Unit 1 - Foundations of Prescribing Practice

Ethical Basis of Intervention



Adams, John, Ethical issues in independent and Supplementary prescribing in Courtenay, M. and Griffiths, M. (2004) Independent and Supplementary Prescribing: An Essential Guide. London: Greenwich Medical Media. Chapter 5.

Ethical theory

In a nutshell, ethics is, "concerned with the promotion of the high standards of conduct by which the public rightly expects health care practitioners to abide" (Courtenay and Griffiths, 2004). Ethics is to do with codes of behaviour based on a system of moral beliefs about right and wrong. This is usually applied in accordance with the principles of professional conduct. Healthcare ethics has its roots in moral philosophy and is concerned with the character and conduct of individuals in the pursuance of good practice.

Non-maleficence and beneficence

Non-maleficence could be considered as the oldest principle applied to humankind, coming as it does from the maxim primum non nocere - above all, do no harm (Beauchamp and Childress, 1989).

Beneficence is the principle of promoting or benefiting the good of/for the individual (Singleton and McLaren, 1995) and is considered to be central to nursing philosophy, application and care.


All nursing interventions that cause distress, fear or pain breach the principle of non-maleficence. However, the usual motivation for the intervention is to promote good for the patient.

Make Notes

With consideration to the above sentence, write down some interventions where you think your future prescribing decisions may be influenced by non-maleficence and beneficence.
Consider factors that may influence your decisions.
Consider the benefit and harm to each patient in each situation.


The NMC code of professional conduct: standards for conduct, performance and ethics (2004).

NMC Guidelines for the Administration of Medicines (2004)


Non-maleficence and beneficence would be useful topics for reflective practice. You may find it helpful to discuss this with your clinical supervisor.

Autonomy and paternalism

Nurses have a duty to respect an individual's autonomy. This is defined as the right to self-government or the freedom to determine one's own actions and behaviours. As there must be some social, cultural and legal limits to complete autonomy, Beauchamp and Childress (1989) suggest that 'autonomy should be respected in so far as it does not interfere with the autonomy of another'.


Think about the implications of patients/clients determining their own actions and behaviours, particularly during times of ill health or infirmity.

Do we, as nurses, enhance patients' potential for maximising autonomy, and do we — in all circumstances — protect patients whose autonomy has been lost?

Sometimes professionals justify actions or inactions in healthcare by citing the 'doctor/nurse knows best' doctrine. This may be a subconscious mechanism to further the aim of the professional by overriding the patient's or client's autonomy. Justification may be sought on the premise that 'it is in the patient's best interest'. This culture of paternalism is not considered to be an ethical principle to apply, as it denies patients' autonomy.

Link to another Unit

You will find more information on this subject in 'Compliance and concordance' in Unit 4, Prescribing Partnerships.

Further Reading

Further reading

Bartter, K. (2001) Ethical Issues in Advanced Nursing Practice. Oxford: Butterworth Heinemann.

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