Ethical Theories
Moral Reasoning in Nursing Practice

Ethical theories provide a structured approach to moral reasoning in nursing practice.

Ethical issues in nursing are better understood if the nurse explores the various methods of moral reasoning that are used to make judgments about the moral value of an action.

There are three classes of theories used most often for moral reasoning in nursing practice.

• teleological or utilitarian theories - teleological - is derived from the Greek word "telos" meaning end and the word "logos" meaning science.


• deontological or principle based theories - deontological - is derived from the word "deon" which refers to duty.


• relational or caring theories

The names given to each of these classifications reflect the approach to the moral reasoning process that results in a judgment of moral wrong and right about a specific action.

Utilitarian Theories

The utilitarian theories follow the line of moral reasoning that suggests that an act is morally good or bad based on its outcome or effect. Under this line of reasoning the action that brings the most good to the most numbers of people would be considered to be a "good" or morally correct act. This approach is sometimes referred to as a consequence based approach to moral reasoning and is often used to make decisions about funding and the delivery of health care in the Canadian health care system.

Deontological Theories

The deontological theories of moral reasoning emphasize the rightness of a particular action based on the ideas that certain principles must be upheld in human relationships. When trying to reason out what is the most moral action to take it is not the nature of the outcome that is judged. The action itself is judged to be morally right or wrong after consideration of individual rights, duties, and obligations that apply in the situation. In Canada there is a moral and legal obligation in nursing practice to act in the best interest of the patient even if that action is not in the best interest of the employer, the physician, or any other health care provider. The moral reasoning used in the following argument against capital punishment uses a deontological approach. "The purposeful killing of human beings is wrong and society uses that reasoning to make laws and punish people who commit such crimes. As humans we have an obligation to follow this principle and not then commit the same crime in the name of justice."

Relational or "Caring" Ethical Theories

These theories bring an entirely new perspective to the process of moral reasoning for ethical issues in nursing. Actions are not judged according to the outcome or the principles of duty and obligation. But rather a perspective of caring and responsibility is used to determine what might be a morally correct act. In others words the morally good act is the one that shows caring and concern for other people and what might be important to them.

The three types of ethical theories use entirely different criteria for moral reasoning in order to come to a decision about right and wrong.

Often when people disagree about "doing the right thing" it is because they are using different methods of moral reasoning to make a decision about the correct course of action. This becomes more obvious when these theories are examined in light of the questions that might be asked to make the moral determination of right and wrong.

Teleological Theories	Deontological Theories	Relational Theories
What is the the action that will bring about the best consequence? What is the best thing to do here that will bring about the most good for the most people?	What is my duty or obligation in this case? To whom or what principle must I remain true? What rights do the people involved have and whose rights supersede the rights of others?	What is the nature of the relationships to be considered in this decision? How does my caring influence my action or my beliefs about what I should do?

Why do Nurses Need to Understand Ethical Theories?

An understanding of the process of moral reasoning helps professional nurses to understand different view points. This is especially helpful when:

• the correct or morally "right" course of action is not immediately apparent when ethical issues in nursing practice are encountered.
• there is disagreement among family members or members of the health care team as to the most appropriate actions in a particular situation.

All nursing programs in Canada are required to have nursing ethics as part of the curriculum and this content is tested on the Canadian Registered nurse Exam.

---

Here is a list of all the the pages on this website (including this one) that contain more specific information about ethics in nursing.

Nursing Ethics in Canada - an introduction to the regulations that require ethical nursing practice in Canada.

What is the Nursing Code of Ethics for nursing practice in Canada?

The What's and Why's of an Ethical Code for Nursing Practice

Ethical Theories - a brief explanation of the three classifications of ethical theories used most often by nurses

What is an Ethical Dilemma in Nursing Practice? - a description of the ethical principles used in moral reasoning in nursing practice.

Ethical Decision Making in Nursing Practice - the Influence of Personal and Professional Values

Ethical Issues in Nursing Practice in Canada - What are Some of the Current Ethical Issues in Nursing?

The requirement for Ethics in Nursing Curriculum in Canada

---