Foundation in theory

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break down of healthcare ethics

Question 1

In your own words, define ethical principles. Discuss an example that you have heard about or experienced where ethical principles have been used to resolve a complex health care issue. What ethical principle(s) were used in this example?

Your journal entry must be at least 200 words in length. No references or citations are necessary.

Question 2

How does utilitarianism affect health care decision-making? Provide an example.

Your response must be at least 200 words in length.

Question 3s

Provide an example of a health care ethical issue, and explain what ethical principle or principles are most appropriate for resolving the issue.

Your response must be at least 200 words in length.

HCA 3302, Critical Issues in Health Care 1

Course Learning Outcomes for Unit I

Upon completion of this unit, students should be able to:

7. Discuss common ethical principles applied to critical bioethical issues.
7.1 Evaluate common principles and theories of health care ethics.


Learning Outcomes
Learning Activity


Unit Lesson
Chapter 1
Chapter 2
Unit I Assessment

Required Unit Resources

Chapter 1: Theory of Healthcare Ethics

Chapter 2: Principles of Healthcare Ethics

Unit Lesson

In this unit, we will discuss foundations in theory. Particularly, we will learn about different theories and
principles of health care ethics. Having a solid foundation of the theories and principles of health care ethics
will allow you to have greater clarity when it comes to ethical decision-making in health care. Change,
particularly in health care, is not new. More specifically, it is a driving force and theme of the current health
care arena. Health care ethics are the moral principles that govern the U.S. health care delivery system. They
provide a framework for which health care products and services are delivered. The 21st century promises
individual, societal, and organizational health care ethical challenges (Morrison & Furlong, 2014). Before
discussing the current state of health care ethics (in future units), it is important to understand the history
behind health care ethics and the theories and principles.

Ancient Greek philosophers sought to understand and apply reasoning in determining the correct course of
action for a situation and how to explain why it was correct (Morrison & Furlong, 2019). Thomas Percival
wrote Percival’s Medical Ethics in 1803, and the American Medical Association (AMA) first met and
established the AMA Principle in 1847. These codes of ethics were established in accordance with the trends
of medicine at the time (AMA, 2017). Recognition and acknowledgement of the rights and needs of patients
receiving highly technical care grew as technology advanced (Mastrian & McGonigle, 2017).

Medical decisions are made based on sound facts and ethical values. Historically, health care decision-
making and patient privacy have been kept by health care professionals using codes of ethics, laws,
principles, and regulations. Ethics codes consist of a list of principles. Several organizations have developed
codes of ethics for patients as well as health care professionals.

Developed by professional organizations, examples of health care codes of ethics include the following:

• American Nurses Association Code of Ethics for Nurses,
• American Association of Medical Assistants (AAMA) Code of Ethics for Medical Assistants,
• AMA Code of Medical Ethics, and
• American Health Information Management Association Code of Ethics.

Foundations in Theory

HCA 3302, Critical Issues in Health Care 2


Normative Ethical Theories

Normative ethics use reasoning as a means of determining the right course of action that should be taken in
certain situations. Normative ethics is the examination of right and wrong. There are six types of normative

• Authority-based theories are typically faith-based and can be purely ideological. An example of this
type of theory would be the works of Karl Marx (1818–1883) or capitalism (Morrison & Furlong, 2019).
These theories determine the right thing to do based on an understanding of what an authority has
said. Most often, religion-based ethics are avoided in health care because they lack the evidence to
support them.

• Natural law theory is the traditional interpretations and works of St. Thomas Aquinas (1224–1274).
Both rationally and in accordance with God’s providence and wisdom, nature has order (Morrison &
Furlong, 2019). This is a moral theory and a legal theory. It is believed that natural law is an inherent
part of nature. This type of theory is important in health care because of the influence of the Roman
Catholic Church and the teachings of St. Thomas Aquinas as an early writer of ethics. Debates about
abortion and social justice are rooted in the natural law theory (Morrison & Furlong, 2014).

• Teleological theories, called consequentialism, advocate that decisions are made from outcomes or
consequences. The idea is to maximize the good of a situation. Consequentialism includes classical
utilitarianism that consist of actions that are dependent on net benefit. It also includes rule
utilitarianism, which are rules that have the greatest net benefit (Morrison & Furlong, 2014). An
action’s consequence is the focus rather than the moral duties (Dixon, n.d.). The originators of this
theory were Jeremy Bentham (1748–1832) and Stuart Mill (1806–1873).

• Deontological theories originated from the work of Immanuel Kant (1724–1804). This theory is the
science of determining duties. It suggests that taking the right action does not always lead to a better
outcome (Morrison & Furlong, 2019). Deontological ethical theories focus on moral obligations and
duties and not so much on the action’s consequences or end. Moral duties are more important that
moral value (Dixon, n.d.).

• Virtue ethics aim to find the proper end for human beings and then to look for that end. This can be
where people seek excellence or perfection. It is used when training health care professionals
(Morrison & Furlong, 2014). The goal of virtue ethics is to build character. It places less weight on
learning rules and strains the importance of developing respectable habits of character (Fieser, n.d.).
It is used as an avenue to assist health professionals with finding their highest good with an intent of
improving health care outcomes. Virtue ethics are used most often in health care and are the premise
for holding medical clinicians to a set of moral standards. Virtue ethics can be traced back to Plato
(427–347 BCE) and Aristotle (384–322 BCE; Morrison & Furlong, 2019).

• Egoistic theories argue that what is correct is what maximizes a person’s self-interest (Morrison &
Furlong, 2019). Egoistic theories are rooted in self-interest and do not take into account the benefit
decisions may have on others outside of oneself. Egoism is a less popular ethical theory because
self-interest supersedes the interest of patients. In health care, the ethical approach of the health care
providers is to put the patient and his or her preferences above the preferences of the care team. In
other words, these types of theories are not ideal in health care because patient interest is deemed to
be the priority.

Principles of Health Care Ethics

The principles of ethics are based on theory and provide a foundation for responding to unforeseen health
care issues, such as the uncertainty that existed with the implementation of the Patient Protection and
Affordable Care Act or ACA of 2010, also known as Obamacare. Although the ACA has been in place for
nearly a decade, ethical issues remain a public concern.

• Nonmaleficence means to do no harm. There is no debate over whether to avoid doing harm in health
care ethics, but a debate does arise as to what the term harm means (Morrison & Furlong, 2014).
This is the first part of the Hippocratic ethical teaching, “first do no harm . . . .”

• Beneficence means to avoid harm and suggest a level of altruism. In health care, it is a common
morality. This is the second part of the Hippocratic ethical teaching, “. . . benefit only.” In all situations,
health care organizations must do all they can do to benefit a patient (Saint Joseph’s University,

HCA 3302, Critical Issues in Health Care 3


• Autonomy means self-ruling. In health care, it can be unclear as to whether or not a patient
possesses the conditions required for autonomy (Morrison & Furlong, 2014). Is a patient competent to
make decisions? A patient has the right to control his or her body and make his or her own decisions
independently and in accordance with personal beliefs and values (Saint Joseph’s University, 2017).

• Theories of justice consist of two main theories: procedural justice and distributive justice. Procedural
justice is due process. In health care, procedural injustices do occur. Distributive justice relates to
what is fair when decision makers are determining how to separate benefits and burdens (Morrison &
Furlong, 2014). Resource allocation has a lot to do with distributive justice. There should be fairness
in all health care decisions; this includes decisions of benefits and burdens and equal distribution of
new treatments or scarce resources. Health care providers must follow all regulations and laws when
treating a patient and making decisions (Saint Joseph’s University, 2017).

Health Care Equilibrium

Principles of ethics take part in the necessary elements for health care equilibrium. Health care equilibrium is
grounded in ethical principles. Justice is complex because what is right is subjective and can always be
disputed. An awareness of rights and justice is essential for the allocation of health care resources (Morrison
& Furlong, 2014). Ethical principles used in health care have helped shape how other industries practice.
Despite the number of ethical principles that exist, not one theory alone will satisfy every complex issue,
which is why more than one is often needed to make health care decisions. The reflective equilibrium
decision-making model can be applied to issues at hand by going through the ethical theories, principles,
morality, and judgments. Typically, in health care, an ethics panel or committee is trained in applying this
model to decision-making.


Ethics is a complex arena. In the 21st century and beyond, the scarcity of health care resources and the
continuous spread of infectious diseases globally will increase the demand for health care professionals and
stakeholders to use ethical concepts and reasoning to improve health care outcomes. An awareness of the
ethical principles that exist is essential for policy makers and health professionals when working with patients
and their families as well as implementing health care reform (Morrison & Furlong, 2014). The cornerstone of
decision-making in health care is ethics. However, health care as a whole has embraced the concept of a
patient-centered mode.


American Medical Association. (2017). History of the code. https://www.ama-

Dixon, M. (n.d.). Normative ethical theories: A closer examination. Ohio Northern University.

Fieser, J. (n.d.). Ethics. In J. Fieser, & B. Dowden (Eds.), Internet encyclopedia of philosophy.

Mastrian, K. G., & McGonigle, D. (2017). Informatics for health professionals. Jones & Bartlett Learning.

Morrison, E. E., & Furlong, B. (Eds.). (2014). Health care ethics: Critical issues for the 21st century (3rd ed.).

Jones & Bartlett Learning.

Morrison, E. E., & Furlong, B. (Eds.). (2019). Health care ethics: Critical issues for the 21st century (4th ed.).

Jones & Bartlett Learning.

Saint Joseph’s University. (2017). How the four principles of health care ethics improve patient care.

  • Course Learning Outcomes for Unit I
  • Required Unit Resources
  • Unit Lesson
    • Normative Ethical Theories
    • Principles of Health Care Ethics
    • Health Care Equilibrium
    • Conclusion
    • References

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