Principles of Ethics

What kinds of acts are right in oncology nursing practice? This basic yet complex question is commonly asked by nurses in oncology and other specialties to determine what they should do in a specific case or how the entire profession should act regarding interactions with patients, families, and colleagues. General ethical principles often are used as guides for right action. The first such contemporary example that proposed principles as guides in a health-related area was the Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1979), which identified the principles of respect for persons, beneficence, and justice in human subjects research. In 1981, Beauchamp and Childress built on this work and applied it to health care in the first edition of their book Principles of Biomedical Ethics, now in its seventh edition (Beauchamp & Childress, 2012). They proposed four key principles: respect for autonomy, beneficence (the obligation to do good), nonmaleficence (the duty not to harm), and justice. Others in bioethics have suggested additional derivative principles, including veracity (the obligation to tell the truth), fidelity (the duty to keep promises), and avoidance of killing (Veatch, Haddad, & English, 2010). Although helpful in illuminating shared values and important ethical norms in health care, the principlist approach to ethics is not without its problems and critics. For example, polarities and problems exist within the principles themselves, such as tensions between present versus future expressions of autonomy (Collopy, 1988) or disagreement regarding who is best suited to determine benefit (Childress, 1982). Conflicts can also arise between principles, such as when one is attempting to fulfill the demands of respect for autonomy, which can run counter to the health professional’s obligation to avoid harm. Additionally, no one principle of the four is given primacy, so determining which principle carries the day in