Bioethical principles and the Code of Ethics

Ethics questions are among the easiest points on the NLE once you can name the principle at play. Most stems describe a nurse's action and ask which principle it upholds or violates. Learn the six principles as behaviors, not definitions.

The six bioethical principles

Principle	Meaning	Classic exam cue
Autonomy	Respect for the client's right to decide	Honoring refusal, obtaining consent, no coercion
Beneficence	Doing good, acting in the client's best interest	Comfort measures, promoting wellbeing
Nonmaleficence	Do no harm, prevent harm	Raising side rails, checking doses, reporting abuse
Justice	Fairness in distributing care and resources	Triage, equal care regardless of status
Veracity	Truth telling	Answering honestly about diagnosis or errors
Fidelity	Keeping promises and commitments	Returning when promised, not abandoning clients

Watch for these traps:

• Beneficence versus nonmaleficence: beneficence actively promotes good; nonmaleficence prevents or avoids harm. Giving pain relief is beneficence; withholding a contraindicated drug is nonmaleficence.
• Autonomy versus paternalism: paternalism overrides client choice "for their own good" and violates autonomy, even with kind intentions.
• Veracity versus nondisclosure: the family asking the nurse to hide a diagnosis from a competent adult sets veracity and autonomy against family wishes. The client's right to the truth prevails, though the physician discloses the medical diagnosis.

Related ethical concepts

• Confidentiality: protecting client information; sharing only with those directly involved in care.
• Privacy: the client's control over personal space and body exposure.
• Accountability: answering for one's own judgments and actions.
• Stewardship: responsible use of resources.
• Double effect: an action with a good intended effect may be permissible even with a foreseen bad effect, as when adequate opioid doses relieve terminal pain but may depress respiration.

The Code of Ethics for Filipino nurses

The Board of Nursing, with the accredited professional organization, promulgated the Code of Ethics for registered nurses under the authority of RA 9173. Its framework centers on the nurse's fourfold responsibility: to promote health, prevent illness, restore health, and alleviate suffering. Core themes organize the nurse's duties toward:

• People: respect for human dignity, individuality, beliefs, and confidentiality
• Practice: competence, accountability, and personal responsibility for growth
• Co-workers: collegial, collaborative relationships and refusal to cover up incompetence
• Society and environment: participation in community health and civic duties
• The profession: upholding its integrity, supporting the professional organization, and advancing nursing through research

Violation of the Code is a ground for disciplinary action, including revocation or suspension of the certificate of registration.

Working through an ethical dilemma

A true dilemma exists when two or more ethical principles conflict and every option sacrifices something. Steps in ethical decision-making mirror the nursing process:

1. Gather the facts and identify the ethical problem
2. Identify the stakeholders and the principles in conflict
3. Explore options and their consequences
4. Choose, act, and evaluate

On the exam, when principles collide, client autonomy usually outweighs family wishes for a competent adult, and safety (nonmaleficence) outweighs convenience or institutional pressure. Ethics committees exist to guide difficult cases; referring a persistent dilemma to the committee is often a correct answer when bedside resolution fails.

Key points

• Name the principle by the behavior: refusal honored is autonomy, harm prevented is nonmaleficence, promise kept is fidelity, truth told is veracity, fair allocation is justice, good actively done is beneficence.
• Paternalism violates autonomy even when well-intentioned.
• The Code of Ethics flows from RA 9173, and violating it can cost the license.
• The fourfold responsibility: promote health, prevent illness, restore health, alleviate suffering.
• In dilemma stems, first identify which two principles conflict; the best answer usually preserves the client's own informed decision.
• Do not confuse ethics with law: an act can be legal but unethical, or ethical but illegal; the exam may ask you to classify which is which.