moral principles are statements about broad, general, philosophic concepts such as autonomy and justice.

They provide the foundation for moral rules, which are specific prescription for actions. For example, the rule people should not lie is based on the moral principle of respect for persons (autonomy). Principles are useful in ethical discussion because even if people disagree about which action is right in a situation, they may be able to agree on the principles that apply. Such an agreement can serve as the basic for a solution that is acceptable to all parties. For example, most people would agree to the principle that nurses are obligated to respect their clients, even if they disagree as to whether the nurse should deceive a particular client about his or her prognosis.

Autonomy refers to the right to make ones own decisions. Nurses who follow this principle recognize that each client is unique, has the right to be what that person is, and has the right to choose personal goals. People have inward autonomy if they have the ability to make choices; they have outward autonomy if their choices are not limited or imposed by others. Honoring the principle of autonomy means that the nurse respect a clients right to make decisions even when those choices seem to the nurse not to be in the clients best interest. It also means treating others with consideration. In a health care setting this principle is violated, for example, when a nurse disregards clients subjective accounts of their symptoms. Finally, respect for autonomy means that the people should not be treated as an impersonal source of knowledge or training. This principle comes into play, for example, in the requirement that clients provide informed consent before tests, procedures, research, or being a teaching subject can be carried out.

Nonmaleficence is duty to do no harm. Although this would seem to be a simple principle to followe, in reality it is complex. Harm can mean intentionally causing harm, placing someone at risk of harm, and unintentionally causing harm. In nursing, intentional harm is never acceptable. However, placing a person at risk of harm has many facets. A client may be at risk of harm as a known consequence of a nursing intervention that is intended to be helpful. For example, a client may react adversely to a medication. Caregivers do not always agree on the degree of risk that is morally permissible in order to attempt the beneficial result. Unintentional harm occurs when the risk could not have anticipated. For example, while catching a client who is falling, the nurse grips the client tightly enough to cause bruises to the clients arm.

Beneficence means doing good. Nurses are obligated to the good, that is, to implement actions that benefit clients and their support persons. However, doing good can also pose a risk of doing harm. For example, a nurse may advise a client about a strenuous exercise program to improve general health, but should not do so if the client is at risk of a heart attack.

Justice is often referred to as fairness. Nurses often face decisions in which a sense of justice should prevail. For example, a nurse making home visits finds one client tearful and depressed, and knows she could help by staying for 30 more minutes to talk. However, that would take time from her next client, who is diabetic who needs a great deal of teaching and observation. The nurse will need to weigh the facts carefully in order to divide her time justly among her clients.

Fidelity means to be faithful to agreements and promises. By virtue of their standing as professional caregivers, nurses have responsibilities to clients, employers, government, and society, as well as to themselves. Nurses often make promises such as Ill be right back with your pain medication or Ill found out for you clients take such promises seriously, and so should nurses.

Veracity refers to telling the truth. Although this seems straightforward, in practice choices are not always clear. Should a nurse tell the truth when it is known that it will cause harm? Does a nurse tell the truth when it is known that the lie will relieve anxiety and fear? Lying to sick or dying people is rarely justified. The loss of trust In the nurse and the anxiety caused by not knowing the truth, for example, usually outweigh any benefits derived from lying.

Nurses must also have professional accountability and responsibility. According to the code of ethics for nurses (ANA, 2001), accountability means answerable to oneself and others for ones own actions, while responsibility refers to the specific of duties of a particular role. Thus, ethical nurse acts, able to explain the rationale for all conduct, and recognizing the standards to which he or she will be held.