Key Takeaways
- Core ethical principles: Autonomy, Beneficence, Non-maleficence, Justice, Fidelity, Veracity
- Autonomy = respecting patient's right to make their own decisions
- Non-maleficence = "do no harm"; Beneficence = "do good"
- Treat all patients fairly regardless of personal characteristics (Justice)
- Maintain professional boundaries—don't accept gifts or develop personal relationships
Ethical Principles in Healthcare
Ethics are principles that guide right and wrong behavior. Healthcare ethics help CNAs make good decisions and provide care that respects patients' values and rights.
Core Ethical Principles
| Principle | Definition | Example in CNA Practice |
|---|---|---|
| Autonomy | Respecting patient's right to make their own decisions | Allowing resident to refuse bath |
| Beneficence | Doing good; acting in patient's best interest | Providing comfort measures |
| Non-maleficence | "Do no harm"; avoiding actions that harm | Not leaving side rails down |
| Justice | Treating all patients fairly and equally | Not giving preferential treatment |
| Fidelity | Being faithful to promises and commitments | Returning when you say you will |
| Veracity | Being truthful and honest | Accurately reporting observations |
Autonomy: Respect for Self-Determination
Autonomy means patients have the right to:
- Make their own healthcare decisions
- Refuse treatment
- Be informed before making decisions
- Have their choices respected
CNA Application:
- Allow choices in daily care
- Respect "no" when a patient refuses
- Don't force care on unwilling patients
- Support independence
Limitations: Autonomy may be limited when:
- Patient is not competent to decide
- Decisions would harm others
- Emergency situations require immediate action
Beneficence and Non-Maleficence
Beneficence (doing good):
- Provide quality care
- Promote well-being
- Advocate for patients
- Go above minimum requirements
Non-maleficence (avoiding harm):
- Never abuse patients
- Follow safety protocols
- Report errors
- Don't take shortcuts
- Prevent falls and injuries
Balancing the Two: Sometimes these principles conflict. Example: A painful injection (harm) that prevents disease (good).
Justice: Fair Treatment
Justice requires:
- Equal treatment regardless of:
- Race, ethnicity, religion
- Age, gender, sexual orientation
- Ability to pay
- Social status
- Personal characteristics
- Fair allocation of resources
- No favoritism or discrimination
CNA Application:
- Provide the same quality care to all residents
- Don't let personal feelings affect care
- Advocate for fair treatment
- Report discrimination
Fidelity and Veracity
Fidelity (faithfulness):
- Keep promises
- Follow through on commitments
- Be reliable and dependable
- Maintain trust
Veracity (truthfulness):
- Document accurately
- Report honestly
- Don't cover up mistakes
- Be truthful with patients (within scope)
Ethical Dilemmas
An ethical dilemma occurs when:
- Two ethical principles conflict
- There is no clear "right" answer
- Any choice has negative consequences
Example Dilemmas:
| Situation | Conflicting Principles |
|---|---|
| Patient refuses life-saving treatment | Autonomy vs. Beneficence |
| Family wants information patient doesn't want shared | Autonomy vs. Family wishes |
| Limited resources, multiple patients | Justice (who gets priority?) |
| Resident asks you to keep secret from nurse | Fidelity vs. Non-maleficence |
What CNAs Should Do with Ethical Concerns
Do:
- Report concerns to supervisor
- Follow facility policies
- Use chain of command
- Participate in care conferences
- Seek guidance when unsure
Don't:
- Try to resolve complex ethical issues alone
- Impose your personal values on patients
- Make decisions outside your scope
- Ignore ethical concerns
- Judge patients for their choices
Professional Boundaries
Boundaries are limits that define the professional relationship between caregivers and patients.
Maintaining Boundaries:
| Appropriate | Inappropriate |
|---|---|
| Friendly and warm | Personal friendships outside work |
| Professional relationship | Dating or romantic relationship |
| Maintaining professional distance | Sharing personal problems with residents |
| Following care plan | Accepting gifts or money |
| Respecting privacy | Sharing your opinions on their life choices |
| Advocating for needs | Making promises you can't keep |
Signs of Boundary Violations:
- Spending extra time with favorite patients
- Accepting gifts
- Sharing personal information
- Keeping secrets from the team
- Special treatment of certain patients
- Feeling responsible for patient's happiness
A patient refuses to take their medication. According to the ethical principle of autonomy, what should the CNA do?
Which ethical principle means "do no harm"?
A resident offers the CNA $20 as a thank-you gift. What should the CNA do?