Deontology and Utilitarianism: Ethical Theories for Nurses

Ethics is the study of right and wrong, and it is essential for all nurses to have a strong understanding of ethical principles. Nurses make important decisions every day that can have a profound impact on the lives of their patients, so it is vital that they have a framework for making ethical choices.

Two of the most important ethical theories in nursing are deontology and utilitarianism. Deontology is a duty-based ethic that focuses on the rightness or wrongness of an action, regardless of the consequences. Utilitarianism is a consequentialist ethic that focuses on choosing the action that will produce the greatest good for the greatest number of people.

Deontology

Deontology is based on the idea that there are certain moral duties that we all have, and that these duties should guide our actions. Deontologists believe that there are certain actions that are always wrong, regardless of the consequences. For example, it is always wrong to lie, steal, or kill, even if doing so would produce a good outcome.

Deontology is often applied to nursing in the form of ethical codes and standards. These codes and standards provide nurses with guidance on how to act in ethically challenging situations. For example, the American Nurses Association Code of Ethics states that nurses have a duty to respect their patients’ autonomy and to provide them with compassionate care.

Key principles of deontology

• Respect for persons: Deontologists believe that all people have inherent dignity and worth, and that they should be treated with respect. This includes respecting their autonomy, their rights, and their privacy.
• Duty: Deontologists believe that we all have moral duties, and that these duties should guide our actions. These duties may come from a variety of sources, such as religion, law, or our own personal values.
• Universality: Deontologists believe that moral principles should be universal, meaning that they should apply to everyone in all situations. This means that we should not make exceptions to moral rules, even if doing so would produce a good outcome.

Application of deontology in nursing

Deontology can be applied to nursing in a variety of ways. For example, nurses can use deontology to guide their decisions about patient care, confidentiality, and end-of-life care.

Here are some examples of how deontology can be applied in nursing:

• Respect for patients’ autonomy: Nurses should respect their patients’ right to make their own decisions about their care. This means providing patients with all the information they need to make informed decisions, and respecting their decisions even if the nurse disagrees with them.
• Beneficence: Nurses have a duty to act in their patients’ best interests. This means providing them with the best possible care, even if it is difficult or time-consuming.
• Non-maleficence: Nurses have a duty to avoid harming their patients. This means being careful not to make mistakes, and being honest with patients about the risks and benefits of any treatment or procedure.
• Justice: Nurses have a duty to treat all patients fairly. This means providing all patients with the same standard of care, regardless of their race, ethnicity, religion, or social status.

Utilitarianism

Utilitarianism is a consequentialist ethic that focuses on choosing the action that will produce the greatest good for the greatest number of people. Utilitarians believe that the morality of an action is determined by its consequences, and that we should always choose the action that will produce the best possible outcome.

Utilitarianism is often applied to nursing in the form of cost-benefit analysis. Cost-benefit analysis is a process of weighing the potential benefits and risks of an action before making a decision. For example, a nurse might use cost-benefit analysis to decide whether to start a new treatment for a patient, or to allocate resources to one patient over another.

Key principles of utilitarianism

• The greatest good for the greatest number: Utilitarians believe that we should always choose the action that will produce the greatest good for the greatest number of people. This means that we should consider the needs of all stakeholders, including the patient, their family, the healthcare system, and society as a whole.
• Utility: Utility is the measure of the good or happiness that an action produces. Utilitarians believe that we should always choose the action that will produce the greatest utility.
• Impartiality: Utilitarians believe that we should treat all people equally, and that we should not make exceptions to moral rules based on personal biases or prejudices.

Nursing is a profession that is constantly faced with ethical dilemmas. Nurses must make decisions that can have a profound impact on the lives of their patients, and they often have to weigh competing ethical values.

Deontology and utilitarianism are two ethical theories that can be used to help nurses make ethical decisions. Deontology focuses on the rightness or wrongness of an action, regardless of the consequences. Utilitarianism focuses on choosing the action that will produce the greatest good for the greatest number of people.

Here are some examples of how nurses might use deontology and utilitarianism to make ethical decisions:

• Case study 1: A patient refuses life-saving treatment

A patient with a terminal illness refuses life-saving treatment. The patient is competent and understands the consequences of their decision.

Deontological perspective: A deontological perspective would respect the patient’s autonomy and their right to refuse treatment. Even though the patient’s decision may lead to their death, it is still their right to make that decision.

Utilitarian perspective: A utilitarian perspective would focus on the consequences of the patient’s decision. The utilitarian might argue that the patient’s death would cause their family and friends a great deal of pain and suffering. They might also argue that the patient’s death would deprive society of a valuable member.

• Case study 2: A nurse is asked to falsify patient records

A nurse is asked by their supervisor to falsify patient records in order to meet quality assurance standards. The nurse knows that falsifying patient records is wrong, but they are afraid of losing their job if they refuse.

Deontological perspective: A deontological perspective would focus on the rightness or wrongness of falsifying patient records. The deontologist would argue that falsifying patient records is always wrong, regardless of the consequences.

Utilitarian perspective: A utilitarian perspective would focus on the consequences of falsifying patient records. The utilitarian might argue that falsifying patient records would allow the nurse to keep their job and continue to provide care for other patients. However, they might also argue that falsifying patient records would undermine public trust in the healthcare system.

• Case study 3: A nurse has to decide which of two patients to treat first during a triage situation

During a mass casualty event, a nurse has to decide which of two patients to treat first. One patient is a young child with a minor injury, and the other patient is an elderly person with a severe injury.

Deontological perspective: A deontological perspective would focus on the rights of the two patients. The deontologist might argue that the child has a greater right to life because they have a longer life expectancy. However, they might also argue that the elderly person has a greater right to treatment because they are in more immediate need.

Utilitarian perspective: A utilitarian perspective would focus on the consequences of treating each patient. The utilitarian might argue that treating the child first would save more lives in the long run, because the child has a longer life expectancy. However, they might also argue that treating the elderly person first would be more compassionate, because the elderly person is in more immediate pain and suffering.

These are just a few examples of how nurses might use deontology and utilitarianism to make ethical decisions. It is important to note that there is no one right way to use either of these theories. Nurses must weigh the specific circumstances of each situation and make the decision that they believe is best.

Conclusion

Deontology and utilitarianism are two ethical theories that can be used to help nurses make ethical decisions. Deontology focuses on the rightness or wrongness of an action, regardless of the consequences. Utilitarianism focuses on choosing the action that will produce the greatest good for the greatest number of people.

Nurses must weigh the specific circumstances of each situation and make the decision that they believe is best. There is no one right way to use either deontology or utilitarianism.

Future implications

The field of ethics is constantly evolving, and new ethical theories are being developed all the time. It is important for nurses to stay up-to-date on the latest ethical theories and frameworks so that they can make informed decisions in their practice.

FAQs

• What is the difference between right and wrong in nursing?

The difference between right and wrong in nursing is a complex question that can be answered in different ways depending on the ethical theory that one subscribes to. Deontology focuses on the rightness or wrongness of an action, regardless of the consequences. Utilitarianism focuses on choosing the action that will produce the greatest good for the greatest number of people.

• How do I make ethical decisions as a nurse?

There is no one right way to make ethical decisions as a nurse. However, there are some frameworks and tools that can help nurses make informed and ethical decisions. One helpful tool is the four-step ethical decision-making process:

Identify the ethical dilemma. What is the situation that is causing you to make an ethical decision? What are the different options available to you?

1. Gather information. What information do you need to make an informed decision? This may include information about the patient’s condition, their prognosis, their treatment options, and their values and preferences.
2. Consider the ethical principles involved. What ethical principles are relevant to the situation? These principles may include autonomy, beneficence, non-maleficence, and justice.
3. Weigh the options. Consider the potential benefits and risks of each option. Think about how each option will affect the patient, their family, and the healthcare system.
4. Make a decision. Based on your assessment of the ethical principles and the potential benefits and risks, make a decision about the best course of action.

5. What are some common ethical dilemmas in nursing?

Some common ethical dilemmas in nursing include:

• End-of-life care: Nurses may face ethical dilemmas when caring for patients who are dying. These dilemmas may include decisions about whether to start or continue life-sustaining treatment, and whether to provide palliative care.
• Consent: Nurses must obtain informed consent from patients before providing any treatment or procedure. This can be a challenge when patients are unconscious or incompetent, or when they are refusing treatment that the nurse believes is in their best interest.
• Confidentiality: Nurses have a duty to protect the confidentiality of their patients’ information. This can be a challenge when nurses are working in a team environment, or when they are required to report certain information to the authorities.
• Resource allocation: Nurses may face ethical dilemmas when they have limited resources and they have to decide which patients to treat first, or how to allocate scarce resources such as ventilators.

• How can I apply deontology and utilitarianism to my nursing practice?

You can apply deontology and utilitarianism to your nursing practice by using them to guide your decision-making process. When faced with an ethical dilemma, you can ask yourself what the deontological and utilitarian perspectives are on the situation. This can help you to think through the different options and to make a decision that is consistent with your own ethical values.

Here are some specific examples of how you can apply deontology and utilitarianism to your nursing practice:

• Deontology: You can respect patients’ autonomy by providing them with all the information they need to make informed decisions about their care, and by respecting their decisions even if you disagree with them. You can also promote beneficence by acting in your patients’ best interests, and by providing them with the best possible care. You can also avoid non-maleficence by being careful not to make mistakes, and by being honest with patients about the risks and benefits of any treatment or procedure. Finally, you can promote justice by treating all patients fairly, and by providing all patients with the same standard of care.
• Utilitarianism: You can maximize the good for the greatest number of people by making decisions that will benefit the most people. You can also balance the needs of individuals and society by considering the impact of your decisions on both individuals and society as a whole. Finally, you can consider the consequences of your actions by thinking about the potential benefits and risks of each option.