SECTION III.

ETHICAL DIRECTIVES FOR OTHER HEALTH-CARE PROFESSIONS

•
This section demonstrates the great number and diversity of ethical In providing care, the nurse promotes an environ-
directives for healthcare professionals other than physicians. The section ment in which the human rights, values, customs
opens with several codes of ethics for nurses, followed by ethics directives and spiritual beliefs of the individual, family and
for other professional groups from chiropractors and dentists to social community are respected.
workers and hospital administrators.
The nurse ensures that the individual receives
Most of the documents in this section represent professional sufficient information on which to base consent for
organizations in the United States.
care and related treatment.
The nurse holds in confidence personal information
and uses judgement in sharing this information.
The nurse shares with society the responsibility for
CODE FOR NURSES initiating and supporting action to meet the health
and social needs of the public, in particular those of
International Council of Nurses vulnerable populations.
1973, REAFFIRMED 1989, REVISED 2000 The nurse also shares responsibility to sustain and
protect the natural environment from depletion,
pollution, degradation and destruction.
• • •
2. Nurses and practice
The International Council of Nurses first adopted an international The nurse carries personal responsibility and ac-
code of ethics for nurses in 1953 and revised it in 1965. In 1973, the countability for nursing practice, and for maintain-
council adopted a new code, which was reaffirmed in 1989, and ing competence by continual learning.
revised in 2000. The text of the International Code for Nurses follows. The nurse maintains a standard of personal health
such that the ability to provide care is not
<http://www.icn.ch/icncode.pdf> compromised.
The nurse uses judgement regarding individ-
ual competence when accepting and delegating
Preamble responsibility.
Nurses have four fundamental responsibilities: to pro- The nurse at all times maintains standards of
mote health, to prevent illness, to restore health and to personal conduct which reflect well on the profes-
alleviate suffering. The need for nursing is universal. sion and enhance public confidence.
Inherent in nursing is respect for human rights, includ- The nurse, in providing care, ensures that use of
ing the right to life, to dignity and to be treated with respect. technology and scientific advances are compatible
with the safety, dignity and rights of people.
Nursing care is unrestricted by considerations of age, colour,
creed, culture, disability or illness, gender, nationality, poli- 3. Nurses and the profession
tics, race or social status. The nurse assumes the major role in determining
Nurses render health services to the individual, the and implementing acceptable standards of clini-
cal nursing practice, management, research and
family and the community and co-ordinate their services
education.
with those of related groups.
The nurse is active in developing a core of research-
based professional knowledge.
THE CODE The nurse, acting through the professional
organisation, participates in creating and maintain-
The ICN Code of Ethics for Nurses has four principal ing equitable social and economic working condi-
elements that outline the standards of ethical conduct. tions in nursing.
4. Nurses and co-workers
Elements of the Code The nurse sustains a co-operative relationship with
co-workers in nursing and other fields.
1. Nurses and people The nurse takes appropriate action to safeguard
The nurse’s primary professional responsibility is to individuals when their care is endangered by a co-
people requiring nursing care. worker or any other person.

2748 ENCYCLOPEDIA OF BIOETHICS 3rd Edition

 SECTION III. ETHICAL DIRECTIVES FOR OTHER HEALTH-CARE PROFESSIONS
•
Suggestions for use of the ICN Code of and the accompanying interpretive statements provide a framework for
Ethics for Nurses ethical decision making that includes several noteworthy aspects: (1) It
identifies the values and beliefs that undergird the ethical standards;
The ICN Code of Ethics for Nurses is a guide for action (2) it encompasses a breadth of social and professional concerns; (3) it
based on social values and needs. It will have meaning only as manifests an awareness of the ethical implications of shifting profes-
a living document if applied to the realities of nursing and sional roles and of the complexity of modern health care; and (4) it goes
health care in a changing society. beyond prescriptive statements regarding personal and professional
conduct by advocating a sense of accountability to the client.
To achieve its purpose the Code must be understood,
internalised and used by nurses in all aspects of their work. It Although the text of the code remains essentially unchanged from
the 1976 revision, both the organization and the text of the interpretive
must be available to students and nurses throughout their
statements have been modified somewhat. Among the changes: (1) The
study and work lives. discussion of human dignity following point 1 is expanded and includes
specific statements that “the nurse does not act deliberately to terminate
the life of any person,” but that nurses may provide symptomatic
Applying the Elements of the ICN Code of intervention to dying clients “even when the interventions entail
Ethics for Nurses substantial risks of hastening death”; and (2) a statement under point
11 in the 1976 code, that “quality health care is mandated as a right to
The four elements of the ICN Code of Ethics for Nurses:
all citizens,” has been deleted. The 2001 ANA Code for Nurses and the
nurses and people, nurses and practice, nurses and co- text of selected interpretive statements are at <http://www.nursingworld.
workers, and nurses and the profession, give a framework for org/ethics/code/ethicscode150.htm>.
the standards of conduct. The following chart will assist
nurses to translate the standards into action. Nurses and
nursing students can therefore:
• Study the standards under each element of
the Code. CODE OF ETHICS FOR NURSING
• Reflect on what each standard means to you. Canadian Nurses Association
Think about how you can apply ethics in your
nursing domain: practice, education, research or 1985, REVISED 1991
management.
• Discuss the Code with co-workers and others.
• • •
• Use a specific example from experience to identify
ethical dilemmas and standards of conduct as
outlined in the Code. Identify how you would The introductory sections of the Canadian Nurses Association (CNA)
resolve the dilemma. code suggest a sophisticated view of the role of codes. For example, the
code “provides clear direction for avoiding ethical violations,” that is,
• Work in groups to clarify ethical decision making
“the neglect of moral obligation,” but it cannot resolve “ethical
and reach a consensus on standards of ethical dilemmas,” in which there are “ethical reasons both for and against a
conduct. particular course of action.” The code also cannot relieve the “ethical
• Collaborate with your national nurses’ association, distress” that occurs “when nurses experience the imposition of practices
co-workers, and others in the continuous applica- that provoke feelings of guilt, concern or distaste.” The CNA code is
tion of ethical standards in nursing practice, unique in its explicit organization around values, which “express broad
education, management and research. ideals of nursing”; obligations, which are “moral norms that have their
basis in nursing values”; and limitations, which “describe exceptional
circumstances in which a value or obligation cannot be applied.”

CODE FOR NURSES WITH Preamble

INTERPRETIVE STATEMENTS
Nursing practice can be defined generally as a “dy-
American Nurses’ Association namic, caring, helping relationship in which the nurse assists
1950, REVISED 1976, 1985, 2001 the client to achieve and maintain optimal health.” Nurses
in clinical practice, education, administration and research
• • • share the common goal of maintaining competent care and
improving nursing practice. “Nurses direct their energies
The 1985 Code for Nurses is a revised version of the code adopted by the toward the promotion, maintenance and restoration of
American Nurses’ Association (ANA) in 1950. The eleven-point code health, the prevention of illness, the alleviation of suffering

ENCYCLOPEDIA OF BIOETHICS 3rd Edition 2749