Nursing practice is based on the philosophy of ethics of care. As its name indicates, this is
based on the care of others from a responsible and empathetic point of view, bearing in
mind its peculiar and contextual characteristics (Barrio Cantalejo, 1999). It grants
importance to ethical, moral and sentimental values such as the commitment with the
health care of patients, with the priority of working for the wellbeing and human rights of
patients and assisting their needs in an effective and humanized way (Fry, 1989).
Apart from the current legislation, health care staff work on the basis of there being ethical
codes produced by the professional colleges and which are agreed rules, approved by
consensus of its membership. These documents gather a set of rules based on values that
are formulated and assumed by those carrying out a professional activity with the purpose
of maintaining a certain level of requirements, competence and quality at work.
Nurses, in their representation of the organisms that regulate them, have produced codes
of conduct in order to regulate decision making in professional practice. These codes are
based on values that are their foundation and are adapted to the social and cultural
context in which they work. Nurses’ ethical codes have evolved with the profession; at the beginning of the nursing profession, Florence Nightingale considered that the nurse should
act within ethical rules and extended the principles of traditional medical ethics (doing
good, not evil) with those of confidentiality and truth (Amaro Cano, 2004).
The International Council of Nurses (ICN) published in 1953 the first deontological code for
nurses that has served as a guide for international ethical codes worldwide and is adapted
as a national code in countries that have produced no other. It is defined as “a guide for action based on social values and needs”. In the preamble section it describes
fundamental duties of nurses, which are: to promote and restore health, prevent illness
and alleviate suffering and it declares that nursing is universally needed. It considers
inherent to nursing respect for human rights and declares there can be absolutely no
discrimination in nursing care. In turn, in element 1 of section 5, it considers the nurse co-
responsible together with society to “start and maintain any action aimed at satisfying public health and social needs, in particular those of vulnerable populations” (Consejo Internacional de Enfermeras, 2012).
Later, in 1986, Official College of Technical Health Assistants and Nursing Graduates of
Barcelona produced the Nursing Code of Ethics with the framework of the GHL and it was
adopted for all Catalonian Colleges by the agreement of the Council of Nursing Colleges of
Catalonia. Its section 1, General Principles, considers that “respect for all human and social rights of the individual, family and community must constitute the fundamental
ethical attitude of professional conscience” and that it is a person’s fundamental right to have the maximum degree of health that can be attained. In turn, it considers health a
public good and that nursing staff must work towards the health system reaching all the
population. It also rejects discrimination for any reason and states that “the nurse must not abandon a patient/user who needs vigilance or nursing care without assuring their
continuance” (Col·legi Oficial Infermeria de Barcelona, 1986).
The Deontological Code for Spanish Nursing, produced by the Spanish General Nursing
Council in 1989, considers that professional ethics must be the framework of the
profession and that the ethical must guide reflection both in extreme and routine situations.
In its conceptual framework, it defines human, society, health and nursing and it is based
on the values of human health, liberty and dignity. It considers duties of nursing to be
serious and responsible professional commitment, active participation in society,
recognition and application of the principles of professional ethics and respect for human
The Codes of Ethics and Conduct of European Nursing, produced by the European
Federation of Nursing Regulatory Organs in 2007, whose principle purpose is to guarantee
the safety of people receiving nursing care in Europe, advising the nursing regulatory
organs on the fundamental principles that they must bear in mind in producing their codes
of ethics and conduct and to inform patients and nurses on common standards of ethics
and conduct, what is expected of all nurses working in Europe. In section 3.4 “Equitable access to quality health care” it considers nurses to be responsible for caring with no discrimination whatsoever and considers nurses as a representative of recognising that
health is a right and, as such, they must defend it “preventing illnesses, caring for patients and carrying out duties of rehabilitation” (Federación Europea de Órganos Reguladores de Enfermería, 2007).
The Catalonian Nurses’ Code of Ethics, elaborated by Council of Nursing Colleges of Catalonia in 2013, is a revision of the Nursing Code of Ethics of 1986 whose purpose is to
provide the foundations for regulating decision making adapting it to the current social and
cultural context. It gives importance to professional values for their relevance to human
beings and considers that they must be reflected in all codes of ethics. These values are:
nursing responsibility, autonomy of the person, intimacy and confidentiality, social justice
and professional commitment. It is based on a scientific study with qualitative and
quantitative approaches to be aware of the ethical problems that most concern Catalonian
nurses in their various professional fields. Section 4, based on the value of social justice,
states that nurses undertake to “treat people equally and to guarantee an equitable access to nursing care, taking into account society’s global nature and favouring the common good”. It considers the nurse responsible for generating social conscience in the face of a breach of human rights, that they must be committed to reducing inequalities that are
generated by social determinants of health and that they must safeguard, through the
health is adapted to people’s needs” (Consell de Col·legis d’Infermeres i Infermers de Catalunya, 2013).