminist Ethic of Care?
• It is an ethical framework that prioritizes relationships, empathy, and responsibility for others, particularly in caregiving roles.
• It challenges traditional male-centered ethical theories (such as justice-based approaches) and emphasizes the importance of emotions, connection, and context in ethical decision-making.
• Gilligan introduced this concept in response to Kohlberg’s moral development theory, arguing that women’s moral reasoning often focuses on care and relationships rather than abstract principles.
• Noddings expanded on this by stating that ethical care should be based on genuine personal engagement and nurturing relationships.
Why is the correct answer “b. A feminist ethic of care”?
• The question mentions a “morality of responsibility in relationships” and “emphasizing connection”, which aligns directly with the feminist ethic of care.
• This approach prioritizes the well-being of individuals within relationships rather than abstract principles or rigid rules.
Why not the other options?
• (a) A distributive justice approach
• This focuses on fair distribution of resources and justice, not relationships or care.
• It is more about equity, fairness, and rights-based approaches.
• (c) A principled approach
• This refers to principlism (autonomy, beneficence, nonmaleficence, justice), which is not focused on relationships or caregiving.
• (d) Virtue ethics
• While virtue ethics emphasizes character and moral development, it does not specifically focus on care and relationships the way feminist ethics does.
Key Takeaways
• The Feminist Ethic of Care is a relationship-centered approach to ethics.
• It values compassion, empathy, and context in decision-making.
• It challenges traditional ethics that emphasize justice, rules, and universal principles over personal connections.
What outcome needs to occur in order to claim that advocacy has been truly successful or effective?
a. Audiences agree with a CHN who is advocating a change.
b. Legislators discuss appropriate legislation to better allocate resources.
c. People demand that the disenfranchised be better treated.
d. Systematic social changes are made to improve quality of life.
d. Systematic social changes are made to improve quality of life.
What is the best way to determine if a community health nurse (CHN) has been effective in advocating for community health needs and planning and implementing appropriate interventions?
a. Asking the CHN about the basis for the interventions and the CHN’s perception of their effectiveness
b. Examining the community’s morbidity and mortality rate
c. Reassessing community health needs to determine if they have been met
d. Systematically surveying community residents regarding their perception
b. Examining the community’s morbidity and mortality rate
Much ethical debate has revolved around issues in acute health care, for example, the continuation or withdrawal of medical treatment. In such a specific situation, what is typically the dominant concern?
a. Doing what is best for the community
b. Doing what is best for the family
c. Obeying legal mandates
d. Upholding the client’s autonomy
d. Upholding the client’s autonomy
Which of the following terms means telling the truth?
a. Nonmaleficence
b. Principlism
c. Utilitarianism
d. Veracity
d. Veracity
