why is critical thinking so important for professional ethics

Why Is Critical Thinking So Important For Professional Ethics?

In today’s complex and ever-changing world, the importance of professional ethics cannot be overstated. As professionals, we are expected to uphold certain ethical standards and make decisions that are morally and socially responsible.

However, the ability to make ethical decisions is not always innate and requires a set of skills that must be developed over time. That is where critical thinking comes into play.

Critical thinking is the ability to analyze information, evaluate arguments, and make reasoned decisions based on evidence and logic. Now you may be thinking, “Why is critical thinking so important for professional ethics?”

Critical thinking is vital for professional ethics because it allows professionals to analyze situations, weigh the consequences of their decisions, and make ethical and responsible choices.

If you want to know more details about the importance of critical thinking for professional ethics, read the entire content. Here you’ll find a comprehensive discussion regarding that.

Table of Contents

Understanding Critical Thinking

Critical thinking is a process of actively and systematically evaluating information, ideas, and beliefs in order to make reasoned judgments and decisions. Critical thinkers analyze situations, identify problems, evaluate alternatives, and propose solutions.

This soft skill involves asking questions, considering biases, and reflecting on personal ethics. Analytical thinking and reflective thinking are both important components of the critical thinking process .

Effective communication is also essential for successful critical thinking. Critical thinking skills are valuable in many careers and can be applied to complex decisions and challenges in personal and professional life.

Relation Between Critical Thinking and Professional Ethics

Critical thinking is closely related to professional ethics. It helps people make conscious, well-informed decisions that align with their personal and professional beliefs.

It involves analyzing situations, questioning assumptions, evaluating biases, and considering alternative solutions before making choices. Critical thinking skills also help individuals recognize and navigate ethical dilemmas in their careers.

Effective communication and analytical thinking are important soft skills that enable professionals to apply ethical concepts and reasoning to their behavior and decision-making.

Critical thinking is a soft skill that is vital for professional ethics. Here, we will explore why critical thinking is essential for professional ethics and how it can be developed.

Analytical Thinking and Reasoning

Critical thinking involves analytical thinking and reasoning to identify and evaluate possible solutions to problems. It helps individuals to think beyond surface-level ideas and analyze situations from multiple perspectives. Critical thinkers are better equipped to identify any potential biases that may influence their decision-making process, allowing them to make more informed and ethical choices.

Reflective Thinking

Reflective thinking is an essential component of critical thinking, as it enables individuals to reflect on their beliefs and values and how they influence their decisions. It helps individuals to be self-aware and understand the impact of their actions on others. Reflective thinking is crucial for professional ethics as it enables individuals to make decisions that align with their personal and organizational values.

Effective Communication

Effective communication is a crucial aspect of critical thinking and professional ethics. Critical thinkers are better able to communicate their ideas and opinions in a clear and concise manner, making it easier to collaborate with others and achieve common goals. Effective communication also helps individuals to understand the perspectives of others and make decisions that consider the needs and values of all stakeholders.

Problem-Solving

Problem-solving is a critical component of professional ethics as individuals must be able to identify problems and develop ethical solutions. Critical thinking skills enable individuals to approach problems with an open mind, considering all possible solutions before making a decision. It helps individuals to be more creative and innovative in their approach to problem-solving, which can lead to more ethical and effective solutions.

Conceptual Thinking

Conceptual thinking is another important aspect of critical thinking and professional ethics. It involves understanding abstract ideas and how they relate to specific situations. Critical thinkers are better equipped to understand the complex relationships between concepts and apply them to real-world situations. This enables individuals to make decisions that consider the long-term implications of their actions, rather than focusing on short-term gains.

How Critical Thinking Enhances Ethical Decision Making?

Critical thinking involves analyzing, evaluating, and reasoning about information in a systematic and logical manner. When making ethical decisions, critical thinking helps individuals consider the various perspectives and potential consequences of their actions.

It encourages individuals to question assumptions, identify biases, and weigh the evidence before making a decision. By using critical thinking, individuals can better understand the ethical implications of their decisions and make informed choices that align with their values and ethical principles.

Critical thinking also promotes accountability and responsibility, as individuals are more likely to take ownership of their decisions and their outcomes.

How to Enhance Critical Thinking For Professional Ethics?

Critical thinking enables individuals to make conscious decisions. To improve critical thinking skills, individuals should:

Ask Questions: Critical thinking involves questioning ideas and information to evaluate its credibility. Individuals should ask questions to understand the situation better and make informed decisions.
Evaluate Information: Evaluating information is an essential step in critical thinking. Individuals should analyze information to determine its relevance and accuracy.
Identify Biases: Individuals should be aware of their biases and try to eliminate them while making decisions.
Reflective Thinking: Reflective thinking involves analyzing past decisions and identifying areas for improvement. Individuals should reflect on their decision-making process and identify areas where they could have made better choices.
Effective Communication: Effective communication is crucial in critical thinking. Individuals should communicate clearly and effectively to convey their ideas and understand others’ perspectives.

Applying the Critical Thinking Process in Professional Ethics

The critical thinking process can be applied to professional ethics in the following steps:

Identify the ethical dilemma or problem.
Gather relevant information and analyze it objectively.
Identify possible solutions to the problem.
Evaluate each solution and its potential consequences.
Choose the best solution based on critical analysis.
Implement the solution and monitor its effectiveness.

Application of Critical Thinking in Professional Ethics

Critical thinking is crucial in professional ethics as it helps professionals to make sound ethical decisions. We explore the application of critical thinking in professional ethics in healthcare, business, and education.

In healthcare, critical thinking is essential in making ethical decisions concerning patient care. Healthcare professionals must evaluate various factors, including the patient’s condition, treatment options, and ethical principles such as autonomy, beneficence, and non-maleficence. Critical thinking helps healthcare professionals to identify potential ethical issues and to assess the risks and benefits of various treatment options.

Critical thinking is also vital in ethical decision-making in the business world. In business, professionals encounter ethical dilemmas, such as conflicts of interest, bribery, and discrimination. Critical thinking enables professionals to identify ethical issues, evaluate the impact of their actions, and make decisions that align with their values and those of their profession.

In education, critical thinking is crucial in ethical decision-making concerning students’ academic performance and well-being. Educators must evaluate various factors, including students’ academic performance, behavior, and ethical principles such as fairness and integrity. Critical thinking enables educators to identify potential ethical issues and assess the risks and benefits of different approaches.

What Part Of The Brain Controls Critical Thinking?

How To Teach Critical Thinking In The Workplace?

Why Is Asking Questions Important In Critical Thinking?

How To Sharpen Your Critical Thinking Skills?

The discussion above has illustrated “Why is critical thinking so important for professional ethics?” Critical thinking allows professionals to make decisions that are based on a reasoned approach that considers all relevant facts and perspectives.

It also encourages professionals to challenge and question their own biases, leading to more ethical decisions. Furthermore, critical thinking helps to prevent errors and ensure compliance with professional ethical standards.

All of these reasons make it clear why critical thinking should be a cornerstone of professional ethics. Without it, there is a greater risk of unethical decisions being made, which can have serious consequences for organizations, professionals, and the public.

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The Connection between Critical Thinking and Ethics: Unraveling the Link

The connection between critical thinking and ethics is a significant one, as both concepts play crucial roles in decision-making and problem-solving. Critical thinking is the process of evaluating and analyzing information to reach well-founded conclusions, while ethics involves the principles and standards that guide our behavior.

Developing a strong sense of critical thinking and ethical awareness is crucial for individuals to become responsible citizens and decision-makers. When applied together, these skills allow people to engage in a balanced and rational examination of various ethical issues, thereby promoting fair judgment and responsible action within their personal and professional lives.

The Concepts of Critical Thinking and Ethics

Defining critical thinking, defining ethics.

Ethics, on the other hand, deals with moral principles that govern an individual’s or group’s behavior. It is the study of what is right or wrong and how we should act in various situations. Ethical reasoning involves the application of moral values to guide actions and decisions in various contexts.

The Importance of Critical Thinking in Ethical Decision-Making

Critical thinking plays a vital role in ethical decision-making by providing the tools needed to carefully evaluate situations, examine various perspectives, and make informed choices that align with personal and professional values without making exaggerated or false claims.

Recognizing Ethical Issues

Evaluating ethical choices, implementing ethical solutions.

Once ethical issues have been recognized and evaluated, critical thinking aids in the implementation of ethical solutions. It allows individuals to weigh the consequences of each action, taking into account the possible impacts on stakeholders and the broader society. Critical thinking promotes conscious, well-informed decisions that are in line with personal and professional beliefs, ensuring that the chosen solutions consider all possible outcomes and adhere to the principles of ethical decision-making.

Section 4: Developing Critical Thinking and Ethical Reasoning Skills

Education and curricula.

By incorporating ethical reasoning into educational programs, students learn to operationalize their reflective questioning skills as the basis for ethical decision-making. Understanding the various ethical frameworks and perspectives can help students think critically and make well-reasoned decisions in complex situations (source) .

Exercises and Practice

Section 5: challenges and limitations, cognitive biases, emotional influence.

Another challenge in connecting critical thinking and ethics is emotional influence. Our emotions can significantly impact our ability to think critically and ethically. Emotional experiences may lead to hasty decisions without considering ethical implications. To overcome this challenge, individuals must learn to balance emotion and reason, allowing them to maintain a neutral perspective during decision-making processes.

Cultural Differences

In conclusion, the relationship between critical thinking and ethics is a fundamental aspect of how we make decisions in our daily lives. Critical thinking allows us to see the world from different perspectives and to make ethical decisions based on our understanding and analysis of facts.

The importance of this relationship cannot be understated, as it influences the choices we make and their impact on ourselves and others. Developing a strong foundation in critical thinking not only allows us to make informed and ethical decisions but also contributes to a deeper understanding of the world and the various perspectives within it.

How Is Critical Thinking Different From Ethical Thinking?

By Linda Fisher Thornton

Ethical thinking and critical thinking are both important and it helps to understand how we need to use them together to make decisions.

Critical thinking helps us narrow our choices. Ethical thinking includes values as a filter to guide us to a choice that is ethical.
Using critical thinking, we may discover an opportunity to exploit a situation for personal gain. It’s ethical thinking that helps us realize it would be unethical to take advantage of that exploit.

Develop An Ethical Mindset Not Just Critical Thinking

Critical thinking can be applied without considering how others will be impacted. This kind of critical thinking is self-interested and myopic.

“Critical thinking varies according to the motivation underlying it. When grounded in selfish motives, it is often manifested in the skillful manipulation of ideas in service of one’s own, or one’s groups’, vested interest.” Defining Critical Thinking, The Foundation For Critical Thinking

Critical thinking informed by ethical values is a powerful leadership tool. Critical thinking that sidesteps ethical values is sometimes used as a weapon.

When we develop leaders, the burden is on us to be sure the mindsets we teach align with ethical thinking. Otherwise we may be helping people use critical thinking to stray beyond the boundaries of ethical business.

Unl eash the Positive Power of Ethical Leadership

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What is Ethical Leadership and Why is it Important?

Ethical leadership is not only the right thing to do, it is key to driving an organization's success.

Valerie Kirk

Errors, bad behavior, and poor judgment in leadership can negatively impact a company’s brand and reputation. For business success, it’s critical for organizations to fill their C-suite with ethical leaders.

Ethical leadership involves leaders and managers making decisions based on the right thing to do for the common good, not just based on what is best for themselves or for the bottom line. While profits are important, ethical leaders take into consideration the needs of customers, communities, and employees in addition to company growth and revenue when making business decisions.

Ethical leaders encourage their team members to model this behavior, too. They help to build a workplace culture that values transparency, collaboration and inclusion, and where everyone feels safe to share their voice.

They can also help organizations recruit and retain top talent. Professionals are increasingly seeking out companies whose leaders strive to do the right thing. Generation Z, who will make up 25 percent of the workforce by 2025, demands leadership ethics more than generations that came before them.

“Gen Z is not going to negotiate. They have really strong values and ethics, and they don’t bend them because of intimidation or because they are just getting a paycheck,” said Michael McCarthy, instructor at Harvard Division of Continuing Education’s Professional & Executive Development and host of the “ Happy at Work ” podcast. “The idea of letting harmful or hurtful behavior slide is not acceptable.”

Leaders who weigh ethical considerations before making key business decisions drive a company’s long-term success.

The 6 Main Principles of Ethical Leadership

Having ethical leaders isn’t as simple as hiring “good” people. Companies should strive to fill their leadership ranks with people who embody the principles of ethical leadership. The six main principles include:

Respect includes valuing others’ skills and contributions. While historically respect in the workplace may have been one-way (leaders demanding respect from employees), in an ethical work environment, respect is mutual.

Mutual respect leads to healthier workplace relationships where both sides appreciate and support what the other is doing and feel secure in talking through issues and challenges. Healthy relationships create positive work environments, which drives increased productivity.

Current and upcoming business leaders should take mutual respect into account as workforce expectations continue to shift.

“I tell current leadership to respect Gen Z. They have values and morals, and you’re going to have a better organization because of them,” McCarthy said. “They aren’t going to put up with the old hierarchy that doesn’t offer mutual respect.”

2. Accountability

Ethical leaders hold themselves accountable for their actions. They make decisions based on integrity and stand behind their work. They also lead by example, communicate openly about challenges, and don’t look to place blame on others for any shortfalls.

Leaders make ethical decisions based on doing what is right for employees, customers, and the community. Because these constituents are always top of mind for ethical leaders, they often have a strong sense of service. They engage in activities such as charitable giving and volunteer work to give back to their communities — and encourage their teams to do the same.

Leaders who are transparent build trust amongst their organizations and amongst customers.

To build and maintain trust, leaders must be good communicators who speak openly and honestly about issues. Regardless of the issue’s severity or unpopularity, leaders’ responsibility to be clear and candid empowers others to make the right decisions with the information they have.

Honesty and transparency also help to build a brand’s reputation, leading to long-term customer loyalty.

Justice is not just about following the law, but about ensuring that everyone is getting what they deserve. Ethical leaders approach situations with a focus on treating everyone fairly, and they expect their teams to treat each other and customers the same way. Through their actions, they build equitable work environments where everyone feels respected.

6. Community

Ethical leaders view their companies as communities and consider everyone involved when evaluating situations and making decisions. By viewing their organizations this way, they build equity and inclusion into their decision-making process and create work environments that encourage collaboration across teams.

Learn more about Harvard DCE’s Ethical Leadership program

Examples of Positive and Negative Ethical Leadership

The following three examples are of companies that were faced with ethical dilemmas and how different leadership styles led to vastly different outcomes.

Johnson & Johnson

One of the most famous examples of ethical leadership was the case of the Tylenol cyanide poisonings in the early 1980s. Seven people died of cyanide poisoning, and the only connecting factor was that they had all taken extra-strength Tylenol. During investigation, it was discovered that the tablets were laced with cyanide.

Johnson & Johnson’s leaders acted quickly and pulled all Tylenol products off the shelves — 31 million bottles, worth over $100 million — and stopped all production and advertising. The swiftness of their decision, although costly, put customers’ well-being first and saved lives.

They partnered with law enforcement to find the perpetrator and subsequently developed the first-ever tamper-resistant packaging. They were transparent with the public about what they were doing to ensure this tragedy never happened again.

The Tylenol brand recovered from the incident, largely because of Johnson & Johnson’s ethical leadership team’s swift action and transparent care for customers.

In 2008, JetBlue left passengers stranded on the tarmac at the John F. Kennedy International Airport for more than five hours during a snowstorm. The delay had a ripple effect — JetBlue had to cancel more than 1,000 flights over the following five days.

In response, JetBlue’s CEO wrote a letter of apology to customers. He also directed his team to draft a customer bill of rights, which outlined customers’ rights to information about flights and information about compensation in the event of delays or cancellations.

The CEO also participated in a public apology tour, taking full responsibility for the incident rather than blaming it on the weather.

His transparency and accountability created trust with customers, who stayed loyal to the airline.

Wells Fargo

In September 2016 , it was revealed that employees of Wells Fargo, one of the largest banks in the United States, opened millions of unauthorized accounts in order to meet aggressive sales targets. This widespread fraudulent activity was the result of a work culture that prioritized quantity over quality and pushed employees to engage in unethical practices.

Company leaders denied knowledge of fraudulent practices. The bank was hit with significant financial penalties, but because of the lack of accountability, they damaged the trust of their customers and investors. They reported a 50 percent profit loss in the quarter following the scandal.

Meeting the Ethical Challenges of Leadership

Companies cannot underestimate the power of different leadership styles on their growth and long term success. Those who practice ethical leadership have positive corporate cultures where employees are engaged, motivated, and feel good about coming to work. Companies without ethical leadership face lower productivity and high turnover rates, impacting the organization’s bottom line.

Ethical leaders aren’t just born with these skills — they develop them over years of experience and training.

Harvard DCE Professional & Executive Development offers a two-day Ethical Leadership program that helps leaders develop skills to make ethical choices and lead companies through challenging dilemmas.

Topics covered include:

Making ethical decisions with conflicting responsibilities
Building a moral framework within yourself and the organization
Understanding the role of employees in both their professional and personal lives
Navigating a slippery slope when seemingly good people do bad things
Building a corporate culture that values moral behavior

Learn more about the ethical leadership program, including how to register.

Leaders looking to expand their ethical leadership skills should also consider the two-day Authentic Leadership program , where they will learn how to develop mindfulness and authenticity to build trust, create engagement, and promote productivity.

Explore all Executive Leadership and Management courses

About the Author

Valerie Kirk is a freelance writer and corporate storyteller specializing in customer and community outreach and topics and trends in education, technology, and healthcare. Based in Maryland near the Chesapeake Bay, she spends her free time exploring nature by bike, paddle board, or on long hikes with her family.

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What is Critical Thinking and Why is it Valuable in the Workplace?

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> Personal Effectiveness and Preparing for Change
> What is Critical Thinking and Why is it Valuable in the Workplace?

There are times at work when you simply have to “do.” A tight deadline, a demanding project outline, or a highly particular superior might mean that it makes sense to complete a task without too much mental tinkering. But work like this can be unsustainable and worse — it won’t leverage your ability to think critically.

There is value in thinking critically in every aspect of your life. From making decisions in your personal life, to interrogating the media you consume, to assessing your work with a critical eye, applying critical thinking is an essential skill everyone should be trying to hone.

At your workplace, critical thinking can distinguish you as a leader, and a valuable mind to bounce ideas off. It can help improve the quality of your work, and the perception those higher up the chain have of you.

Here’s what you need to know about critical thinking in the workplace:

What Exactly is “Critical Thinking”?

In a nutshell, critical thinking is the ability to think reasonably, detaching yourself from personal bias, emotional responses, and subjective opinions. It involves using the data at hand to make a reasoned choice without falling prey to the temptations of doing things simply because they’ve always been done a certain way.

Critical thinking takes time. It might be quicker simply to take instruction at face value, or rely on the traditions of your team. But without analyzing the reasons behind decisions and tasks, it becomes extremely easy to adopt bad habits. This might be time-wasting meetings, inefficient uses of effort, or poor interactions with team members. Taking the time to ask “why” you’re doing something is the first step to thinking critically.

Sometimes, data is available which allows you to make reasoned decisions based on absolute facts. If you can show that a new best practice can objectively improve current processes with hard data, you’ve used the very basics of critical thinking. That said, actual numbers aren’t always available when making a decision. Real critical thinking involves taking a careful look at situations and making a decision based on what is known, not what is felt.

Why Is Critical Thinking Important in the Workplace?

The short answer to the above question is this: critical thinkers make the best decisions, most often. And in the workplace, where choices about how to complete tasks, communicate information, relate with coworkers, and develop strategy are so common, critical thinkers are extremely valuable.

A savvy hiring manager will make this part of the recruitment process. It’s pretty easy to gauge how someone is inclined to solve a problem — ask them how they would deal with a specific situation, and give them the opportunity to use their critical thinking skills, versus deferring to an emotional, or prescribed reaction. Employing people who can think and act reasonably will pay enormous dividends down the road.

Using your critical thinking skills in the workplace will define you as a problem solver. This is not only useful career-wise (although having upper-level people at your company think highly of you is undoubtedly a benefit) it also establishes you as a leader among your fellow team members. Demonstrating your ability to solve problems and accomplish goals effectively will help instill confidence in you with all your coworkers.

How to Use Critical Thinking in the Workplace

The first step to actually using critical thinking is approaching every situation with an open mind. You need to be receptive to all information available, not just the kind that satisfies your preconceived notions or personal biases. This can be easier said than done, of course — lessons learned and beliefs held are often done so with a reason. But when it comes to critical thinking, it’s important to analyze each situation independently.

Once you’ve analyzed a situation with an open mind, you need to consider how to communicate it properly. It’s all very well and good to approach situations with objective logic, but it doesn’t do you any favours to sound like Mr. Spock when you’re conveying your conclusions. Be tactful, patient and humble when you are explaining how and why you’ve come to decisions. Use data if available to support your findings, but understand that not everyone is able to remove emotion from situations.

The final, and perhaps least obvious, application with critical thinking is creativity. Often, getting creative means pushing boundaries and reshaping convention. This means taking a risk — one that can often be worth the reward. Using a critical thinking approach when getting creative can help you mitigate the risk, and better determine what value your creativity can bring. It will help you and your team try new things and reinvent current processes while hopefully not rocking the boat too much.

Learn More About Critical Thinking

Critical thinking is a valuable skill for all aspects of your life. It benefits problem solving, creativity, and teamwork. And it translates particularly well to the workplace, where it can distinguish you as a valuable employee and leader.

Taking the extra time to examine things objectively, make decisions based on logic, and communicate it tactfully will help you, those you work with, and your work goals prosper. To learn more about how to do that, have a look at our Critical Thinking and Problem Solving for Effective Decision-Making workshop and register today!

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7 Main Ethical Principles in Nursing + Why They’re Important

Are you a nurse with a genuine desire to give the best care possible to patients and their families and to become a strong member of your nursing team? Maybe you are a nursing student eager to learn as much as possible to help you succeed in nursing. If so, the most important lesson you can learn is how to establish ethical nursing practices. There are several ways to demonstrate strong ethics, and knowing the main ethical principles of nursing is a great place to start. Perhaps you are wondering, "What are the 7 main ethical principles in nursing, and why they are important?” In this article, you will learn about ethical nursing principles and how they apply to you. As you continue reading, you will find an in-depth look at the 7 main ethical principles in nursing, why they’re important, and examples of how they are applied in the four main areas of nursing.

What Exactly is an Ethical Principle in Nursing?

What is the source of ethical principles in nursing, 7 reasons why ethical principles are so important in nursing, how many ethical principles are there in nursing.

1. Accountability 2. Justice 3. Nonmaleficence 4. Autonomy 5. Beneficence 6. Fidelity 7. Veracity

Are There any Conflicting Ethical Principles in Nursing?

What are the 7 main ethical principles in nursing and why they are important.

Per the , professional accountability, one of the important ethical principles in nursing is defined as "being answerable to oneself and others for one's own actions." Nurses are accountable for their actions when caring for patients and must accept the personal and professional consequences of those actions or any inactions.

The following is detailed information about why accountability is important, examples of ways to apply it, and consequences of not applying it in the four main areas of nursing: clinical practice, nursing leadership, nursing education, and nursing research.

Establishing an atmosphere of accountability in nursing is every nurse's responsibility. There are several key reasons being an accountable nurse is essential, including the following.

When nurses practice accountability, they build stronger nurse-patient relationships based on increased trust and reduced fear.

Accountable nurses demonstrate higher quality job performance, which benefits patients, peers, organizations, and the profession.

Nurses who act with a high level of accountability are more likely to succeed in their roles. As a nurse, if you take personal responsibility for your actions, right or wrong, employers and peers appreciate you and your efforts, increasing your chance for success.

The best way to demonstrate accountability in nursing is to stay within your designated Scope of Practice. The scope of practice describes the care and services a qualified health professional is competent to perform and permitted to accept within the terms of their professional license. Each state's legislature passes a "Nurse Practice Act." Regulatory bodies then create and implement the rules and regulations of the nurse practice act intended to protect the nurse and the public.

Nurse Vicky, RN and charge nurse at a local hospital, completed an admission assessment on a newly admitted patient, Mr. Hendrix. Following the admission assessment, Nurse Vicky created a nursing care plan specific to Mr. Hendrix, including establishing which tasks the licensed practical/vocational nurse will complete. Although she delegates the patient's routine care to the LPN/LVN, Nurse Vicky realizes she is responsible for ensuring Mr. Hendrix is cared for within the boundaries of the patient care plan. She follows up with Mr. Hendrix by performing assessments as needed and ensuring all delegated tasks are completed promptly and efficiently.

Lack of accountability in nursing can result in significant consequences. Nurses must understand their roles and perform within their scope of practice to prevent risks to patients, themselves, and their organization. The following are a few examples of the far-reaching consequences of nurses failing to be accountable.

Patients expect nurses to provide quality, professional care to promote their well-being and improve their health. Nurses who do not demonstrate accountability lack professional responsibility, leading to distrust from patients and their loved ones. The lack of trust can compromise nurse-patient relationships, leading to a risk of non-compliance and resulting in negative patient outcomes.

Depending on the level of unaccountability, nurses could face a reprimand from management or risk losing their jobs.

Serious cases of lack of accountability resulting in patient harm may lead to disciplinary action through the state board of nursing or loss of licensure.

Accountability in nursing leadership is instrumental in establishing strong nursing teams, promoting positive patient outcomes, and contributing to the success of the healthcare facility or organization. The following are a few reasons why nurse leaders should demonstrate accountability.

Effective nurse leaders lead by example. If a nurse leader is accountable for her actions, the likelihood of the nurses on the team being accountable increases.

The behavior of accountable nurse leaders positively impacts employee morale, making teams happier and more content with their jobs.

The best way to ensure accountability among nursing teams is for nurse leaders to model accountability in their behaviors and practices. Nurse leaders are accountable for their actions and the actions of their nursing team. At times, accountability in nurse leadership involves assessing a situation, delegating responsibilities, and following up to ensure work is complete.

Nurse Kristy is the charge nurse in a busy emergency department with a team of registered nurses under her supervision. After a multi-car pileup on the interstate, several crash victims came to her emergency room for care. Nurse Kristy assigned additional nurses to work triage to determine which patients require immediate care. She also distributes nurses for each area of care in the emergency department, carefully following the nurse-to-patient ratio as designated by the hospital policies and procedures. Nurse Kristy monitors the status of patient flow, ensures supply cabinets are stocked to accommodate the needs of all patients, including those in the car crash, and offers assistance as needed.

In this scenario, the charge nurse demonstrates accountability by making sure the staff she supervises have appropriate supplies, patients are triaged and treated in a timely manner, and offering her assistance.

Nurse leaders play an integral role in developing strong teams. Positive leadership behaviors lead to favorable outcomes. Conversely, poor leadership behaviors lead to unfavorable outcomes. If nurse leaders fail to demonstrate the ethical principle of accountability, subordinate nurses are likely to follow their behavior, leading to negative consequences like the ones listed below.

When leadership lacks essential ethical principles, it doesn't take long to see a breakdown in the team's structure.

Lack of accountability not only affects professional relationships but it can also affect patient outcomes. Nurse leaders who lack accountability rarely demand it from their teams, which impacts patient care, leading to poor health outcomes.

The old saying, "the buck stops here," could be taken quite literally when discussing the ethical principle of accountability. Nurse leaders are responsible for how their teams perform, and when they lack the accountability true leadership demands, errors in care occur more often, leading to increased healthcare costs.

There are three main types of nurse educators:

Instructional nurse faculty teach nursing students in academic settings such as colleges or universities.

Clinical nurse educators typically work in hospitals or other healthcare facilities, helping nurses gain hands-on experience as they learn facility processes and best practices. CNEs also teach staff nurses about new policies and procedures and may educate nurses about new equipment.

Staff development nurses train nursing staff in new roles and provide ongoing mentorship and training to help nurses enhance their skills. All nurse educators play a vital role in healthcare and promoting ethical principles in nursing.

The following are a few reasons nurse educators must exercise accountability in their practice.

Nurse educators bear significant responsibility for educating current and future nurses. Demonstrating accountability shows other nurses the importance of accepting responsibility for their own behavior.

Nurse educators are influential in advocating for change in nursing education in higher institutions of learning and within healthcare organizations. Acting with professional accountability makes their efforts more appealing to decision- and policymakers, as those who make vital nursing and healthcare decisions desire to work with nurses they can depend on.

Nurse educators are obligated to provide the education and tools nurses, and nursing students need to become better nurses, which impacts patients, their families, healthcare facilities, and the nursing profession.

Mrs. Stennett is the clinical nurse educator at a large university hospital. Part of her job description includes having the responsibility to update staff nurses about new policies and procedures within the organization. The administration recently approved new guidelines for reporting errors related to patient care. In response to the updates, Mrs. Stennett scheduled four in-service meetings to accommodate nursing staff and update them on the new policies and procedures. At each in-service, the staff in attendance sign the attendance log to verify their presence. Mrs. Stennett logs information about the in-service in her activity logbook and attaches each sign-in sheet.

Although Mrs. Stennett could have conducted the in-service and expected administration or state surveyors to take her word that the staff was aware of policy changes, she understands the importance of being accountable for her own work. By logging information about the in-services and attaching sign-in sheets, Mrs. Stennett protects herself. Suppose a staff member acts outside the scope of the new policies and procedures but attended the in-service. In that case, Mrs. Stennett can show the sign-in sheet to her supervisor, removing any risk of repercussion due to the other staff member's actions.

The lack of accountability in any nursing position can have dire consequences. In nursing education, the lack of ethical principles like accountability can have significant long-term effects. Here are a few things to consider about the lack of accountability in nursing education.

If nurse educators lack accountability, the nursing students they teach are likely to conduct themselves with a lack of accountability, as well. This blatant lack of accountability can result in shifting blame, poor patient care, and negative patient outcomes.

Nurse educators working in healthcare facilities or for healthcare organizations are responsible for ensuring staff nurses get adequate hands-on training to help develop the skills necessary to provide adequate care. Failure to demonstrate accountability in this example could mean staff nurses are poorly prepared to take on patients and provide independent care, which could result in errors in care and other safety issues.

Nurse researchers are at the forefront of clinical efforts to find new treatments and improve patient care. It is of utmost importance for nurse researchers to be accountable in their practices. Here are a few reasons why:

The results of nursing research are instrumental in determining future steps in patient care. Nurses must be accountable for conducting research according to the plan so results can be validated.

When nurse researchers demonstrate accountability, investors and other funding sources have confidence in their intentions, making it easier for them to offer financial resources to support research.

Nurse researchers are accountable to themselves, their team, study participants, supporting organizations, and financial contributors, to name a few. One of the best ways to demonstrate accountability in nursing research is to use resources for their intended use.

Nurse Researcher Ava is working on a research project with a group of colleagues. After securing their project's funding, Nurse Ava and her team realize they may have a significant amount of the funds remaining when the project is complete. Some colleagues suggest moving the extra money to another project, stating that since the money was for a research grant, it shouldn't be a problem. However, Nurse Ava objects to the suggestion arguing that the funds they received were designated for a specific project. She recommends completing the research project and then assessing how much, if any, of the funds remain available. She also suggests if funds are still available, the team should notify the grantor and request permission to use the funds toward another project.

When nurses act outside the boundaries of ethical principles and behaviors, it can lead to several consequences, of which some may be severe. Here are a few possible consequences of lack of accountability in nursing research.

If nurse researchers do not act with accountability in nursing research, they may be viewed as unreliable or untrustworthy and lose future research opportunities.

Money designated for research projects must be used to achieve the purpose for which it is granted. When nurse researchers do not handle financial contributions within the guidelines of the research proposal and outline, they may be forced to repay the misused money.

is another one of the essential ethical principles in nursing. It refers to a nurse's ability to act according to their knowledge and judgment while providing nursing care within their scope of practice. The full scope of one's nursing practice is defined by existing regulatory, organizational, and professional rules.

The following is detailed information about why Autonomy is important, examples of ways to apply it, and consequences of not applying it in the four main areas of nursing: clinical practice, nursing leadership, nursing education, and nursing research.

Autonomy is essential in all aspects of nursing practice. This vital ethical nursing principle goes hand-in-hand with the principle of accountability. The following are a few reasons why autonomy is important in nursing practice.

Autonomy helps nurses strengthen their critical thinking and decision-making skills.

Nurses who practice with autonomy typically have more confidence and freedom to make critical patient care decisions.

Any time a nurse acts within their scope of practice and knowledge to perform a patient care task independently, this is considered an act of autonomy in nursing practice. Nurses can demonstrate autonomy by administering PRN medications, delegating tasks to appropriate personnel, and checking vital signs when a patient's condition concerns them.

Mr. Phillips is a patient at Mercy Hospital, where Nurse William is his primary nurse. Upon entering Mr. Phillips' room to give routine medications, Nurse William observes that Mr. Phillips is pale, diaphoretic, and complaining of dizziness. Nurse William checks Mr. Phillips' vital signs, finding his blood pressure is extremely low. Nurse William holds Mr. Phillips' medications, including an antihypertensive, notifying the physician of Mr. Phillips' current status and continues monitoring the patient until the doctor responds with new orders.

Autonomy is one of the nursing ethical principles that often directly affects the nurse's outlook on their job. Lack of autonomy can significantly impact the way nurses relate to others and how they feel their employers feel about them. The following are a few consequences of lack of autonomy in nursing practice.

Nurses who experience a lack of autonomy, whether it is related to their choice not to exercise autonomy or because of employer restrictions, experience burnout at a much higher rate than nurses who have higher levels of autonomy.

The absence of autonomy in nursing often leaves nurses feeling their knowledge and skills underappreciated. Unfortunately, this can lead to patient care that lacks the personal approach needed to establish solid nurse-patient relationships.

Autonomy in nursing leadership gives leaders the authority to enrich nursing practices within their teams and organization. Nurse leaders who demonstrate autonomy contribute their unique nursing knowledge and experiences, helping to strengthen the profession and positively impact patient outcomes.

Nurse leaders make autonomous decisions daily. A few ways nurse leaders act with autonomy include collaborating with staff to develop nursing care plans, delegating assignments to staff nurses, implementing emergency measures according to policies and procedures, and handling conflicts within their team.

Nurse Mitchell is the Assistant Director of Nursing at Magnolia Long-Term Care Facility. It has been brought to his attention that staff nurses on the west wing are unhappy with their assignments. Nurse Mitchell meets with the nurses to discuss their concerns and possible resolutions. He explains to the nurses that the team's primary concern is patient-centered teamwork and the delivery of high-quality care. After meeting with the nurses and determining which nurses are better suited to care for specific patients, Nurse Mitchell updates and distributes new nursing assignments.

Nurse Mitchell exercised the principle of autonomy by initiating communication with the nursing team and trying to find ways to resolve their issues and concerns. He was not required to change the assignments. However, his willingness to listen to his staff and adjust assignments with patient care at the center of his decisions shows genuine concern for his staff as well as the patients, which promotes employee satisfaction and retention.

Strong nursing teams require strong nursing leadership. Nurse leaders must understand the importance of their role and how their leadership impacts teams and patient care. The following are a few examples of what could happen if there is a lack of autonomy in nurse leadership.

Nurse leaders set the tone for how teams collaborate. If they fail to exercise authority in decision-making and establishing means of effective, respectful communication, it could result in poor collaborative efforts, negatively impacting patient outcomes, interdisciplinary relationships, and organizational order.

One of the primary responsibilities of nurse leaders is to manage nursing teams. Some of their activities include creating work schedules, managing staffing issues, and supporting continuing education within their facilities. If nurse leaders fail to implement autonomy within their roles, important decisions may be overlooked, resulting in poor team management and impacting patient and organizational outcomes.

Nurse educators impact nursing students and current nurses on many levels. Implementing the ethical principle of autonomy in nursing education is vital for several reasons, including the following.

Nursing Students Learn Autonomy by Their Educators’ Example: Nurse educators teach nursing students how to conduct themselves in practice. They teach the ethical principles of nursing, including autonomy, in theory, and then demonstrate them in clinical settings.

Autonomy in Nursing Education Promotes Independence While Supporting Teamwork: Although nurse educators work with a level of independence or autonomy, their actions impact everyone on the nursing team. Nurses and nursing students observe how nurse educators handle situations and learn to engage in the same behaviors in nursing care.

Nurse educators apply autonomy in several ways. Whether they establish class schedules, assign clinical rotations, or arrange for continuing education classes for staff at healthcare facilities, applying autonomy in nursing education is essential.

Mrs. Williams is a nurse educator working at a local university school of nursing. She primarily works with fourth-year students. Her students are preparing for final clinical skills exams, including demonstrating their ability to make sound clinical judgments and work independently. Mrs. Williams creates clinical lesson plans and schedules assignments for each student. She also works with nursing leadership at various clinical sites to arrange preceptors for students.

Mrs. Williams' ability to work independently and oversee nursing students is an example of practicing autonomy in nursing education. The students who accept assignments and work within their scope of practice as nursing students also practice autonomy, within designated guidelines.

Nursing education is multi-faceted, requiring independent decision-making and critical thinking skills. A lack of autonomy in nursing education could result in the following consequences.

Nurse educators are responsible for arranging clinical contracts and assignments for students. Although the director of nursing may approve or assist with procuring contracts, most instructors have some level of freedom to choose sites where they prefer to work and train students. If nurse educators fail to act responsibly and independently to arrange clinical training sites and assignments, nursing students may not have adequate experiences to meet the requirements for graduation or to sit for the licensure examination.

Nurse educators independently prepare a syllabus, and schedule quizzes, tests, and laboratory intensives for each class they teach. If they do not exercise their authority to establish class guidelines and schedules, lessons and classroom experiences become poorly structured, and student success suffers.

Autonomy in nursing research relates to the researcher and study participants alike. Nurse researchers make autonomous decisions throughout the course of a study based on study guidelines. They must also respect the autonomy of participants or prospective participants to decide whether to be involved in the research study.

Recognizing the participant's right to autonomy and respecting their decisions helps ensure willing participation in studies. This is vital, as coercion or manipulation of a potential participant to encourage participation in a study is unethical.

Nurse researchers must develop an understanding of autonomy and how to apply this ethical nursing principle in nursing research.

Nurse Holyfield is responsible for collecting and reviewing surveys from research participant applicants and presenting suitable candidates to her research team. She independently reviews each application and makes notes about the applicants. Nurse Holyfield then schedules interviews with the top prospects from the applicant pool. She provides each applicant with detailed information about the research project, the expected outcomes, and an explanation of the participant's role in the study. Nurse Holyfield gives each applicant the opportunity to ask questions about the study and consider if they wish to continue with the application process.

In this example, Nurse Holyfield demonstrates autonomy in two ways. First, she acts independently to review applications and interview applicants. She then promotes the individual autonomy of the applicants by providing them with pertinent information so they can make an informed decision about participation in the study.

When there is a lack of autonomy in nursing research, the consequences may affect the study, persons conducting the study, and participants negatively. Here are a few examples.

If nurse researchers fail to contribute to the autonomy of study participants or applicants, that means they fail to adhere to the patient/participant’s rights. Violating ethical principles related to one’s right to autonomy can be grounds for disciplinary action, loss of job, or cancellation of a research project.

Nursing research involves teams of people working together for an end cause. Typically, team members have individual responsibilities related to the project. Although they work together, if one member fails to demonstrate autonomy or perform their work, it can result in work not being completed and compromise the validity of the research study.

Beneficence, another one of the important ethical principles in nursing is defined as charity and kindness and is demonstrated by nursing actions that benefit others. The ethical principle of beneficence is a quality requiring nurses to act with genuine care, concern, and generosity regarding the welfare of others, acting with the best interest of patients in mind, regardless of the nurse's personal opinion or self-interest.

The following is detailed information about why Beneficence is important, examples of ways to apply it, and consequences of not applying it in the four main areas of nursing: clinical practice, nursing leadership, nursing education, and nursing research.

Beneficence is vital to effective nursing practice. The following are a few reasons why beneficence in nursing practice is important.

Beneficence in nursing practice ensures the nurse considers the individual circumstances of each patient, recognizing that what is good or helpful for one patient may not be the best option for another.

The principle of beneficence requires nurses to provide nursing care to the best of their ability, which promotes positive patient outcomes.

Nurses apply beneficence in practice in several ways. The most common acts of beneficence involve simple acts of kindness, such as holding a patient's hand, offering to sit with a loved one, or ensuring privacy for patients and loved ones as they say their final goodbyes.

Mr. Douglas, whose wife has stage IV breast cancer, just learned his wife's condition has worsened. She is not responding to verbal commands and has little response to tactile stimulation. The doctors have advised Mr. Douglas all they can do for Mrs. Douglas at this time is to help make her comfortable. Mr. Douglas is visibly shaken. Nurse Leah demonstrates beneficence when she offers to sit with Mr. Douglas for a while, holding his hand and letting him talk. At the appropriate time, Nurse Leah asks Mr. Douglas if there is anyone he would like for her to call to be with him and his wife, stating she wants to help as much as possible so he can spend time at his wife’s bedside.

Because the principle of beneficence is based upon promoting the welfare of others, a lack of beneficence can be counterproductive, resulting in profound consequences.

If nurses fail to promote the best interest of patients, the risk of safety issues increases. Safety events may include , not using the most appropriate equipment, or failure to chart vital information.

Patients want to know the nurses caring for them have their best interest in mind and can typically determine if they do by the nurse's behavior toward them. When nurses do not demonstrate beneficence in practice, it can create a strain on the nurse-patient relationship. Unfortunately, poor nurse-patient relationships tend to have a snowball effect, resulting in a lack of compliance on the patient's part and a risk of poor patient outcomes.

Nurse leaders should strive to demonstrate beneficence in every aspect of their roles. The following are a few reasons why beneficence in nursing leadership is important.

Nurse leaders who practice beneficence support efforts to not only improve patient care but also work to ensure safe work environments with leadership support for staff nurses. When nurses feel safe and supported, they are typically happier with their jobs which improves job performance and employee satisfaction rates. It also contributes to higher employee retention rates.

Beneficence reflects the nurse leader's ability to contribute to the welfare of patients, staff, and organizations. As nurse leaders act with beneficence, everyone within their leadership grasp is positively influenced and benefits from their ethical behavior.

Beneficence in nurse leadership may be a simple act, or it could require a nurse leader to step out of their comfort zone to get things done that benefit patients and staff.

Nurse Mark works in a small community hospital and is the nurse leader in the surgical unit. Despite nurses on his team making maintenance requests, some equipment on the unit needs repair. Nurse Mark also contacted maintenance and received no response. He understands the maintenance department is busy, but he also realizes patient and staff safety is his priority. Because requests for maintenance have been overlooked, Nurse Mark contacts the nursing supervisor and asks if the supervisor will contact the maintenance supervisor for assistance.

In this example, Nurse Mark followed the chain of command, which is a good leadership quality. He made the safety of the patients and staff on the surgical unit a priority and chose to seek help from upper management to help promote the safety and well-being of everyone on his team.

Beneficence is one of the essential ethical principles in nursing. Because beneficence involves promoting the best interests of others, the lack of the principle can have far-reaching, serious consequences. A few examples follow here:

A lack of beneficence in nursing leadership typically leads to a lack of beneficence among all nursing staff, which impacts the level of patient care they provide, often leading to poor outcomes.

Nurses working under the supervision of leaders who have little interest in promoting their welfare or success often feel frustrated or bitter. If the situation is not remedied, it can lead to conflicts between nurses and their leaders. Unresolved conflicts can result in poor employee satisfaction rates and higher employee turnover.

Nurse educators are responsible for teaching student nurses and other nurses, preparing them to provide the best possible nursing care. One of the most important lessons nurse educators can teach students is the principle of beneficence, and the most effective way to teach it is by demonstrating it in action.

• Beneficence in nursing education creates an atmosphere conducive to developing strong bonds between students, nurses, and nurse educators. As bonds strengthen, nursing teams become more effective in providing patient care and improving outcomes for patients and the profession.

• Beneficence in nursing education seeks to promote the greater good of students and staff. As nurse leaders demonstrate beneficence, students and staff learn how to apply this ethical nursing principle.

Nurse educators must demonstrate beneficence on behalf of patients, students, and staff. Sometimes, acting with beneficence means making difficult decisions.

Dr. Jones, DNP, is making rounds at a local hospital where students in her nursing program are involved in clinical rotations. Students have been assigned to work with preceptors in various specialty areas, such as Med-Surg, Labor and Delivery, Emergency, and Pediatrics. As Dr. Jones visits the various stations to check on students, she finds several preceptors have allowed the first-year nursing students to work alone, stating it is the best way for them to learn. The school of nursing policy is that all first-year nursing students must be accompanied by a preceptor or nursing instructor any time hands-on patient care is provided.

The Director of Nursing at the hospital is unavailable to discuss the dilemma, and the charge nurse on the floor reports they are too short-staffed to require preceptors to accompany students. Dr. Jones makes the decision to end the clinical day and instructs students to return to campus tomorrow for an update and possible new assignments.

Dr. Jones acted with beneficence on behalf of the patients, her students, and the hospital staff. Allowing students to continue providing care unsupervised could lead to liability against the school, Dr. Jones, the students, and the hospital.

Nurse educators have a great responsibility to prepare nurses to provide high-quality care focused on improving patient outcomes. Acting with beneficence is critical in nursing education. The lack of beneficence, on the other hand, can also have serious consequences.

Nurse educators who fail to demonstrate beneficence send a message that it may not be necessary to promote the well-being of others at all costs. This is false and can lead to compromised patient outcomes.

Good nurses know the importance of acting with beneficence. When there is a lack of beneficence in nursing education, students and peers alike tend to lose respect for the nurse educator.

The nursing code of conduct emphasizes the need to care for patients, offer beneficial services, and do no harm. The ethical principle of beneficence is as important to nursing research as it is to clinical nursing, nursing leadership, and education. Beneficence requires the nurse researcher to weigh the balance of potential risks and benefits and make judgment calls about beginning, continuing, or stopping research based on that assessment.

Although all principles of ethics in nursing are vital, beneficence is especially important in nursing research. Research should benefit individuals and society. However, no matter how beneficial research is to society, it should never be more important than the safety of patients and participants.

Researchers must place more emphasis on the safety and well-being of research participants than the potential effects the results could have on society.

Nurse Brown is working on a nursing research project involving four participants. At the midpoint of the research project, two participants experience unexpected negative effects. Although the other two participants show no significant changes or complications, the risk to participants at this point seems greater than the potential benefits. Therefore, Nurse Brown consults with her research team and chooses to conclude the study until sufficient data is gathered and a new plan is developed.

Beneficence is perhaps the most important of the ethical principles in nursing research. Beneficence in nursing research operates with the understanding that it is unethical to involve research participants or patients in any type of research that is not expected to demonstrate benefits to patients and/or society. Lack of beneficence on the part of nurse researchers could result in the following consequences.

If it is determined that nursing research is being conducted without the expectation of beneficial results, a research organization could lose funding. Loss of funding may be temporary until the goals and anticipated outcomes are more clearly defined. In some cases, funding may be withdrawn permanently, especially if there is evidence that positive outcomes were never anticipated.

If nurse researchers fail to practice beneficence and patient harm results, the researcher and/or funding party could be sued. It is the responsibility of the person or organization conducting research to inform any participant of any possible risks. When a participant understands the risks of research participation and makes an informed decision to continue, negative consequences are typically not grounds for lawsuits. However, if the nurse researcher fails to inform the participant of known potential risks or performs research out of their scope of practice, resulting in harm, they may be held legally responsible.

Another one of the main ethical principles in nursing is fidelity. Fidelity is the act of being faithful and keeping one's promises. It is demonstrated by offering support and loyalty to a person, cause, or belief.

The following is detailed information about why Fidelity is important, examples of ways to apply it, and consequences of not applying it in the four main areas of nursing: clinical practice, nursing leadership, nursing education, and nursing research.

Fidelity addresses the nurse’s responsibility to be honest and loyal in their relationships with others. The following are a few reasons fidelity in nursing practice is important.

In nursing practice, fidelity supports fulfilling professional commitments and being trustworthy.

Fidelity in nursing is associated with more positive patient outcomes, increased patient satisfaction scores, and more trusting relationships.

Nurses demonstrate the ethical principle of fidelity by meeting the reasonable expectations of their role and the nursing profession. Simple acts such as following up on medication or treatments or delegating a job to appropriate staff are ways to show fidelity in nursing practice.

Mr. Grayson is a patient at an inpatient rehabilitation center following left knee surgery. Following physical therapy this morning, Mr. Grayson complained of increased pain and asked the nurse for pain medication. Nurse Michaels administered pain-relieving medicine as per the physician's order at 1:20 p.m. and told Mr. Grayson she would check on him in an hour. At 2:15 p.m., Nurse Michaels returned to Mr. Grayson's room to evaluate the effectiveness of the pain medication and verify if he requires any other assistance.

Nurses are in a unique position to create an atmosphere of trust where patients feel safe and cared for and can make this happen by being open and honest and delivering quality patient care. Solid nurse-patient and interprofessional relationships are built upon a foundation of trust and confidence, which are basic characteristics of fidelity. Lack of fidelity in nursing practice can result in serious consequences. Here are a few examples of the consequences of lack of fidelity in nursing practice.

Patients often feel vulnerable and unsure of who they can trust or depend on. Failure to demonstrate fidelity in nursing leaves patients questioning whether the nurse is dedicated to their care or has their best interests at heart, negatively impacting nurse-patient relationships.

When patients feel a lack of trust in their nurses, it leads to non-compliance with treatment plans, which negatively impacts patient outcomes.

Nurse leaders impact every aspect of patient care in every healthcare setting. A few reasons nurse leaders must practice fidelity include the following.

It is no secret that subordinates tend to follow the behavioral patterns of their leaders. Therefore, nurse leaders should strive to create an acceptable model of behavior for other nurses to follow.

When nurse leaders demonstrate fidelity, it helps strengthen relationships with patients, families, team members, and other healthcare professionals.

An excellent way for nurse leaders to show fidelity is to fulfill commitments associated with their role. As nurse leaders fulfill commitments, patients, staff, and interdisciplinary colleagues typically consider them dependable and trustworthy.

Charge Nurse Victoria was recently assigned to lead a nursing team at her hospital. To her surprise, she learned two nurses on her team were classmates and graduated from her nursing class with her.

When making morning rounds, one of the patients asked to speak to Nurse Victoria privately. The patient reported that his nurse did not give his morning medication and that she was rude every time she entered his room. He asked for a new nurse. Nurse Victoria discovered the nurse in question was one of her former classmates. Despite her care for the nurse on her staff, Nurse Victoria was obligated to provide fair patient care in the most responsible way. She discussed the situation with the nurse and stated another nurse would take over the patient's care.

Fidelity in nursing leadership requires leaders to promote competent patient care in the most honest, fair, and responsible way possible. Although she could have told the patient she would make sure his medications were given on time and that the nurse would be more cheerful, that response could have left the patient guarded, which would have been counterproductive. Instead, Nurse Victoria assessed the situation as a whole and made the appropriate judgment call.

Lack of fidelity in nursing leadership can have significant effects on patients, nurses, healthcare organizations, and the profession of nursing. The following are a few examples of consequences of lack of fidelity in nursing leadership.

Fidelity means demonstrating honesty and integrity. When nurse leaders lack those qualities, they may be viewed as unreliable or unprofessional and lose credibility with their team and among peers.

The way nurses act and their willingness to demonstrate ethical principles in nursing, such as fidelity, can impact the atmosphere of their organizations. For example, a lack of fidelity among nurse leaders can lead to poor relationships within our healthcare facilities, leading to conflicts within the organization.

Fidelity in nursing education is of utmost importance. A few reasons fidelity in nursing education is important are listed below.

Nurse educators play an integral role in developing desired characteristics in nursing students and nursing staff through staff development. Practicing fidelity gives students and staff a positive model upon which to base their own practices.

Fidelity involves promoting all ethical principles of nursing and promoting positive patient outcomes. When nurse educators act with fidelity, they create an atmosphere conducive to learning and implementing good nursing practices in those they teach.

One of the best ways to demonstrate fidelity in nursing education is to teach students the importance of promoting patient autonomy. If students realize how patient autonomy impacts decision-making and nursing care, they soon realize that it is wise to be supportive of that right, which is an act of fidelity. Nurse educators are instrumental in helping students learn this.

Nurse Joseph is working with a small group of students at a local long-term care facility. One of the students is concerned about a patient who has been given a poor prognosis related to colon cancer. The student feels it is important for the patient to try any means necessary to prolong his life, despite doctors saying the only option is to keep him comfortable.

Nurse Joseph talks with the student and reiterates the importance of the patient's right to choose what care, if any, to pursue. He explains that if the patient is competent to make decisions, it is the nurse's job to be loyal and supportive and to continue providing competent, efficient care.

It is essential to have fidelity in nursing education. The principle is based on the nurse’s obligation to be faithful to their professional promises and responsibilities. A lack of fidelity in nursing education can result in consequences like the following.

Patient care requires the collaborative efforts of everyone on the healthcare team. If nurse educators fail to promote fidelity among students and staff, it can cause conflicts, resulting in difficult interprofessional relationships. Nurses can promote better relationships between themselves and other healthcare team members by acting with fidelity. The stronger the relationships between nurses and other team members, the higher the chances of improved patient outcomes and employee satisfaction.

Success of nursing programs means it is essential for nursing faculty to work together. Nurse educators must demonstrate dedication to their professional role, their students, and peers. Lack of fidelity in nursing education can lead to a breakdown in the structure of the educational team. The lack of cohesiveness that results can lead to poor student outcomes, low NCLEX pass rates, and loss of funding for programs.

Fidelity is an important aspect of nursing research. It is the research principle concerned with building trusting relationships between nurse researchers and research participants. Everything nurse researchers do impacts clinical nursing, nursing leadership, and nursing education, making the need for fidelity paramount.

Research participants entrust themselves to the researcher. This trust creates an obligation for the nurse researcher to safeguard the participant and their welfare throughout the research period. The best way to apply fidelity in nursing research is to be honest and open with participants.

Nurse Kayla is the lead nurse researcher working on a new project. As the time to initiate the study begins, she meets with participants to discuss the goal and anticipated outcomes for the study. Nurse Kayla understands the importance of informed consent and discusses known and potential risks associated with the research, and explains her role in ensuring her commitment to their care, demonstrating fidelity to the prospective participants. She also discusses the fact that some risks remain unknown, as this is new research, and there are no previous studies to base conclusions upon.

Lack of fidelity can negatively impact all aspects of nursing research. Some of the consequences nurse researchers may experience due to lack of fidelity include the following.

When nurse researchers lack fidelity, participants or prospective participants can lose confidence in them and their ability to provide safe, effective care.

If any area of nursing demands faithfulness to a belief or cause, it is nursing research. A lack of fidelity in nursing research can lead to conflicts among team members, which could cause concern for participants. If disagreements remain unresolved, team members may branch out and make individual choices or actions which undermine the research and invalidate the study.

Justice is one of the ethical principles in nursing concerned with the act of being fair or impartial. Nurses must make impartial decisions about patient care without showing partiality due to a patient's age, ethnicity, economic status, religion, or sexual orientation.

The following is detailed information about why Justice is important, examples of ways to apply it, and consequences of not applying it in the four main areas of nursing: clinical practice, nursing leadership, nursing education, and nursing research.

The ethical nursing principle of justice is centered on achieving and maintaining equity, obligation, and fairness in nursing by applying moral rules, principles, and standards. It is crucial for nurses to understand the impact justice has on nurse-patient and interprofessional relationships. When nurses apply justice in clinical practice, patients feel valued and are typically more compliant with care, improving patient outcomes. Justice also reflects the level of fairness and impartiality expressed by employers, impacting the way nurses and other healthcare team members feel about their jobs and their employers.

Applying justice in nursing practice means treating patients fairly. Fairness means providing the same quality of care for all patients.

Nurse Brooks is working in the after-hours pediatric clinic. Two families arrived within a few minutes of one another. One family has a fifteen-month-old son with a severe rash and cough. His parents report he has had an elevated temperature for the past eight hours. The second family has three children suspected of being exposed to COVID. None of the children is currently symptomatic. Nurse Brooks must decide which patient to treat first and what protocol to follow.

Some people may think that fairness would be for Nurse Brooks to see the children potentially exposed to COVID first. Nurse Brooks understands the importance of preventing the spread of COVID. However, the three children who may have been exposed are asymptomatic. Therefore, she takes the family to an isolation room to await triage and the physician. She then takes the fifteen-month-old patient to an examination room, gets all his vital signs and health history, and notifies the physician the child is ready to be evaluated.

In this situation, Nurse Brooks understood the importance of reducing the risk of possible COVID exposure but also realized the children were asymptomatic. Conversely, the fifteen-month-old patient had a fever, rash, and a cough, which warranted immediate attention.

It is important for nurses to understand how to apply justice in nursing practice. It is equally important to know the consequences which could arise if there is a lack of justice in nursing. Here are a few examples of what could happen if nurses do not apply justice in their practices.

Justice in clinical practice involves acting fairly and requires nurses to utilize critical thinking and decision-making skills. Without utilizing those skills to implement justice, it is possible that treatment for patients requiring priority care could be delayed. In some cases, delay of treatment could result in dire consequences for the patient and the nurse.

Without justice, nurses may show partiality to one patient or population over another. If this occurs, some patients may feel rejected or even abandoned. Depending on the severity of the situation, nurses could face reprimand for not demonstrating ethical principles.

It is especially vital for nurse leaders to treat the nurses on their teams with fairness and impartiality. Nurses who feel they are as equally valued by their leaders as others on their team feel appreciated and tend to work well with others. Further, staff nurses often mimic the behavior of their leaders. When nurse leaders demonstrate justice within their roles, the nurses they lead usually do, as well.

Justice in nursing leadership can take many forms. For instance, nurse leaders make decisions about schedules, patient assignments, and work to resolve conflicts within their teams.

Nurse Collins is the RN, nurse leader in the Medical-Surgical unit. The med-surg unit typically staffs ten nurses per shift. In addition to making daily nurse assignments and ensuring proper nurse-patient ratios, Nurse Collins is responsible for reviewing requests from nurses for time off work. Two nurses have made formal requests for a week off for vacation. Consequently, the nurses have asked for the same week off. Like other hospitals and healthcare facilities nationwide, there is a shortage of nurses at Nurse Collins' facility, making it difficult to approve vacation for two nurses at the same time.

To be fair, Nurse Collins reviews both requests. She speaks to each nurse privately to tell them another nurse has requested the same vacation time and asks if they have an alternate date that will work for them. This is her attempt to be fair and allow the nurses to find a solution. Because neither nurse wants to change their vacation date, Nurse Collins must decide whose request to approve. The nurses have the same amount of experience and have worked at the facility for the same length of time, meaning neither has seniority. However, one nurse turned her request in for consideration two days before the other. With no other information to consider and neither nurse willing to change their request, Nurse Collins made the impartial decision to approve the request she received first.

Lack of justice in nursing leadership can be detrimental to the success of nursing teams and healthcare organizations and can negatively impact patient and organizational outcomes. Here are a few examples of the consequences of lack of justice in nursing leadership.

Nurses who feel like their leaders value others more than them or believe their leaders make unfair decisions typically have a poor outlook on their job. These negative feelings can affect the whole team resulting in poor morale. This dissatisfaction leads to lower-quality care, poor patient outcomes, and higher rates of employee turnover.

I remember my mother always told us, "Work hard and do your best in every task, especially work, because everyone is replaceable." Her words are still true today. Nurse leaders who fail to exercise the fundamental ethical principles of nursing, such as justice, may find their supervisors or employers become dissatisfied with them. The leader's job, after all, is to make things run smoothly and efficiently, and if they don't deliver, they could find themselves in big trouble, maybe even without a job.

Nurse educators must provide adequate education to nursing students to help them understand the concept of justice and develop ways of implementing this ethical principle in practice. Students must learn to promote justice in contemporary healthcare while caring for diverse patient populations.

Nurse educators apply justice in several ways. They must first demonstrate fairness and impartiality when dealing with students, such as when making clinical assignments, grouping students for class work, and the way they interact with students' individuality.

One of the most influential methods nurse educators use to apply justice in nursing education is to use mock scenarios and laboratory intensives. In these situations, students interact with one another in a supervised environment, allowing them to act out planned scenarios and giving feedback on how to improve their judgment, critical thinking, hands-on skills, and the way they demonstrate ethical nursing principles.

Ms. Bayles is reviewing ethical principles in nursing with second-year nursing students. Today, she has separated the class into groups, with some acting as patients and others acting as staff nurses. The group of "patients" is comprised of male and female students from diverse ethnic and religious backgrounds. Two of the students in this group are openly members of the LGBTQ population.

Ms. Bayles gathers the group of students acting as nurses, gives a mock report, and then asks each "nurse" which "patient(s)" they prefer to care for. She asks the students to write down the patient they want to care for and give an explanation of why they chose that patient. After gathering the student's requests, she assigns patients without reading the requests.

At the end of class, Ms. Bayles reads each student nurse's request and their reason for choosing the patient they wanted. She then gives the students an opportunity to discuss how justice may or may not have been served if the students were assigned the patient they chose. They also discuss how Ms. Bayles' decision to assign patients without input from the nurses demonstrated justice, as there were no conditions for care, no partiality, and no opportunities to deny care based on the student nurse's opinions.

The lack of justice in nursing education can negatively impact students, nurse educators, nursing schools, and the healthcare facilities that host students and later employee graduates. Here are a few consequences that could result.

Perhaps the most profound consequences of the absence of justice in nursing education relate to how nursing students perform in the clinical setting during and after graduating. If nurse educators do not teach justice and demonstrate the principle in the classroom and in clinicals, students may lack the ability to apply justice themselves. Until they learn the importance of justice and how to effectively apply the principle in their practices, they may find it difficult to establish good nurse-patient relationships or to work well within a team.

Nursing instructors and educators must be careful to treat all students equally, avoiding stereotyping or showing partiality to one student or group of students. When nurse educators fail to demonstrate the ethical principle of justice, it may be difficult to develop rapport with students, compromising their ability to effectively teach students.

Justice is a crucial ethical principle in nursing research. This principle requires the nurse researcher to be fair to research participants. One of the biggest obstacles to utilizing the principle of justice in nursing research is knowing how to select appropriate research participants based on populations. For example, the mentally ill, the elderly, and prisoners are considered vulnerable and should not be used simply because researchers may have convenient access to them.

It is essential for nurse researchers to carefully choose study participants. Anyone from a vulnerable population or whose health history contradicts the reason for the study should not be included.

Nurse Hillman is screening applications for potential participants in a new research study focused on the effectiveness of a new cardiac medication. Ten people applied to participate in the study. Nurse Hillman may choose six participants.

As she reviews applications, Nurse Hillman finds one applicant is seventy-nine years old and has no family. Another applicant was recently discharged from an inpatient psychiatric unit due to complications of paranoid schizophrenia. Seven applicants have little or no significant health history other than cardiac-related issues. The final applicant has no history of any health issues. That applicant answered the screening questionnaire and included a statement about her need to "earn some money as a guinea pig" to help pay for college.

Nurse Hillman demonstrates justice in nursing research by first eliminating the two applicants from vulnerable populations, the seventy-nine-year-old applicant and the applicant who was recently treated in the psychiatric unit. She also declines the applicant who wants to earn money for college, as this client has no significant health history. Nurse Hillman then schedules one-on-one interviews with each of the remaining applicants to determine those who best meet the criteria for the study.

While there are consequences for the lack of any of the ethical principles in nursing, the consequences of lack of justice can be significant. Here are a few examples.

Nurse researchers must choose targeted participants based on the type of research they are conducting. If researchers use participants because of their ease of access instead of carefully considering each applicant and choosing the most appropriate, it could raise questions as to the validity of the participant pool.

Research is funded by several sources, and individuals or groups conducting research are accountable to those sources to perform ethically. If the question of whether justice is lacking in nursing research arises, it could cause contributions to slow or stop. Therefore, it is crucial for nurse researchers to conduct business within the confines of ethical nursing practices.

Nonmaleficence is one of the ethical principles in nursing that means to do no harm to others. This principle involves actions by which a positive effect is intended and expected, and any risk of harm is outweighed by the likelihood that no harm will come to the patient or nurse.

The following is detailed information about why Nonmaleficence is important, examples of ways to apply it, and consequences of not applying it in the four main areas of nursing: clinical practice, nursing leadership, nursing education, and nursing research.

Nonmaleficence in nursing is a vital part of safe, effective, and high-quality patient care. Intentionally exercising nonmaleficence helps the nurse ensure every possible effort is made to protect patient safety and improve patient outcomes.

Nonmaleficence in nursing may include measures such as withholding a medication until a patient’s allergies are confirmed, stopping a medication that is causing adverse reactions, or discontinuing a treatment strategy that seems to be causing more harm than good to the patient.

Nurse Adam received an order to administer Sumatriptan to his patient, Mrs. Elliott, for the treatment of migraines. When Nurse Adam asked Mrs. Elliott if she had ever taken Sumatriptan, she reported she had never tried the medication and stated, "Let's try it. The only medicine I'm allergic to is Azulfidine." Nurse Adam recognizes Azulfidine as a sulfa-containing drug and knows that Sumatriptan also contains sulfa. He asks Mrs. Elliott to describe the type of reaction she has when taking Azulfidine. Mrs. Elliott reports that when she took Azulfidine, she experienced a severe sunburn-like rash and tightness in her chest and throat. With this information, Nurse Adam chooses to hold the Sumatriptan and notify the physician of her sulfa-allergy and request an alternative non-sulfa-containing medication.

Nurse Adam demonstrated nonmaleficence by acting in the best interest of Mrs. Elliott. With the knowledge he had of her severe allergic reaction to a sulfa drug previously, had Nurse Adam administered the new medication, he would be held accountable for any adverse events.

If nonmaleficence is lacking in nursing practice, it can result in dire consequences affecting patients, their loved ones, nurses, and the profession. Here are a few examples of what happens when there is a lack of nonmaleficence in nursing.

Nonmaleficence is based on the principle of preventing harm. When nurses fail to practice nonmaleficence, the risk of medication errors and other safety risks increase.

Nurses must be especially careful to act with nonmaleficence in every nursing action. Failure to do so, resulting in patient or employee harm, could cause severe consequences for the nurse, including loss of job or loss of nursing license if the harm is severe.

While all nurses must practice nonmaleficence in practice, it may be easy to overlook the importance of this ethical principle in the nursing leadership role. Nevertheless, it is vital for nursing leaders to demonstrate nonmaleficence in their roles. The principle of doing no harm applies to our actions toward patients and peers. For nursing leaders, this also encompasses the way we relate to the nurses in our charge.

Nurse leaders may demonstrate nonmaleficence by removing risks to safe work environments, which helps staff feel more at ease in the performance of their duties.

Nonmaleficence in nursing leadership is instrumental in promoting strong interprofessional relationships based on goals to serve the greater good of patients and staff.

Nonmaleficence in nursing leadership is not only demonstrated in the way we care for patients and our expectation for the nurses on our team to do the same, it also includes implementing measures to protect the nurses we lead. Nurse leaders must implement measures to promote the safety and well-being of nurses to reduce the risk of harm and should never intentionally cause harm to another.

Nurse leaders can be very influential, and that influence can be positive or negative, depending on the leader's behavior. If nurse leaders lack nonmaleficence in their practices, it can cause severe issues and dire consequences.

If nursing leadership has a lack of nonmaleficence, it is likely every member of the team will be affected. Whether other nurses demonstrate the same behavior or simply avoid addressing the issue, it still creates issues related to patient care and outcomes.

Nonmaleficence is the principle of promoting good and not causing harm. When nurse leaders lack nonmaleficence, their behavior could result in termination and may lead to the loss of their nursing license.

Nurse educators must demonstrate desirable behavior in the classroom and in clinical settings. Promoting an attitude that supports nonmaleficence is of utmost importance. Here are a few reasons why nonmaleficence in nursing education is vital.

Nonmaleficence in nursing education promotes the delivery of high-quality patient care and supports any action by the nurse to ensure patient safety and well-being.

Nurse educators who act with nonmaleficence are excellent role models for how to put patient needs first without causing harm.

Acting with the patient's best interest at heart and implementing measures to promote patient safety and prevent harm are at the heart of nonmaleficence. It is essential for nurse educators to demonstrate this behavior to students and staff.

Nurse Wilson is a registered nurse employed in clinical staff development. One of the staff nurses at her facility has asked for guidance on how to administer a new medication the physician ordered for a client. Nurse Wilson is unfamiliar with the medication, so she consulted the pharmacist, who told her the medication is in a trial period and has not yet been proven to be effective. He also states that some serious side effects are associated with the medication.

Based on the information she gathered from the pharmacist, Nurse Wilson decided the medication may not be in the best interest of the patient. She informs the staff nurse she is not comfortable educating about administering a drug that has not been proven effective. She also notifies the nursing supervisor and physician of her findings, requesting the medication order be reconsidered.

Although the physician wrote an order for the medication, Nurse Wilson could not in good conscience be a party to giving the drug to the patient because she felt the risk was too high. Her refusal to take part in the education and administration of this drug at this time also protected the staff nurse who came to her for guidance. This is one way to demonstrate nonmaleficence in nursing education.

Nonmaleficence is one of the most important ethical principles in nursing and is closely linked to all other ethical principles. It is crucial for nurse educators to understand the risks associated with a lack of nonmaleficence and to make those risks clear to the students and nurses they teach.

Lack of nonmaleficence is associated with adverse medication events, which can lead to serious patient complications, including death. Nurse educators must stress the importance of nonmaleficence and make it clear to the nurses they teach it is their responsibility to verify and question any order they feel is inappropriate or unsafe.

In nursing research, nonmaleficence assumes no harm will come to any research participant as a result of participating in the research study. While all research studies have the potential to cause harm, nonmaleficence ensures no intentional harm will come to any participant.

Nonmaleficence is important in nursing research as it involves a conscientious act on the part of the nurse researcher to ensure participant safety throughout the study.

Practicing nonmaleficence in nursing research creates a positive reputation for the research team, which can have a positive impact on future research endeavors.

The principle of nonmaleficence is based on the concept of doing no harm. It is every nurse's responsibility to demonstrate this ethical nursing principle. Although all nursing research has the potential to cause some degree of harm, nurse researchers must identify the risks and determine the extent to which participants may be affected. They must also determine if a study should continue, be stopped, or never start at all.

Nurse Phillips is the head nurse researcher at a local research center. As she reviews data related to a scheduled research study, Nurse Phillips must determine the category of risk the study falls under and ensure it is safe to proceed.

After careful consideration of all available data, Nurse Phillips discovers some data indicate risk of permanent damage while other data suggest certainty of permanent damage. Although data also suggests some benefits are likely, the risk of permanent damage to participants outweighs the chance of benefit. Therefore, Nurse Phillips concludes the study is not safe and cancels the research study.

The lack of principles of ethics in nursing, especially nonmaleficence, can carry dire consequences in nursing research. The following are a few examples of what could happen if nurse researchers do not practice nonmaleficence.

Some nursing research is considered highly questionable, even if it has the potential to create benefits. Nonmaleficence in nursing research ensures that nurse researchers act in the best interests of the participants, causing no intentional harm. A lack of nonmaleficence could result in research studies that cause permanent damage to participants.

All nursing research should offer greater benefits than risks, or the research study should not occur. If nurse researchers fail to practice nonmaleficence, they are less likely to weigh the benefits and risks to ensure the benefits are greater than the risks.

Veracity is sometimes viewed as one of the most difficult ethical principles in nursing to uphold. The principle of veracity requires nurses to be completely honest with patients. It means telling the truth, even if the truth may cause the patient distress.

The following is detailed information about why Veracity is important, examples of ways to apply it, and consequences of not applying it in the four main areas of nursing: clinical practice, nursing leadership, nursing education, and nursing research.

Although implementing veracity may feel a little overwhelming, especially in difficult patient situations, it is an essential ethical principle in nursing. Here are a few reasons why demonstrating veracity is so important.

Veracity creates a bond of trust between patients and nurses. It helps bind and strengthen nurse-patient relationships, which are essential in developing treatment plans and establishing attainable goals.

Veracity in nurses helps promote patient autonomy. Honesty between nurses and patients allows patients to make informed decisions about their care, which is the right of every competent patient.

Veracity in nursing practice requires the nurse to tell the truth in every situation, regardless of how others may respond to that truth.

Mr. Douglas has congestive heart failure and lung cancer that has metastasized to his spine. The doctor came to his room to explain the severity of his condition and told Mr. Douglas they had tried all possible treatments and his life expectancy is less than six months. The doctor recommends hospice at home.

After the doctor leaves, Mrs. Douglas questions the nurse stating, "As soon as we get him home, the hospice people will take good care of him. He will be better in no time, right?" The nurse understands that Mrs. Douglas is grasping for hope and wants the nurse to give her something to cling to. However, the principle of veracity demands the nurse to explain what the doctor said to Mrs. Douglas without giving her false hope.

Although nurses may wish to withhold all or part of the information to help ease a patient or loved one, it is crucial to avoid that. Even with the best of intentions, a lack of veracity in nursing practice can cause more problems than good.

When nurses are dishonest with patients and family members, it creates barriers to effective communication, which complicates patient care even more.

If patients feel they cannot trust nurses to be honest, they may distance themselves and begin to be non-compliant. Poor nurse-patient relationships make it difficult to communicate patient needs and care plans, and non-compliance leads to poor patient outcomes.

Nurses count on nurse leaders to be honest and forthcoming with them about all issues related to patient care or other pertinent information affecting their roles. It is vital for nurse leaders to grasp the need for veracity and implement it in every way possible.

Veracity in nursing leadership helps establish trusting nurse-nurse leader and interprofessional relationships.

Nurse leaders who act with honesty and integrity usually experience higher employee morale and job satisfaction rates within their teams, leading to decreased nurse turnover.

Nurse leaders can positively impact patients, nurses, and their organizations by always demonstrating veracity.

Nurse Brister is the primary nurse leader for a large outpatient clinic located within the university hospital. The outpatient clinic includes several sub-clinics that each employ five to ten nurses. Nurse Brister announced to his staff during a staff meeting that he plans to meet with the nursing administration and seek allocation of funds to improve the outpatient facility. Several of the clinics have old furniture and have not been cosmetically updated for several years. So, this announcement made the nurses happy.

Despite being told the administration would likely deny his request for funds, Nurse Brister typed a proposal and asked for an appointment with the hospital administrator and chief financial officer. He presented his request and made a cordial argument as to how the updates could be a positive change for the hospital. After considering the request, the administration approved a plan to allocate funds to update the clinic.

After being discouraged about approaching administration, Nurse Brister could have simply told his staff he was unable to secure an appointment with them. However, his word to his staff meant more than the risk of being denied a request. This is an excellent way for a nurse leader to demonstrate honesty toward their team members.

Lack of veracity in nurse leadership can cause challenges at every level of the organization. Here are a few examples of consequences of lack of veracity.

If staff nurses feel they cannot trust their leaders, they are less likely to develop strong relationships, which could impact patient care and organizational outcomes.

Employers seek to hire nurse leaders who demonstrate all the ethical principles in nursing. Veracity is especially important as they need to count on what leaders say as the truth. If nurse leaders fail to be honest, they may lose leadership positions or be separated from employment.

Veracity in nursing education is vital to the development of ethically strong nurses. Here are a few reasons why it is an important ethical nursing principle.

Nurse educators who act with honesty and integrity are instrumental in cultivating those behaviors in student nurses and staff nurses.

Veracity in nursing education encourages students to approach any situation with honesty, facing the consequences, good or bad, and learning how to overcome challenges.

Nurse educators can demonstrate veracity in a number of ways. The following is an example of how a nursing instructor may apply veracity in a clinical setting with students.

Mrs. Adams is the nursing instructor supervising students on the Medical-Surgical unit at a local hospital. After students complete assignments and are dismissed to go home, Mrs. Adams remains at the hospital to discuss the next day’s clinical assignments with the nursing supervisor.

The nursing supervisor expresses concerns about one of the students stating she feels the student “may not make it” in the program. She asks Mrs. Adams’ opinion about the student.

Mrs. Adams responds to the nursing supervisor by assuring her that each student in the clinical rotation has strengths and weaknesses. She tells the nursing instructor she is aware of which students need more hands-on skills development and who may need coaching to develop better communication skills, etc. She does not discuss a student by name, but thanks the nursing supervisor for her input and agrees to pay special attention to any student who needs help to succeed.

Lack of veracity can be detrimental to the success of nursing students, staff, and healthcare organizations. The following are a few consequences associated with a lack of veracity in nursing education.

If nurse educators do not teach the need for veracity in patient care, students may fail to exercise veracity, negatively impacting relationships with patients, nursing staff, and instructors.

Healthcare facilities and organizations enter into contracts with nursing schools allowing students to engage in clinical rotations. If nursing students or nurse educators do not demonstrate veracity, it could indicate to the facility the nursing school does not value important ethical principles of nursing. When this occurs, the facility may choose to terminate clinical contracts.

The principle of veracity in nursing research highlights the obligation of the nurse researcher to be honest about the research project. The following are some reasons veracity in nursing research is vital.

Veracity in nursing research gives investors and prospective participants the opportunity to make decisions about the research and their level of involvement based on facts, not assumptions.

Nurse researchers who practice veracity are more likely to be respected, making future research opportunities easier to procure.

Veracity in nursing research is vital for the success of any research project. In nursing research, its veracity involves several aspects.

The research team at ABC Research Lab wishes to conduct a study on patients with paranoid schizophrenia. The team develops a question upon which they wish to base their research. They discuss criteria for research participants, meet with applicants, and ensure informed consent. The team also meets with investors to describe the nature of the research and anticipated outcome. They answer questions and present evidence to support their proposal.

By being open and honest with everyone involved with the proposed research project, nurse researchers allow each person or group to make an informed decision about their involvement before moving forward.

Lack of veracity in nursing research, like the lack of other ethical nursing principles, can result in unpleasant consequences, including the following.

Lack of veracity in nursing research undermines one’s respect for autonomy, which leaves prospective participants feeling as though their wants, needs, or concerns are not important.

Lack of veracity among nurse researchers could lead to deceiving research participants.

5 Most Common Challenges You Will Face While Applying the 7 Ethical Principles in Nursing and How to Overcome Them

Challenge #1: knowing where to draw the line between autonomy and beneficence, what is it:, how to overcome:, challenge #2: deciding whether to withhold information or be honest about a patient’s status or prognosis, challenge #3: supporting autonomy related to informed consent, challenge #4: keeping promises when your circumstances change, challenge #5: determining if nonmaleficence overrules a patient’s right to privacy, my final thoughts.

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WHAT IS CRITICAL ETHICS AND WHY IT MATTERS

2021, Academia Letters

Critical Ethics (as a unified account of normative and meta-ethics) uses critical thinking to get around the limitations of personal belief and indoctrination to get to what ought to be done and why to improve the human condition. For, if we teach only moral beliefs (whether as a set of absolutistic or relativistic normative codes)—no matter how useful and even inspiring they may be to a particular culture or community—the adherent will have a hard time distinguishing, or simply may not be able to distinguish, good from bad as an act of personal responsibility and free choice. Moreover, without critical thinking the adherent could possibly end-up believing all kinds of false or inconsistent things and moral beliefs may well end-up in conflict with better established background information. This would very likely lead to cognitive dissonance and inconsistency in a person’s actions; and, when generalized, would have devastating consequences for the survival of the human species because a person’s beliefs would not align or match with (at times dangerous) reality. Accordingly, it is crucial that we learn how to evaluate and to select among alternatives to do the thing that must be done, when it ought to be done, using critical thinking.

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Principles of Clinical Ethics and Their Application to Practice

An overview of ethics and clinical ethics is presented in this review. The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed. In patient care situations, not infrequently, there are conflicts between ethical principles (especially between beneficence and autonomy). A four-pronged systematic approach to ethical problem-solving and several illustrative cases of conflicts are presented. Comments following the cases highlight the ethical principles involved and clarify the resolution of these conflicts. A model for patient care, with caring as its central element, that integrates ethical aspects (intertwined with professionalism) with clinical and technical expertise desired of a physician is illustrated.

Highlights of the Study

Main principles of ethics, that is beneficence, nonmaleficence, autonomy, and justice, are discussed.
Autonomy is the basis for informed consent, truth-telling, and confidentiality.
A model to resolve conflicts when ethical principles collide is presented.
Cases that highlight ethical issues and their resolution are presented.
A patient care model that integrates ethics, professionalism, and cognitive and technical expertise is shown.

Introduction

A defining responsibility of a practicing physician is to make decisions on patient care in different settings. These decisions involve more than selecting the appropriate treatment or intervention.

Ethics is an inherent and inseparable part of clinical medicine [ 1 ] as the physician has an ethical obligation (i) to benefit the patient, (ii) to avoid or minimize harm, and to (iii) respect the values and preferences of the patient. Are physicians equipped to fulfill this ethical obligation and can their ethical skills be improved? A goal-oriented educational program [ 2 ] (Table (Table1) 1 ) has been shown to improve learner awareness, attitudes, knowledge, moral reasoning, and confidence [ 3 , 4 ].

Goals of ethics education

• To appreciate the ethical dimensions of patient care

• To understand ethical principles of medical profession

• To have competence in core ethical behavioral skills ( )

• To know the commonly encountered ethical issues in general and in one's specialty

• To have competence in analyzing and resolving ethical problems

• To appreciate cultural diversity and its impact on ethics

Ethics, Morality, and Professional Standards

Ethics is a broad term that covers the study of the nature of morals and the specific moral choices to be made. Normative ethics attempts to answer the question, “Which general moral norms for the guidance and evaluation of conduct should we accept, and why?” [ 5 ]. Some moral norms for right conduct are common to human kind as they transcend cultures, regions, religions, and other group identities and constitute common morality (e.g., not to kill, or harm, or cause suffering to others, not to steal, not to punish the innocent, to be truthful, to obey the law, to nurture the young and dependent, to help the suffering, and rescue those in danger). Particular morality refers to norms that bind groups because of their culture, religion, profession and include responsibilities, ideals, professional standards, and so on. A pertinent example of particular morality is the physician's “accepted role” to provide competent and trustworthy service to their patients. To reduce the vagueness of “accepted role,” physician organizations (local, state, and national) have codified their standards. However, complying with these standards, it should be understood, may not always fulfill the moral norms as the codes have “often appeared to protect the profession's interests more than to offer a broad and impartial moral viewpoint or to address issues of importance to patients and society” [ 6 ].

Bioethics and Clinical (Medical) Ethics

A number of deplorable abuses of human subjects in research, medical interventions without informed consent, experimentation in concentration camps in World War II, along with salutary advances in medicine and medical technology and societal changes, led to the rapid evolution of bioethics from one concerned about professional conduct and codes to its present status with an extensive scope that includes research ethics, public health ethics, organizational ethics, and clinical ethics.

Hereafter, the abbreviated term, ethics, will be used as I discuss the principles of clinical ethics and their application to clinical practice.

The Fundamental Principles of Ethics

Beneficence, nonmaleficence, autonomy, and justice constitute the 4 principles of ethics. The first 2 can be traced back to the time of Hippocrates “to help and do no harm,” while the latter 2 evolved later. Thus, in Percival's book on ethics in early 1800s, the importance of keeping the patient's best interest as a goal is stressed, while autonomy and justice were not discussed. However, with the passage of time, both autonomy and justice gained acceptance as important principles of ethics. In modern times, Beauchamp and Childress' book on Principles of Biomedical Ethics is a classic for its exposition of these 4 principles [ 5 ] and their application, while also discussing alternative approaches.

Beneficence

The principle of beneficence is the obligation of physician to act for the benefit of the patient and supports a number of moral rules to protect and defend the right of others, prevent harm, remove conditions that will cause harm, help persons with disabilities, and rescue persons in danger. It is worth emphasizing that, in distinction to nonmaleficence, the language here is one of positive requirements. The principle calls for not just avoiding harm, but also to benefit patients and to promote their welfare. While physicians' beneficence conforms to moral rules, and is altruistic, it is also true that in many instances it can be considered a payback for the debt to society for education (often subsidized by governments), ranks and privileges, and to the patients themselves (learning and research).

Nonmaleficence

Nonmaleficence is the obligation of a physician not to harm the patient. This simply stated principle supports several moral rules − do not kill, do not cause pain or suffering, do not incapacitate, do not cause offense, and do not deprive others of the goods of life. The practical application of nonmaleficence is for the physician to weigh the benefits against burdens of all interventions and treatments, to eschew those that are inappropriately burdensome, and to choose the best course of action for the patient. This is particularly important and pertinent in difficult end-of-life care decisions on withholding and withdrawing life-sustaining treatment, medically administered nutrition and hydration, and in pain and other symptom control. A physician's obligation and intention to relieve the suffering (e.g., refractory pain or dyspnea) of a patient by the use of appropriate drugs including opioids override the foreseen but unintended harmful effects or outcome (doctrine of double effect) [ 7 , 8 ].

The philosophical underpinning for autonomy, as interpreted by philosophers Immanuel Kant (1724–1804) and John Stuart Mill (1806–1873), and accepted as an ethical principle, is that all persons have intrinsic and unconditional worth, and therefore, should have the power to make rational decisions and moral choices, and each should be allowed to exercise his or her capacity for self-determination [ 9 ]. This ethical principle was affirmed in a court decision by Justice Cardozo in 1914 with the epigrammatic dictum, “Every human being of adult years and sound mind has a right to determine what shall be done with his own body” [ 10 ].

Autonomy, as is true for all 4 principles, needs to be weighed against competing moral principles, and in some instances may be overridden; an obvious example would be if the autonomous action of a patient causes harm to another person(s). The principle of autonomy does not extend to persons who lack the capacity (competence) to act autonomously; examples include infants and children and incompetence due to developmental, mental or physical disorder. Health-care institutions and state governments in the US have policies and procedures to assess incompetence. However, a rigid distinction between incapacity to make health-care decisions (assessed by health professionals) and incompetence (determined by court of law) is not of practical use, as a clinician's determination of a patient's lack of decision-making capacity based on physical or mental disorder has the same practical consequences as a legal determination of incompetence [ 11 ].

Detractors of the principle of autonomy question the focus on the individual and propose a broader concept of relational autonomy (shaped by social relationships and complex determinants such as gender, ethnicity and culture) [ 12 ]. Even in an advanced western country such as United States, the culture being inhomogeneous, some minority populations hold views different from that of the majority white population in need for full disclosure, and in decisions about life support (preferring a family-centered approach) [ 13 ].

Resistance to the principle of patient autonomy and its derivatives (informed consent, truth-telling) in non-western cultures is not unexpected. In countries with ancient civilizations, rooted beliefs and traditions, the practice of paternalism ( this term will be used in this article, as it is well-entrenched in ethics literature, although parentalism is the proper term ) by physicians emanates mostly from beneficence. However, culture (a composite of the customary beliefs, social forms, and material traits of a racial, religious or social group) is not static and autonomous, and changes with other trends over passing years. It is presumptuous to assume that the patterns and roles in physician-patient relationships that have been in place for a half a century and more still hold true. Therefore, a critical examination of paternalistic medical practice is needed for reasons that include technological and economic progress, improved educational and socioeconomic status of the populace, globalization, and societal movement towards emphasis on the patient as an individual, than as a member of a group. This needed examination can be accomplished by research that includes well-structured surveys on demographics, patient preferences on informed consent, truth-telling, and role in decision-making.

Respecting the principle of autonomy obliges the physician to disclose medical information and treatment options that are necessary for the patient to exercise self-determination and supports informed consent, truth-telling, and confidentiality.

Informed Consent

The requirements of an informed consent for a medical or surgical procedure, or for research, are that the patient or subject (i) must be competent to understand and decide, (ii) receives a full disclosure, (iii) comprehends the disclosure, (iv) acts voluntarily, and (v) consents to the proposed action.

The universal applicability of these requirements, rooted and developed in western culture, has met with some resistance and a suggestion to craft a set of requirements that accommodate the cultural mores of other countries [ 14 ]. In response and in vigorous defense of the 5 requirements of informed consent, Angell wrote, “There must be a core of human rights that we would wish to see honored universally, despite variations in their superficial aspects …The forces of local custom or local law cannot justify abuses of certain fundamental rights, and the right of self-determination on which the doctrine of informed consent is based, is one of them” [ 15 ].

As competence is the first of the requirements for informed consent, one should know how to detect incompetence. Standards (used singly or in combination) that are generally accepted for determining incompetence are based on the patient's inability to state a preference or choice, inability to understand one's situation and its consequences, and inability to reason through a consequential life decision [ 16 ].

In a previously autonomous, but presently incompetent patient, his/her previously expressed preferences (i.e., prior autonomous judgments) are to be respected [ 17 ]. Incompetent (non-autonomous) patients and previously competent (autonomous), but presently incompetent patients would need a surrogate decision-maker. In a non-autonomous patient, the surrogate can use either a substituted judgment standard (i.e., what the patient would wish in this circumstance and not what the surrogate would wish), or a best interests standard (i.e., what would bring the highest net benefit to the patient by weighing risks and benefits). Snyder and Sulmasy [ 18 ], in their thoughtful article, provide a practical and useful option when the surrogate is uncertain of the patient's preference(s), or when patient's preferences have not kept abreast of scientific advances. They suggest the surrogate use “substituted interests,” that is, the patient's authentic values and interests, to base the decision.

Truth-Telling

Truth-telling is a vital component in a physician-patient relationship; without this component, the physician loses the trust of the patient. An autonomous patient has not only the right to know (disclosure) of his/her diagnosis and prognosis, but also has the option to forgo this disclosure. However, the physician must know which of these 2 options the patient prefers.

In the United States, full disclosure to the patient, however grave the disease is, is the norm now, but was not so in the past. Significant resistance to full disclosure was highly prevalent in the US, but a marked shift has occurred in physicians' attitudes on this. In 1961, 88% of physicians surveyed indicated their preference to avoid disclosing a diagnosis [ 19 ]; in 1979, however, 98% of surveyed physicians favored it [ 20 ]. This marked shift is attributable to many factors that include − with no order of importance implied − educational and socioeconomic progress, increased accountability to society, and awareness of previous clinical and research transgressions by the profession.

Importantly, surveys in the US show that patients with cancer and other diseases wish to have been fully informed of their diagnoses and prognoses. Providing full information, with tact and sensitivity, to patients who want to know should be the standard. The sad consequences of not telling the truth regarding a cancer include depriving the patient of an opportunity for completion of important life-tasks: giving advice to, and taking leave of loved ones, putting financial affairs in order, including division of assets, reconciling with estranged family members and friends, attaining spiritual order by reflection, prayer, rituals, and religious sacraments [ 21 , 22 ].

In contrast to the US, full disclosure to the patient is highly variable in other countries [ 23 ]. A continuing pattern in non-western societies is for the physician to disclose the information to the family and not to the patient. The likely reasons for resistance of physicians to convey bad news are concern that it may cause anxiety and loss of hope, some uncertainty on the outcome, or belief that the patient would not be able to understand the information or may not want to know. However, this does not have to be a binary choice, as careful understanding of the principle of autonomy reveals that autonomous choice is a right of a patient, and the patient, in exercising this right, may authorize a family member or members to make decisions for him/her.

Confidentiality

Physicians are obligated not to disclose confidential information given by a patient to another party without the patient's authorization. An obvious exception (with implied patient authorization) is the sharing necessary of medical information for the care of the patient from the primary physician to consultants and other health-care teams. In the present-day modern hospitals with multiple points of tests and consultants, and the use of electronic medical records, there has been an erosion of confidentiality. However, individual physicians must exercise discipline in not discussing patient specifics with their family members or in social gatherings [ 24 ] and social media. There are some noteworthy exceptions to patient confidentiality. These include, among others, legally required reporting of gunshot wounds and sexually transmitted diseases and exceptional situations that may cause major harm to another (e.g., epidemics of infectious diseases, partner notification in HIV disease, relative notification of certain genetic risks, etc.).

Justice is generally interpreted as fair, equitable, and appropriate treatment of persons. Of the several categories of justice, the one that is most pertinent to clinical ethics is distributive justice . Distributive justice refers to the fair, equitable, and appropriate distribution of health-care resources determined by justified norms that structure the terms of social cooperation [ 25 ]. How can this be accomplished? There are different valid principles of distributive justice. These are distribution to each person (i) an equal share, (ii) according to need, (iii) according to effort, (iv) according to contribution, (v) according to merit, and (vi) according to free-market exchanges. Each principle is not exclusive, and can be, and are often combined in application. It is easy to see the difficulty in choosing, balancing, and refining these principles to form a coherent and workable solution to distribute medical resources.

Although this weighty health-care policy discussion exceeds the scope of this review, a few examples on issues of distributive justice encountered in hospital and office practice need to be mentioned. These include allotment of scarce resources (equipment, tests, medications, organ transplants), care of uninsured patients, and allotment of time for outpatient visits (equal time for every patient? based on need or complexity? based on social and or economic status?). Difficult as it may be, and despite the many constraining forces, physicians must accept the requirement of fairness contained in this principle [ 26 ]. Fairness to the patient assumes a role of primary importance when there are conflicts of interests. A flagrant example of violation of this principle would be when a particular option of treatment is chosen over others, or an expensive drug is chosen over an equally effective but less expensive one because it benefits the physician, financially, or otherwise.

Conflicts between Principles

Each one of the 4 principles of ethics is to be taken as a prima facie obligation that must be fulfilled, unless it conflicts, in a specific instance, with another principle. When faced with such a conflict, the physician has to determine the actual obligation to the patient by examining the respective weights of the competing prima facie obligations based on both content and context. Consider an example of a conflict that has an easy resolution: a patient in shock treated with urgent fluid-resuscitation and the placement of an indwelling intravenous catheter caused pain and swelling. Here the principle of beneficence overrides that of nonmaleficence. Many of the conflicts that physicians face, however, are much more complex and difficult. Consider a competent patient's refusal of a potentially life-saving intervention (e.g., instituting mechanical ventilation) or request for a potentially life-ending action (e.g., withdrawing mechanical ventilation). Nowhere in the arena of ethical decision-making is conflict as pronounced as when the principles of beneficence and autonomy collide.

Beneficence has enjoyed a historical role in the traditional practice of medicine. However, giving it primacy over patient autonomy is paternalism that makes a physician-patient relationship analogous to that of a father/mother to a child. A father/mother may refuse a child's wishes, may influence a child by a variety of ways − nondisclosure, manipulation, deception, coercion etc., consistent with his/her thinking of what is best for the child. Paternalism can be further divided into soft and hard .

In soft paternalism, the physician acts on grounds of beneficence (and, at times, nonmaleficence) when the patient is nonautonomous or substantially nonautonomous (e.g., cognitive dysfunction due to severe illness, depression, or drug addiction) [ 27 ]. Soft paternalism is complicated because of the difficulty in determining whether the patient was nonautonomous at the time of decision-making but is ethically defensible as long as the action is in concordance with what the physician believes to be the patient's values. Hard paternalism is action by a physician, intended to benefit a patient, but contrary to the voluntary decision of an autonomous patient who is fully informed and competent, and is ethically indefensible.

On the other end of the scale of hard paternalism is consumerism, a rare and extreme form of patient autonomy, that holds the view that the physician's role is limited to providing all the medical information and the available choices for interventions and treatments while the fully informed patient selects from the available choices. In this model, the physician's role is constrained, and does not permit the full use of his/her knowledge and skills to benefit the patient, and is tantamount to a form of patient abandonment and therefore is ethically indefensible.

Faced with the contrasting paradigms of beneficence and respect for autonomy and the need to reconcile these to find a common ground, Pellegrino and Thomasma [ 28 ] argue that beneficence can be inclusive of patient autonomy as “the best interests of the patients are intimately linked with their preferences” from which “are derived our primary duties to them.”

One of the basic and not infrequent reasons for disagreement between physician and patient on treatment issues is their divergent views on goals of treatment. As goals change in the course of disease (e.g., a chronic neurologic condition worsens to the point of needing ventilator support, or a cancer that has become refractory to treatment), it is imperative that the physician communicates with the patient in clear and straightforward language, without the use of medical jargon, and with the aim of defining the goal(s) of treatment under the changed circumstance. In doing so, the physician should be cognizant of patient factors that compromise decisional capacity, such as anxiety, fear, pain, lack of trust, and different beliefs and values that impair effective communication [ 29 ].

The foregoing theoretical discussion on principles of ethics has practical application in clinical practice in all settings. In the resource book for clinicians, Jonsen et al. [ 30 ] have elucidated a logical and well accepted model (Table (Table2), 2 ), along the lines of the systematic format that practicing physicians have been taught and have practiced for a long time (Chief Complaint, History of Present Illness, Past History, pertinent Family and Social History, Review of Systems, Physical Examination and Laboratory and Imaging studies). This practical approach to problem-solving in ethics involves:

Clinical assessment (identifying medical problems, treatment options, goals of care)
Patient (finding and clarifying patient preferences on treatment options and goals of care)
Quality of life (QOL) (effects of medical problems, interventions and treatments on patient's QOL with awareness of individual biases on what constitutes an acceptable QOL)
Context (many factors that include family, cultural, spiritual, religious, economic and legal).

Application of principles of ethics in patient care

Beneficence,
nonmaleficence	Nature of illness (acute, chronic, reversible, terminal)? Goals of treatment?
	Treatment options and probability of success for each option?
	Adverse effects of treatment and does benefit outweigh harm?
	Effects of no medical/surgical treatment?
	If treated, plans for limiting treatment? Stopping treatment?

Respect for autonomy
	Information given to patient on benefits and risks of treatment? Patient understood the information and gave consent?
	Patent mentally competent? If competent, what are his/her preferences?
	If patient mentally incompetent, are patient's prior preferences known? If preferences unknown, who is the appropriate surrogate?

Beneficence,	( )
nonmaleficence,	Expected QOL with and without treatment?
respect for autonomy	Deficits − physical, mental, social − may have after treatment?
	Judging QOL of patient who cannot express himself/herself? Who is the judge?
	Recognition of possible physician bias in judging QOL?
	Rationale to forgo life-sustaining treatment(s)?

Distributive justice
	Conflicts of interests − does physician benefit financially, professionally by ordering tests, prescribing medications, seeking consultations?
	Research or educational considerations that affect clinical decisions, physician orders?
	Conflicts of interests based on religious beliefs? Legal issues?
	Conflicts of interests between organizations (clinics, hospitals), 3rd party payers?
	Public health and safety issues?
	Problems in allocation of scarce resources?

Using this model, the physician can identify the principles that are in conflict, ascertain by weighing and balancing what should prevail, and when in doubt, turn to ethics literature and expert opinion.

Illustrative Cases

There is a wide gamut of clinical patient encounters with ethical issues, and some, especially those involving end-of-life care decisions, are complex. A few cases (Case 1 is modified from resource book [ 30 ]) are presented below as they highlight the importance of understanding and weighing the ethical principles involved to arrive at an ethically right solution. Case 6 was added during the revision phase of this article as it coincided with the outbreak of Coronavirus Infectious Disease-2019 (COVID-19) that became a pandemic rendering a discussion of its ethical challenges necessary and important.

A 20-year old college student living in the college hostel is brought by a friend to the Emergency Department (ED) because of unrelenting headache and fever. He appeared drowsy but was responsive and had fever (40°C), and neck rigidity on examination. Lumbar puncture was done, and spinal fluid appeared cloudy and showed increased white cells; Gram stain showed Gram-positive diplococci. Based on the diagnosis of bacterial meningitis, appropriate antibiotics were begun, and hospitalization was instituted. Although initial consent for diagnosis was implicit, and consent for lumbar puncture was explicit, at this point, the patient refuses treatment without giving any reason, and insists to return to his hostel. Even after explanation by the physician as to the seriousness of his diagnosis, and the absolute need for prompt treatment (i.e., danger to life without treatment), the patient is adamant in his refusal.

Comment . Because of this refusal, the medical indications and patient preferences (see Table Table2) 2 ) are at odds. Is it ethically right to treat against his will a patient who is making a choice that has dire consequences (disability, death) who gives no reason for this decision, and in whom a clear determination of mental incapacity cannot be made (although altered mental status may be presumed)? Here the principle of beneficence and principle of autonomy are in conflict. The weighing of factors: (1) patient may not be making a reasoned decision in his best interest because of temporary mental incapacity; and (2) the severity of life-threatening illness and the urgency to treat to save his life supports the decision in favor of beneficence (i.e., to treat).

A 56-year old male lawyer and current cigarette smoker with a pack-a-day habit for more than 30 years, is found to have a solitary right upper lobe pulmonary mass 5 cm in size on a chest radiograph done as part of an insurance application. The mass has no calcification, and there are no other pulmonary abnormalities. He has no symptoms, and his examination is normal. Tuberculosis skin test is negative, and he has no history of travel to an endemic area of fungal infection. As lung cancer is the most probable and significant diagnosis to consider, and early surgical resection provides the best prospects for cure, the physician, in consultation with the thoracic surgeon, recommends bronchoscopic biopsy and subsequent resection. The patient understands the treatment plan, and the significance of not delaying the treatment. However, he refuses, and states that he does not think he has cancer; and is fearful that the surgery would kill him. Even after further explanations on the low mortality of surgery and the importance of removing the mass before it spreads, he continues to refuse treatment.

Comment . Even though the physician's prescribed treatment, that is, removal of the mass that is probably cancer, affords the best chance of cure, and delay in its removal increases its chance of metastases and reaching an incurable stage − the choice by this well informed and mentally competent patient should be respected. Here, autonomy prevails over beneficence. The physician, however, may not abandon the patient and is obligated to offer continued outpatient visits with advice against making decision based on fear, examinations, periodic tests, and encouragement to seek a second opinion.

A 71-year-old man with very severe chronic obstructive pulmonary disease (COPD) is admitted to the intensive care unit (ICU) with pneumonia, sepsis, and respiratory failure. He is intubated and mechanically ventilated. For the past 2 years, he has been on continuous oxygen treatment and was short of breath on minimal exertion. In the past 1 year, he had 2 admissions to the ICU; on both occasions he required intubation and mechanical ventilation. Presently, even with multiple antibiotics, intravenous fluid hydration, and vasopressors, his systolic blood pressure remains below 60 mm Hg, and with high flow oxygen supplementation, his oxygen saturation stays below 80%; his arterial blood pH is 7.0. His liver enzymes are elevated. He is anuric, and over next 8 h his creatinine has risen to 5 mg/dL and continues to rise. He has drifted into a comatose state. The intensivist suggests discontinuation of vasopressors and mechanical ventilation as their continued use is futile. The patient has no advance care directives or a designated health-care proxy.

Comment . The term “futility” is open to different definitions [ 31 ] and is often controversial, and therefore, some experts suggest the alternate term, “clinically non-beneficial interventions” [ 32 ]. However, in this case the term futility is appropriate to indicate that there is evidence of physiological futility (multisystem organ failure in the setting of preexisting end stage COPD, and medical interventions would not reverse the decline). It is appropriate then to discuss the patient's condition with his family with the goal of discontinuing life-sustaining interventions. These discussions should be done with sensitivity, compassion and empathy. Palliative care should be provided to alleviate his symptoms and to support the family until his death and beyond in their bereavement.

A 67-year old widow, an immigrant from southern India, is living with her son and his family in Wisconsin, USA. She was experiencing nausea, lack of appetite and weight loss for a few months. During the past week, she also had dark yellow urine, and yellow coloration of her skin. She has basic knowledge of English. She was brought to a multi-specialty teaching hospital by her son, who informed the doctor that his mother has “jaundice,” and instructed that, if any serious life-threatening disease was found, not to inform her. He asked that all information should come to him, and if there is any cancer not to treat it, since she is older and frail. Investigations in the hospital reveals that she has pancreatic cancer, and chemotherapy, while not likely to cure, would prolong her life.

Comment . In some ancient cultures, authority is given to members of the family (especially senior men) to make decisions that involve other members on marriage, job, and health care. The woman in this case is a dependent of her son, and given this cultural perspective, the son can rightfully claim to have the authority to make health-care decisions for her. Thus, the physician is faced with multiple tasks that may not be consonant. To respect cultural values [ 33 ], to directly learn the patient's preferences, to comply with the American norm of full disclosure to the patient, and to refuse the son's demands.

The principle of autonomy provides the patient the option to delegate decision-making authority to another person. Therefore, the appropriate course would be to take the tactful approach of directly informing the patient (with a translator if needed), that the diagnosed disease would require decisions for appropriate treatment. The physician should ascertain whether she would prefer to make these decisions herself, or whether she would prefer all information to be given to her son, and all decisions to be made by him.

A 45-year-old woman had laparotomy and cholecystectomy for abdominal pain and multiple gall stones. Three weeks after discharge from the hospital, she returned with fever, abdominal pain, and tenderness. She was given antibiotics, and as her fever continued, laparotomy and exploration were undertaken; a sponge left behind during the recent cholecystectomy was found. It was removed, the area cleansed, and incision closed. Antibiotics were continued, and she recovered without further incident and was discharged. Should the surgeon inform the patient of his error?

Comment . Truth-telling, a part of patient autonomy is very much applicable in this situation and disclosure to patient is required [ 34 , 35 , 36 ]. The mistake caused harm to the patient (morbidity and readmission, and a second surgery and monetary loss). Although the end result remedied the harm, the surgeon is obligated to inform the patient of the error and its consequences and offer an apology. Such errors are always reported to the Operating Room Committees and Surgical Quality Improvement Committees of US Hospitals. Hospital-based risk reduction mechanisms (e.g., Risk Management Department) present in most US hospitals would investigate the incident and come up with specific recommendations to mitigate the error and eliminate them in the future. Many institutions usually make financial settlements to obviate liability litigation (fees and hospital charges waived, and/or monetary compensation made to the patient). Elsewhere, if such mechanisms do not exist, it should be reported to the hospital. Acknowledgment from the hospital, apologies from the institution and compensation for the patient are called for. Whether in US or elsewhere, a malpractice suit is very possible in this situation, but a climate of honesty substantially reduces the threat of legal claims as most patients trust their physicians and are not vindictive.

The following scenario is at a city hospital during the peak of the COVID-19 pandemic: A 74-year-old woman, residing in an assisted living facility, is brought to the ED with shortness of breath and malaise. Over the past 4 days she had been experiencing dry cough, lack of appetite, and tiredness; 2 days earlier, she stopped eating and started having a low-grade fever. A test for COVID-19 undertaken by the assisted living facility was returned positive on the morning of the ED visit.

She, a retired nurse, is a widow; both of her grown children live out-of-state. She has had hypertension for many years, controlled with daily medications. Following 2 strokes, she was moved to an assisted living facility 3 years ago. She recovered most of her functions after the strokes and required help only for bathing and dressing. She is able to answer questions appropriately but haltingly, because of respiratory distress. She has tachypnea (34/min), tachycardia (120/min), temperature of 101°F, BP 100/60 and 90% O 2 saturation (on supplemental O 2 of 4 L/min). She has dry mouth and tongue and rhonchi on lung auscultation. Her respiratory rate is increasing on observation and she is visibly tiring.

Another patient is now brought in by ambulance; this is a 22-year-old man living in an apartment and has had symptoms of “flu” for a week. Because of the pandemic, he was observing the recommended self-distancing, and had no known exposure to coronavirus. He used saline gargles, acetaminophen, and cough syrup to alleviate his sore throat, cough, and fever. In the past 2 days, his symptoms worsened, and he drove himself to a virus testing station and got tested for COVID-19; he was told that he would be notified of the results. He returned to his apartment and after a sleepless night with fever, sweats, and persistent cough, he woke up and felt drained of all strength. The test result confirmed COVID-19. He then called for an ambulance.

He has been previously healthy. He is a non-smoker and uses alcohol rarely. He is a second-year medical student. He is single, and his parents and sibling live hundreds of miles away.

On examination, he has marked tachypnea (>40/min), shallow breathing, heart rate of 128/min, temperature of 103°F and O 2 saturation of 88 on pulse oximetry. He appears drowsy and is slow to respond to questions. He is propped up to a sitting position as it is uncomfortable for him to be supine. Accessory muscles of neck and intercostals are contracting with each breath, and on auscultation, he has basilar crackles and scattered rhonchi. His O 2 saturation drops to 85 and he is in respiratory distress despite nebulized bronchodilator treatment.

Both of these patients are in respiratory failure, clinically and confirmed by arterial blood gases, and are in urgent need of intubation and mechanical ventilation. However, only one ventilator is available; who gets it?

Comment . The decision to allocate a scarce and potentially life-saving equipment (ventilator) is very difficult as it directly addresses the question “Who shall live when not everyone can live? [ 5 ]. This decision cannot be emotion-driven or arbitrary; nor should it be based on a person's wealth or social standing. Priorities need to be established ethically and must be applied consistently in the same institution and ideally throughout the state and the country. The general social norm to treat all equally or to treat on a first come, first saved basis is not the appropriate choice here. There is a consensus among clinical ethics scholars, that in this situation, maximizing benefits is the dominant value in making a decision [ 37 ]. Maximizing benefits can be viewed in 2 different ways; in lives saved or in life-years saved; they differ in that the first is non-utilitarian while the second is utilitarian. A subordinate consideration is giving priority to patients who have a better chance of survival and a reasonable life expectancy. The other 2 considerations are promoting and rewarding instrumental value (benefit to others) and the acuity of illness. Health-care workers (physicians, nurses, therapists etc.) and research participants have instrumental value as their work benefits others; among them those actively contributing are of more value than those who have made their contributions. The need to prioritize the sickest and the youngest is also a recognized value when these are aligned with the dominant value of maximizing benefits. In the context of COVID-19 pandemic, Emanuel et al. [ 37 ] weighed and analyzed these values and offered some recommendations. Some ethics scholars opine that in times of a pandemic, the burden of making a decision as to who gets a ventilator and who does not (often a life or death choice) should not be on the front-line physicians, as it may cause a severe and life-long emotional toll on them [ 35 , 36 ]. The toll can be severe for nurses and other front-line health-care providers as well. As a safeguard, they propose that the decision should rest on a select committee that excludes doctors, nurses and others who are caring for the patient(s) under consideration [ 38 ].

Both patients described in the case summaries have comparable acuity of illness and both are in need of mechanical ventilator support. However, in the dominant value of maximizing benefits the two patients differ; in terms of life-years saved, the second patient (22-year-old man) is ahead as his life expectancy is longer. Additionally, he is more likely than the older woman, to survive mechanical ventilation, infection, and possible complications. Another supporting factor in favor of the second patient is his potential instrumental value (benefit to others) as a future physician.

Unlike the other illustrative cases, the scenario of these 2 cases, does not lend itself to a peaceful and fully satisfactory resolution. The fairness of allocating a scarce and potentially life-saving resource based on maximizing benefits and preference to instrumental value (benefit to others) is open to question. The American College of Physicians has stated that allocation decisions during resource scarcity should be made “based on patient need, prognosis (determined by objective scientific measure and informed clinical judgment) and effectiveness (i.e., likelihood that the therapy will help the patient to recover), … to maximize the number of patients who will recover” [ 39 ].

This review has covered basics of ethics founded on morality and ethical principles with illustrative examples. In the following segment, professionalism is defined, its alignment with ethics depicted, and virtues desired of a physician (inclusive term for medical doctor regardless of type of practice) are elucidated. It concludes with my vision of an integrated model for patient care.

The core of professionalism is a therapeutic relationship built on competent and compassionate care by a physician that meets the expectation and benefits a patient. In this relationship, which is rooted in the ethical principles of beneficence and nonmaleficence, the physician fulfills the elements shown in Table Table3. 3 . Professionalism “demands placing the interest of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health” [ 26 , 40 ].

Physicians obligations

• Cure of disease when possible

• Maintenance or improvement of functional status and quality of life (relief of symptoms and suffering)

• Promotion of health and prevention of disease

• Prevention of untimely death

• Education and counseling of patients (condition and prognosis)

• Avoidance of harm to the patient in the course of care

• Providing relief and support near time of death (end-of-life care)

Drawing on several decades of experience in teaching and mentoring, I envisage physicians with qualities of both “heart” and “head.” Ethical and humanistic values shape the former, while knowledge (e.g., by study, research, practice) and technical skills (e.g., medical and surgical procedures) form the latter. Figure Figure1 1 is a representation of this model. Morality that forms the base of the model and ethical principles that rest on it were previously explained. Virtues are linked, some more tightly than others, to the principles of ethics. Compassion, a prelude to caring, presupposes sympathy, is expressed in beneficence. Discernment is especially valuable in decision-making when principles of ethics collide. Trustworthiness leads to trust, and is a needed virtue when patients, at their most vulnerable time, place themselves in the hands of physicians. Integrity involves the coherent integration of emotions, knowledge and aspirations while maintaining moral values. Physicians need both professional integrity and personal integrity, as the former may not cover all scenarios (e.g., prescribing ineffective drugs or expensive drugs when effective inexpensive drugs are available, performing invasive treatments or experimental research modalities without fully informed consent, any situation where personal monetary gain is placed over patient's welfare). Conscientiousness is required to determine what is right by critical reflection on good versus bad, better versus good, logical versus emotional, and right versus wrong.

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Integrated model of patient care.

In my conceptualized model of patient care (Fig. (Fig.1), 1 ), medical knowledge, skills to apply that knowledge, technical skills, practice-based learning, and communication skills are partnered with ethical principles and professional virtues. The virtues of compassion, discernment, trustworthiness, integrity, and conscientiousness are the necessary building blocks for the virtue of caring. Caring is the defining virtue for all health-care professions. In all interactions with patients, besides the technical expertise of a physician, the human element of caring (one human to another) is needed. In different situations, caring can be expressed verbally and non-verbally (e.g., the manner of communication with both physician and patient closely seated, and with unhurried, softly spoken words); a gentle touch especially when conveying “bad news”; a firmer touch or grip to convey reassurance to a patient facing a difficult treatment choice; to hold the hand of a patient dying alone). Thus, “caring” is in the center of the depicted integrated model, and as Peabody succinctly expressed it nearly a hundred years ago, “The secret of the care of the patient is caring for the patient” [ 41 ].

Conflict of Interest Statement

The author declares that he has no conflicts of interest.

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5 min read · Updated on September 25, 2024

Use critical thinking skills to move your career forward

Have you ever stopped to ask yourself why some people seem to be able to effortlessly resolve problems, lead a business, and make sound decisions? It could be down to their critical thinking skills. Critical thinking skills bring clarity, but not everyone has them.

In this article, we're asking: what is critical thinking, exactly, and how can it help my career?

What is critical thinking?

Let's begin with a critical thinking definition. According to Merriam-Webster , critical thinking is the act of thinking critically in order to solve problems, evaluate information, and discern biases. Critical thinking skills are generally considered to be a high-level reasoning attribute required to get ahead in any sector.

So, what is a critical thinker? We'd consider a critical thinker to be someone who is open-minded, questioning, and willing to look at things from different points of view in order to arrive at a logical conclusion.

Why are critical thinking skills important to a career?

Critical thinkers have a lot to offer in the workplace and can be highly valued employees. The ability to think critically means that they're likely to make better decisions, feel more confident and empowered, and take an informed approach to problem-solving. Clearly, these are all desirable traits and ones possessed by successful senior leaders .

If you can develop and demonstrate strong critical thinking skills, you'll be positioning yourself for career success. As a bonus, critical thinking skills are transferable, meaning that you'll be able to use them to propel your career in any industry.

Examples of critical thinking skills

Critical thinking skills come in all shapes and sizes, so let's take a look at the most common.

Critical thinkers don't just take information at face value. They dive deep, analyzing and evaluating information, data, and statistics in order to draw a fully informed conclusion.

Logic and reasoning are key for critical thinkers. They're driven by facts rather than emotion and make decisions based on careful consideration of all options.

Problem-solving

Problem-solving is where critical thinkers excel. They're able to resolve complex challenges by going beyond the obvious, taking various sources into consideration, and showing a willingness to consider different ideas.

Listening and open-mindedness

Active listening is a necessary skill for critical thinkers. Rather than relying solely on their own instincts and judgments, critical thinkers take input from multiple people and places and give fair weight to each.

Managing ambiguity

As they're open to new ideas and information and use logic and analysis to solve problems, critical thinkers are well-equipped to manage and navigate through ambiguity to develop realistic solutions.

Examples of using critical thinking in the workplace

Let's look now at some examples of how those critical thinking skills can be applied practically in the workplace.

Resolving conflict

A leader with good critical thinking skills will evaluate both sides in any workforce disagreement, forging a path to the truth and developing solutions acceptable to all parties.

Providing feedback

In situations such as performance appraisal or mentoring, critical thinking is necessary to evaluate strengths and weaknesses and to provide constructive feedback.

Allocating resources

When projects or teams are competing for the same people or assets, critical thinking is required to evaluate, prioritize, and resolve the situation.

Planning future strategy

Business leaders are never content to roll with the status quo. Driving a business forward requires constant re-evaluation, input, and analysis. The critical thinker will use all the information at their disposal to resolve existing issues and plan strategies that will put the business in a strong position in the future.

Ways to improve your critical thinking skills

While some people seem to be natural critical thinkers, it is possible to develop this skill with time and effort. Try some of these techniques to build your own critical thinking abilities:

Ask questions to gather information

Don't accept information at face value

Analyze arguments and evidence before making decisions

Seek multiple perspectives

Be aware of biases – your own and those of others

Participate in discussions and read widely

Show off your critical thinking skills on your resume

In this article, we've provided a definition of critical thinking, showing why critical thinking skills are valued in the workplace and looking at some practical examples. Does your resume reflect these skills , though? Use your resume to show how you can solve business problems, accommodate different perspectives, and account for biases, and you'll soon be rocketing up that career ladder.

Do you need a new perspective on your resume? The experts at TopResume are waiting to give you constructive feedback. Send yours in now for a free resume review to ensure you're capturing the skills needed for your next step.

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Thinking Ethically

Markkula Center for Applied Ethics
Ethics Resources
Ethical Decision Making

Moral issues greet us each morning in the newspaper, confront us in the memos on our desks, nag us from our children's soccer fields, and bid us good night on the evening news. We are bombarded daily with questions about the justice of our foreign policy, the morality of medical technologies that can prolong our lives, the rights of the homeless, the fairness of our children's teachers to the diverse students in their classrooms.

Dealing with these moral issues is often perplexing. How, exactly, should we think through an ethical issue? What questions should we ask? What factors should we consider?

The first step in analyzing moral issues is obvious but not always easy: Get the facts. Some moral issues create controversies simply because we do not bother to check the facts. This first step, although obvious, is also among the most important and the most frequently overlooked.

But having the facts is not enough. Facts by themselves only tell us what is ; they do not tell us what ought to be. In addition to getting the facts, resolving an ethical issue also requires an appeal to values. Philosophers have developed five different approaches to values to deal with moral issues.

The Utilitarian Approach Utilitarianism was conceived in the 19th century by Jeremy Bentham and John Stuart Mill to help legislators determine which laws were morally best. Both Bentham and Mill suggested that ethical actions are those that provide the greatest balance of good over evil.

To analyze an issue using the utilitarian approach, we first identify the various courses of action available to us. Second, we ask who will be affected by each action and what benefits or harms will be derived from each. And third, we choose the action that will produce the greatest benefits and the least harm. The ethical action is the one that provides the greatest good for the greatest number.

The Rights Approach The second important approach to ethics has its roots in the philosophy of the 18th-century thinker Immanuel Kant and others like him, who focused on the individual's right to choose for herself or himself. According to these philosophers, what makes human beings different from mere things is that people have dignity based on their ability to choose freely what they will do with their lives, and they have a fundamental moral right to have these choices respected. People are not objects to be manipulated; it is a violation of human dignity to use people in ways they do not freely choose.

Of course, many different, but related, rights exist besides this basic one. These other rights (an incomplete list below) can be thought of as different aspects of the basic right to be treated as we choose.

The right to the truth: We have a right to be told the truth and to be informed about matters that significantly affect our choices.

The right of privacy: We have the right to do, believe, and say whatever we choose in our personal lives so long as we do not violate the rights of others.

The right not to be injured: We have the right not to be harmed or injured unless we freely and knowingly do something to deserve punishment or we freely and knowingly choose to risk such injuries.

The right to what is agreed: We have a right to what has been promised by those with whom we have freely entered into a contract or agreement.

In deciding whether an action is moral or immoral using this second approach, then, we must ask, Does the action respect the moral rights of everyone? Actions are wrong to the extent that they violate the rights of individuals; the more serious the violation, the more wrongful the action.

The Fairness or Justice Approach The fairness or justice approach to ethics has its roots in the teachings of the ancient Greek philosopher Aristotle, who said that "equals should be treated equally and unequals unequally." The basic moral question in this approach is: How fair is an action? Does it treat everyone in the same way, or does it show favoritism and discrimination?

Favoritism gives benefits to some people without a justifiable reason for singling them out; discrimination imposes burdens on people who are no different from those on whom burdens are not imposed. Both favoritism and discrimination are unjust and wrong.

The Common-Good Approach This approach to ethics assumes a society comprising individuals whose own good is inextricably linked to the good of the community. Community members are bound by the pursuit of common values and goals.

The common good is a notion that originated more than 2,000 years ago in the writings of Plato, Aristotle, and Cicero. More recently, contemporary ethicist John Rawls defined the common good as "certain general conditions that are...equally to everyone's advantage."

In this approach, we focus on ensuring that the social policies, social systems, institutions, and environments on which we depend are beneficial to all. Examples of goods common to all include affordable health care, effective public safety, peace among nations, a just legal system, and an unpolluted environment.

Appeals to the common good urge us to view ourselves as members of the same community, reflecting on broad questions concerning the kind of society we want to become and how we are to achieve that society. While respecting and valuing the freedom of individuals to pursue their own goals, the common-good approach challenges us also to recognize and further those goals we share in common.

The Virtue Approach The virtue approach to ethics assumes that there are certain ideals toward which we should strive, which provide for the full development of our humanity. These ideals are discovered through thoughtful reflection on what kind of people we have the potential to become.

Virtues are attitudes or character traits that enable us to be and to act in ways that develop our highest potential. They enable us to pursue the ideals we have adopted. Honesty, courage, compassion, generosity, fidelity, integrity, fairness, self-control, and prudence are all examples of virtues.

Virtues are like habits; that is, once acquired, they become characteristic of a person. Moreover, a person who has developed virtues will be naturally disposed to act in ways consistent with moral principles. The virtuous person is the ethical person.

In dealing with an ethical problem using the virtue approach, we might ask, What kind of person should I be? What will promote the development of character within myself and my community?

Ethical Problem Solving These five approaches suggest that once we have ascertained the facts, we should ask ourselves five questions when trying to resolve a moral issue:

What benefits and what harms will each course of action produce, and which alternative will lead to the best overall consequences?

What moral rights do the affected parties have, and which course of action best respects those rights?

Which course of action treats everyone the same, except where there is a morally justifiable reason not to, and does not show favoritism or discrimination?

Which course of action advances the common good?

Which course of action develops moral virtues?

This method, of course, does not provide an automatic solution to moral problems. It is not meant to. The method is merely meant to help identify most of the important ethical considerations. In the end, we must deliberate on moral issues for ourselves, keeping a careful eye on both the facts and on the ethical considerations involved.

This article updates several previous pieces from Issues in Ethics by Manuel Velasquez - Dirksen Professor of Business Ethics at Santa Clara University and former Center director - and Claire Andre, associate Center director. "Thinking Ethically" is based on a framework developed by the authors in collaboration with Center Director Thomas Shanks, S.J., Presidential Professor of Ethics and the Common Good Michael J. Meyer, and others. The framework is used as the basis for many programs and presentations at the Markkula Center for Applied Ethics.

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Critical Thinking

Critical thinking is a widely accepted educational goal. Its definition is contested, but the competing definitions can be understood as differing conceptions of the same basic concept: careful thinking directed to a goal. Conceptions differ with respect to the scope of such thinking, the type of goal, the criteria and norms for thinking carefully, and the thinking components on which they focus. Its adoption as an educational goal has been recommended on the basis of respect for students’ autonomy and preparing students for success in life and for democratic citizenship. “Critical thinkers” have the dispositions and abilities that lead them to think critically when appropriate. The abilities can be identified directly; the dispositions indirectly, by considering what factors contribute to or impede exercise of the abilities. Standardized tests have been developed to assess the degree to which a person possesses such dispositions and abilities. Educational intervention has been shown experimentally to improve them, particularly when it includes dialogue, anchored instruction, and mentoring. Controversies have arisen over the generalizability of critical thinking across domains, over alleged bias in critical thinking theories and instruction, and over the relationship of critical thinking to other types of thinking.

2.1 Dewey’s Three Main Examples

2.2 dewey’s other examples, 2.3 further examples, 2.4 non-examples, 3. the definition of critical thinking, 4. its value, 5. the process of thinking critically, 6. components of the process, 7. contributory dispositions and abilities, 8.1 initiating dispositions, 8.2 internal dispositions, 9. critical thinking abilities, 10. required knowledge, 11. educational methods, 12.1 the generalizability of critical thinking, 12.2 bias in critical thinking theory and pedagogy, 12.3 relationship of critical thinking to other types of thinking, other internet resources, related entries.

Use of the term ‘critical thinking’ to describe an educational goal goes back to the American philosopher John Dewey (1910), who more commonly called it ‘reflective thinking’. He defined it as

active, persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it, and the further conclusions to which it tends. (Dewey 1910: 6; 1933: 9)

and identified a habit of such consideration with a scientific attitude of mind. His lengthy quotations of Francis Bacon, John Locke, and John Stuart Mill indicate that he was not the first person to propose development of a scientific attitude of mind as an educational goal.

In the 1930s, many of the schools that participated in the Eight-Year Study of the Progressive Education Association (Aikin 1942) adopted critical thinking as an educational goal, for whose achievement the study’s Evaluation Staff developed tests (Smith, Tyler, & Evaluation Staff 1942). Glaser (1941) showed experimentally that it was possible to improve the critical thinking of high school students. Bloom’s influential taxonomy of cognitive educational objectives (Bloom et al. 1956) incorporated critical thinking abilities. Ennis (1962) proposed 12 aspects of critical thinking as a basis for research on the teaching and evaluation of critical thinking ability.

Since 1980, an annual international conference in California on critical thinking and educational reform has attracted tens of thousands of educators from all levels of education and from many parts of the world. Also since 1980, the state university system in California has required all undergraduate students to take a critical thinking course. Since 1983, the Association for Informal Logic and Critical Thinking has sponsored sessions in conjunction with the divisional meetings of the American Philosophical Association (APA). In 1987, the APA’s Committee on Pre-College Philosophy commissioned a consensus statement on critical thinking for purposes of educational assessment and instruction (Facione 1990a). Researchers have developed standardized tests of critical thinking abilities and dispositions; for details, see the Supplement on Assessment . Educational jurisdictions around the world now include critical thinking in guidelines for curriculum and assessment.

For details on this history, see the Supplement on History .

2. Examples and Non-Examples

Before considering the definition of critical thinking, it will be helpful to have in mind some examples of critical thinking, as well as some examples of kinds of thinking that would apparently not count as critical thinking.

Dewey (1910: 68–71; 1933: 91–94) takes as paradigms of reflective thinking three class papers of students in which they describe their thinking. The examples range from the everyday to the scientific.

Transit : “The other day, when I was down town on 16th Street, a clock caught my eye. I saw that the hands pointed to 12:20. This suggested that I had an engagement at 124th Street, at one o’clock. I reasoned that as it had taken me an hour to come down on a surface car, I should probably be twenty minutes late if I returned the same way. I might save twenty minutes by a subway express. But was there a station near? If not, I might lose more than twenty minutes in looking for one. Then I thought of the elevated, and I saw there was such a line within two blocks. But where was the station? If it were several blocks above or below the street I was on, I should lose time instead of gaining it. My mind went back to the subway express as quicker than the elevated; furthermore, I remembered that it went nearer than the elevated to the part of 124th Street I wished to reach, so that time would be saved at the end of the journey. I concluded in favor of the subway, and reached my destination by one o’clock.” (Dewey 1910: 68–69; 1933: 91–92)

Ferryboat : “Projecting nearly horizontally from the upper deck of the ferryboat on which I daily cross the river is a long white pole, having a gilded ball at its tip. It suggested a flagpole when I first saw it; its color, shape, and gilded ball agreed with this idea, and these reasons seemed to justify me in this belief. But soon difficulties presented themselves. The pole was nearly horizontal, an unusual position for a flagpole; in the next place, there was no pulley, ring, or cord by which to attach a flag; finally, there were elsewhere on the boat two vertical staffs from which flags were occasionally flown. It seemed probable that the pole was not there for flag-flying.

“I then tried to imagine all possible purposes of the pole, and to consider for which of these it was best suited: (a) Possibly it was an ornament. But as all the ferryboats and even the tugboats carried poles, this hypothesis was rejected. (b) Possibly it was the terminal of a wireless telegraph. But the same considerations made this improbable. Besides, the more natural place for such a terminal would be the highest part of the boat, on top of the pilot house. (c) Its purpose might be to point out the direction in which the boat is moving.

“In support of this conclusion, I discovered that the pole was lower than the pilot house, so that the steersman could easily see it. Moreover, the tip was enough higher than the base, so that, from the pilot’s position, it must appear to project far out in front of the boat. Moreover, the pilot being near the front of the boat, he would need some such guide as to its direction. Tugboats would also need poles for such a purpose. This hypothesis was so much more probable than the others that I accepted it. I formed the conclusion that the pole was set up for the purpose of showing the pilot the direction in which the boat pointed, to enable him to steer correctly.” (Dewey 1910: 69–70; 1933: 92–93)

Bubbles : “In washing tumblers in hot soapsuds and placing them mouth downward on a plate, bubbles appeared on the outside of the mouth of the tumblers and then went inside. Why? The presence of bubbles suggests air, which I note must come from inside the tumbler. I see that the soapy water on the plate prevents escape of the air save as it may be caught in bubbles. But why should air leave the tumbler? There was no substance entering to force it out. It must have expanded. It expands by increase of heat, or by decrease of pressure, or both. Could the air have become heated after the tumbler was taken from the hot suds? Clearly not the air that was already entangled in the water. If heated air was the cause, cold air must have entered in transferring the tumblers from the suds to the plate. I test to see if this supposition is true by taking several more tumblers out. Some I shake so as to make sure of entrapping cold air in them. Some I take out holding mouth downward in order to prevent cold air from entering. Bubbles appear on the outside of every one of the former and on none of the latter. I must be right in my inference. Air from the outside must have been expanded by the heat of the tumbler, which explains the appearance of the bubbles on the outside. But why do they then go inside? Cold contracts. The tumbler cooled and also the air inside it. Tension was removed, and hence bubbles appeared inside. To be sure of this, I test by placing a cup of ice on the tumbler while the bubbles are still forming outside. They soon reverse” (Dewey 1910: 70–71; 1933: 93–94).

Dewey (1910, 1933) sprinkles his book with other examples of critical thinking. We will refer to the following.

Weather : A man on a walk notices that it has suddenly become cool, thinks that it is probably going to rain, looks up and sees a dark cloud obscuring the sun, and quickens his steps (1910: 6–10; 1933: 9–13).

Disorder : A man finds his rooms on his return to them in disorder with his belongings thrown about, thinks at first of burglary as an explanation, then thinks of mischievous children as being an alternative explanation, then looks to see whether valuables are missing, and discovers that they are (1910: 82–83; 1933: 166–168).

Typhoid : A physician diagnosing a patient whose conspicuous symptoms suggest typhoid avoids drawing a conclusion until more data are gathered by questioning the patient and by making tests (1910: 85–86; 1933: 170).

Blur : A moving blur catches our eye in the distance, we ask ourselves whether it is a cloud of whirling dust or a tree moving its branches or a man signaling to us, we think of other traits that should be found on each of those possibilities, and we look and see if those traits are found (1910: 102, 108; 1933: 121, 133).

Suction pump : In thinking about the suction pump, the scientist first notes that it will draw water only to a maximum height of 33 feet at sea level and to a lesser maximum height at higher elevations, selects for attention the differing atmospheric pressure at these elevations, sets up experiments in which the air is removed from a vessel containing water (when suction no longer works) and in which the weight of air at various levels is calculated, compares the results of reasoning about the height to which a given weight of air will allow a suction pump to raise water with the observed maximum height at different elevations, and finally assimilates the suction pump to such apparently different phenomena as the siphon and the rising of a balloon (1910: 150–153; 1933: 195–198).

Diamond : A passenger in a car driving in a diamond lane reserved for vehicles with at least one passenger notices that the diamond marks on the pavement are far apart in some places and close together in others. Why? The driver suggests that the reason may be that the diamond marks are not needed where there is a solid double line separating the diamond lane from the adjoining lane, but are needed when there is a dotted single line permitting crossing into the diamond lane. Further observation confirms that the diamonds are close together when a dotted line separates the diamond lane from its neighbour, but otherwise far apart.

Rash : A woman suddenly develops a very itchy red rash on her throat and upper chest. She recently noticed a mark on the back of her right hand, but was not sure whether the mark was a rash or a scrape. She lies down in bed and thinks about what might be causing the rash and what to do about it. About two weeks before, she began taking blood pressure medication that contained a sulfa drug, and the pharmacist had warned her, in view of a previous allergic reaction to a medication containing a sulfa drug, to be on the alert for an allergic reaction; however, she had been taking the medication for two weeks with no such effect. The day before, she began using a new cream on her neck and upper chest; against the new cream as the cause was mark on the back of her hand, which had not been exposed to the cream. She began taking probiotics about a month before. She also recently started new eye drops, but she supposed that manufacturers of eye drops would be careful not to include allergy-causing components in the medication. The rash might be a heat rash, since she recently was sweating profusely from her upper body. Since she is about to go away on a short vacation, where she would not have access to her usual physician, she decides to keep taking the probiotics and using the new eye drops but to discontinue the blood pressure medication and to switch back to the old cream for her neck and upper chest. She forms a plan to consult her regular physician on her return about the blood pressure medication.

Candidate : Although Dewey included no examples of thinking directed at appraising the arguments of others, such thinking has come to be considered a kind of critical thinking. We find an example of such thinking in the performance task on the Collegiate Learning Assessment (CLA+), which its sponsoring organization describes as

a performance-based assessment that provides a measure of an institution’s contribution to the development of critical-thinking and written communication skills of its students. (Council for Aid to Education 2017)

A sample task posted on its website requires the test-taker to write a report for public distribution evaluating a fictional candidate’s policy proposals and their supporting arguments, using supplied background documents, with a recommendation on whether to endorse the candidate.

Immediate acceptance of an idea that suggests itself as a solution to a problem (e.g., a possible explanation of an event or phenomenon, an action that seems likely to produce a desired result) is “uncritical thinking, the minimum of reflection” (Dewey 1910: 13). On-going suspension of judgment in the light of doubt about a possible solution is not critical thinking (Dewey 1910: 108). Critique driven by a dogmatically held political or religious ideology is not critical thinking; thus Paulo Freire (1968 [1970]) is using the term (e.g., at 1970: 71, 81, 100, 146) in a more politically freighted sense that includes not only reflection but also revolutionary action against oppression. Derivation of a conclusion from given data using an algorithm is not critical thinking.

What is critical thinking? There are many definitions. Ennis (2016) lists 14 philosophically oriented scholarly definitions and three dictionary definitions. Following Rawls (1971), who distinguished his conception of justice from a utilitarian conception but regarded them as rival conceptions of the same concept, Ennis maintains that the 17 definitions are different conceptions of the same concept. Rawls articulated the shared concept of justice as

a characteristic set of principles for assigning basic rights and duties and for determining… the proper distribution of the benefits and burdens of social cooperation. (Rawls 1971: 5)

Bailin et al. (1999b) claim that, if one considers what sorts of thinking an educator would take not to be critical thinking and what sorts to be critical thinking, one can conclude that educators typically understand critical thinking to have at least three features.

It is done for the purpose of making up one’s mind about what to believe or do.
The person engaging in the thinking is trying to fulfill standards of adequacy and accuracy appropriate to the thinking.
The thinking fulfills the relevant standards to some threshold level.

One could sum up the core concept that involves these three features by saying that critical thinking is careful goal-directed thinking. This core concept seems to apply to all the examples of critical thinking described in the previous section. As for the non-examples, their exclusion depends on construing careful thinking as excluding jumping immediately to conclusions, suspending judgment no matter how strong the evidence, reasoning from an unquestioned ideological or religious perspective, and routinely using an algorithm to answer a question.

If the core of critical thinking is careful goal-directed thinking, conceptions of it can vary according to its presumed scope, its presumed goal, one’s criteria and threshold for being careful, and the thinking component on which one focuses. As to its scope, some conceptions (e.g., Dewey 1910, 1933) restrict it to constructive thinking on the basis of one’s own observations and experiments, others (e.g., Ennis 1962; Fisher & Scriven 1997; Johnson 1992) to appraisal of the products of such thinking. Ennis (1991) and Bailin et al. (1999b) take it to cover both construction and appraisal. As to its goal, some conceptions restrict it to forming a judgment (Dewey 1910, 1933; Lipman 1987; Facione 1990a). Others allow for actions as well as beliefs as the end point of a process of critical thinking (Ennis 1991; Bailin et al. 1999b). As to the criteria and threshold for being careful, definitions vary in the term used to indicate that critical thinking satisfies certain norms: “intellectually disciplined” (Scriven & Paul 1987), “reasonable” (Ennis 1991), “skillful” (Lipman 1987), “skilled” (Fisher & Scriven 1997), “careful” (Bailin & Battersby 2009). Some definitions specify these norms, referring variously to “consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusions to which it tends” (Dewey 1910, 1933); “the methods of logical inquiry and reasoning” (Glaser 1941); “conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication” (Scriven & Paul 1987); the requirement that “it is sensitive to context, relies on criteria, and is self-correcting” (Lipman 1987); “evidential, conceptual, methodological, criteriological, or contextual considerations” (Facione 1990a); and “plus-minus considerations of the product in terms of appropriate standards (or criteria)” (Johnson 1992). Stanovich and Stanovich (2010) propose to ground the concept of critical thinking in the concept of rationality, which they understand as combining epistemic rationality (fitting one’s beliefs to the world) and instrumental rationality (optimizing goal fulfillment); a critical thinker, in their view, is someone with “a propensity to override suboptimal responses from the autonomous mind” (2010: 227). These variant specifications of norms for critical thinking are not necessarily incompatible with one another, and in any case presuppose the core notion of thinking carefully. As to the thinking component singled out, some definitions focus on suspension of judgment during the thinking (Dewey 1910; McPeck 1981), others on inquiry while judgment is suspended (Bailin & Battersby 2009, 2021), others on the resulting judgment (Facione 1990a), and still others on responsiveness to reasons (Siegel 1988). Kuhn (2019) takes critical thinking to be more a dialogic practice of advancing and responding to arguments than an individual ability.

In educational contexts, a definition of critical thinking is a “programmatic definition” (Scheffler 1960: 19). It expresses a practical program for achieving an educational goal. For this purpose, a one-sentence formulaic definition is much less useful than articulation of a critical thinking process, with criteria and standards for the kinds of thinking that the process may involve. The real educational goal is recognition, adoption and implementation by students of those criteria and standards. That adoption and implementation in turn consists in acquiring the knowledge, abilities and dispositions of a critical thinker.

Conceptions of critical thinking generally do not include moral integrity as part of the concept. Dewey, for example, took critical thinking to be the ultimate intellectual goal of education, but distinguished it from the development of social cooperation among school children, which he took to be the central moral goal. Ennis (1996, 2011) added to his previous list of critical thinking dispositions a group of dispositions to care about the dignity and worth of every person, which he described as a “correlative” (1996) disposition without which critical thinking would be less valuable and perhaps harmful. An educational program that aimed at developing critical thinking but not the correlative disposition to care about the dignity and worth of every person, he asserted, “would be deficient and perhaps dangerous” (Ennis 1996: 172).

Dewey thought that education for reflective thinking would be of value to both the individual and society; recognition in educational practice of the kinship to the scientific attitude of children’s native curiosity, fertile imagination and love of experimental inquiry “would make for individual happiness and the reduction of social waste” (Dewey 1910: iii). Schools participating in the Eight-Year Study took development of the habit of reflective thinking and skill in solving problems as a means to leading young people to understand, appreciate and live the democratic way of life characteristic of the United States (Aikin 1942: 17–18, 81). Harvey Siegel (1988: 55–61) has offered four considerations in support of adopting critical thinking as an educational ideal. (1) Respect for persons requires that schools and teachers honour students’ demands for reasons and explanations, deal with students honestly, and recognize the need to confront students’ independent judgment; these requirements concern the manner in which teachers treat students. (2) Education has the task of preparing children to be successful adults, a task that requires development of their self-sufficiency. (3) Education should initiate children into the rational traditions in such fields as history, science and mathematics. (4) Education should prepare children to become democratic citizens, which requires reasoned procedures and critical talents and attitudes. To supplement these considerations, Siegel (1988: 62–90) responds to two objections: the ideology objection that adoption of any educational ideal requires a prior ideological commitment and the indoctrination objection that cultivation of critical thinking cannot escape being a form of indoctrination.

Despite the diversity of our 11 examples, one can recognize a common pattern. Dewey analyzed it as consisting of five phases:

suggestions , in which the mind leaps forward to a possible solution;
an intellectualization of the difficulty or perplexity into a problem to be solved, a question for which the answer must be sought;
the use of one suggestion after another as a leading idea, or hypothesis , to initiate and guide observation and other operations in collection of factual material;
the mental elaboration of the idea or supposition as an idea or supposition ( reasoning , in the sense on which reasoning is a part, not the whole, of inference); and
testing the hypothesis by overt or imaginative action. (Dewey 1933: 106–107; italics in original)

The process of reflective thinking consisting of these phases would be preceded by a perplexed, troubled or confused situation and followed by a cleared-up, unified, resolved situation (Dewey 1933: 106). The term ‘phases’ replaced the term ‘steps’ (Dewey 1910: 72), thus removing the earlier suggestion of an invariant sequence. Variants of the above analysis appeared in (Dewey 1916: 177) and (Dewey 1938: 101–119).

The variant formulations indicate the difficulty of giving a single logical analysis of such a varied process. The process of critical thinking may have a spiral pattern, with the problem being redefined in the light of obstacles to solving it as originally formulated. For example, the person in Transit might have concluded that getting to the appointment at the scheduled time was impossible and have reformulated the problem as that of rescheduling the appointment for a mutually convenient time. Further, defining a problem does not always follow after or lead immediately to an idea of a suggested solution. Nor should it do so, as Dewey himself recognized in describing the physician in Typhoid as avoiding any strong preference for this or that conclusion before getting further information (Dewey 1910: 85; 1933: 170). People with a hypothesis in mind, even one to which they have a very weak commitment, have a so-called “confirmation bias” (Nickerson 1998): they are likely to pay attention to evidence that confirms the hypothesis and to ignore evidence that counts against it or for some competing hypothesis. Detectives, intelligence agencies, and investigators of airplane accidents are well advised to gather relevant evidence systematically and to postpone even tentative adoption of an explanatory hypothesis until the collected evidence rules out with the appropriate degree of certainty all but one explanation. Dewey’s analysis of the critical thinking process can be faulted as well for requiring acceptance or rejection of a possible solution to a defined problem, with no allowance for deciding in the light of the available evidence to suspend judgment. Further, given the great variety of kinds of problems for which reflection is appropriate, there is likely to be variation in its component events. Perhaps the best way to conceptualize the critical thinking process is as a checklist whose component events can occur in a variety of orders, selectively, and more than once. These component events might include (1) noticing a difficulty, (2) defining the problem, (3) dividing the problem into manageable sub-problems, (4) formulating a variety of possible solutions to the problem or sub-problem, (5) determining what evidence is relevant to deciding among possible solutions to the problem or sub-problem, (6) devising a plan of systematic observation or experiment that will uncover the relevant evidence, (7) carrying out the plan of systematic observation or experimentation, (8) noting the results of the systematic observation or experiment, (9) gathering relevant testimony and information from others, (10) judging the credibility of testimony and information gathered from others, (11) drawing conclusions from gathered evidence and accepted testimony, and (12) accepting a solution that the evidence adequately supports (cf. Hitchcock 2017: 485).

Checklist conceptions of the process of critical thinking are open to the objection that they are too mechanical and procedural to fit the multi-dimensional and emotionally charged issues for which critical thinking is urgently needed (Paul 1984). For such issues, a more dialectical process is advocated, in which competing relevant world views are identified, their implications explored, and some sort of creative synthesis attempted.

If one considers the critical thinking process illustrated by the 11 examples, one can identify distinct kinds of mental acts and mental states that form part of it. To distinguish, label and briefly characterize these components is a useful preliminary to identifying abilities, skills, dispositions, attitudes, habits and the like that contribute causally to thinking critically. Identifying such abilities and habits is in turn a useful preliminary to setting educational goals. Setting the goals is in its turn a useful preliminary to designing strategies for helping learners to achieve the goals and to designing ways of measuring the extent to which learners have done so. Such measures provide both feedback to learners on their achievement and a basis for experimental research on the effectiveness of various strategies for educating people to think critically. Let us begin, then, by distinguishing the kinds of mental acts and mental events that can occur in a critical thinking process.

Observing : One notices something in one’s immediate environment (sudden cooling of temperature in Weather , bubbles forming outside a glass and then going inside in Bubbles , a moving blur in the distance in Blur , a rash in Rash ). Or one notes the results of an experiment or systematic observation (valuables missing in Disorder , no suction without air pressure in Suction pump )
Feeling : One feels puzzled or uncertain about something (how to get to an appointment on time in Transit , why the diamonds vary in spacing in Diamond ). One wants to resolve this perplexity. One feels satisfaction once one has worked out an answer (to take the subway express in Transit , diamonds closer when needed as a warning in Diamond ).
Wondering : One formulates a question to be addressed (why bubbles form outside a tumbler taken from hot water in Bubbles , how suction pumps work in Suction pump , what caused the rash in Rash ).
Imagining : One thinks of possible answers (bus or subway or elevated in Transit , flagpole or ornament or wireless communication aid or direction indicator in Ferryboat , allergic reaction or heat rash in Rash ).
Inferring : One works out what would be the case if a possible answer were assumed (valuables missing if there has been a burglary in Disorder , earlier start to the rash if it is an allergic reaction to a sulfa drug in Rash ). Or one draws a conclusion once sufficient relevant evidence is gathered (take the subway in Transit , burglary in Disorder , discontinue blood pressure medication and new cream in Rash ).
Knowledge : One uses stored knowledge of the subject-matter to generate possible answers or to infer what would be expected on the assumption of a particular answer (knowledge of a city’s public transit system in Transit , of the requirements for a flagpole in Ferryboat , of Boyle’s law in Bubbles , of allergic reactions in Rash ).
Experimenting : One designs and carries out an experiment or a systematic observation to find out whether the results deduced from a possible answer will occur (looking at the location of the flagpole in relation to the pilot’s position in Ferryboat , putting an ice cube on top of a tumbler taken from hot water in Bubbles , measuring the height to which a suction pump will draw water at different elevations in Suction pump , noticing the spacing of diamonds when movement to or from a diamond lane is allowed in Diamond ).
Consulting : One finds a source of information, gets the information from the source, and makes a judgment on whether to accept it. None of our 11 examples include searching for sources of information. In this respect they are unrepresentative, since most people nowadays have almost instant access to information relevant to answering any question, including many of those illustrated by the examples. However, Candidate includes the activities of extracting information from sources and evaluating its credibility.
Identifying and analyzing arguments : One notices an argument and works out its structure and content as a preliminary to evaluating its strength. This activity is central to Candidate . It is an important part of a critical thinking process in which one surveys arguments for various positions on an issue.
Judging : One makes a judgment on the basis of accumulated evidence and reasoning, such as the judgment in Ferryboat that the purpose of the pole is to provide direction to the pilot.
Deciding : One makes a decision on what to do or on what policy to adopt, as in the decision in Transit to take the subway.

By definition, a person who does something voluntarily is both willing and able to do that thing at that time. Both the willingness and the ability contribute causally to the person’s action, in the sense that the voluntary action would not occur if either (or both) of these were lacking. For example, suppose that one is standing with one’s arms at one’s sides and one voluntarily lifts one’s right arm to an extended horizontal position. One would not do so if one were unable to lift one’s arm, if for example one’s right side was paralyzed as the result of a stroke. Nor would one do so if one were unwilling to lift one’s arm, if for example one were participating in a street demonstration at which a white supremacist was urging the crowd to lift their right arm in a Nazi salute and one were unwilling to express support in this way for the racist Nazi ideology. The same analysis applies to a voluntary mental process of thinking critically. It requires both willingness and ability to think critically, including willingness and ability to perform each of the mental acts that compose the process and to coordinate those acts in a sequence that is directed at resolving the initiating perplexity.

Consider willingness first. We can identify causal contributors to willingness to think critically by considering factors that would cause a person who was able to think critically about an issue nevertheless not to do so (Hamby 2014). For each factor, the opposite condition thus contributes causally to willingness to think critically on a particular occasion. For example, people who habitually jump to conclusions without considering alternatives will not think critically about issues that arise, even if they have the required abilities. The contrary condition of willingness to suspend judgment is thus a causal contributor to thinking critically.

Now consider ability. In contrast to the ability to move one’s arm, which can be completely absent because a stroke has left the arm paralyzed, the ability to think critically is a developed ability, whose absence is not a complete absence of ability to think but absence of ability to think well. We can identify the ability to think well directly, in terms of the norms and standards for good thinking. In general, to be able do well the thinking activities that can be components of a critical thinking process, one needs to know the concepts and principles that characterize their good performance, to recognize in particular cases that the concepts and principles apply, and to apply them. The knowledge, recognition and application may be procedural rather than declarative. It may be domain-specific rather than widely applicable, and in either case may need subject-matter knowledge, sometimes of a deep kind.

Reflections of the sort illustrated by the previous two paragraphs have led scholars to identify the knowledge, abilities and dispositions of a “critical thinker”, i.e., someone who thinks critically whenever it is appropriate to do so. We turn now to these three types of causal contributors to thinking critically. We start with dispositions, since arguably these are the most powerful contributors to being a critical thinker, can be fostered at an early stage of a child’s development, and are susceptible to general improvement (Glaser 1941: 175)

8. Critical Thinking Dispositions

Educational researchers use the term ‘dispositions’ broadly for the habits of mind and attitudes that contribute causally to being a critical thinker. Some writers (e.g., Paul & Elder 2006; Hamby 2014; Bailin & Battersby 2016a) propose to use the term ‘virtues’ for this dimension of a critical thinker. The virtues in question, although they are virtues of character, concern the person’s ways of thinking rather than the person’s ways of behaving towards others. They are not moral virtues but intellectual virtues, of the sort articulated by Zagzebski (1996) and discussed by Turri, Alfano, and Greco (2017).

On a realistic conception, thinking dispositions or intellectual virtues are real properties of thinkers. They are general tendencies, propensities, or inclinations to think in particular ways in particular circumstances, and can be genuinely explanatory (Siegel 1999). Sceptics argue that there is no evidence for a specific mental basis for the habits of mind that contribute to thinking critically, and that it is pedagogically misleading to posit such a basis (Bailin et al. 1999a). Whatever their status, critical thinking dispositions need motivation for their initial formation in a child—motivation that may be external or internal. As children develop, the force of habit will gradually become important in sustaining the disposition (Nieto & Valenzuela 2012). Mere force of habit, however, is unlikely to sustain critical thinking dispositions. Critical thinkers must value and enjoy using their knowledge and abilities to think things through for themselves. They must be committed to, and lovers of, inquiry.

A person may have a critical thinking disposition with respect to only some kinds of issues. For example, one could be open-minded about scientific issues but not about religious issues. Similarly, one could be confident in one’s ability to reason about the theological implications of the existence of evil in the world but not in one’s ability to reason about the best design for a guided ballistic missile.

Facione (1990a: 25) divides “affective dispositions” of critical thinking into approaches to life and living in general and approaches to specific issues, questions or problems. Adapting this distinction, one can usefully divide critical thinking dispositions into initiating dispositions (those that contribute causally to starting to think critically about an issue) and internal dispositions (those that contribute causally to doing a good job of thinking critically once one has started). The two categories are not mutually exclusive. For example, open-mindedness, in the sense of willingness to consider alternative points of view to one’s own, is both an initiating and an internal disposition.

Using the strategy of considering factors that would block people with the ability to think critically from doing so, we can identify as initiating dispositions for thinking critically attentiveness, a habit of inquiry, self-confidence, courage, open-mindedness, willingness to suspend judgment, trust in reason, wanting evidence for one’s beliefs, and seeking the truth. We consider briefly what each of these dispositions amounts to, in each case citing sources that acknowledge them.

Attentiveness : One will not think critically if one fails to recognize an issue that needs to be thought through. For example, the pedestrian in Weather would not have looked up if he had not noticed that the air was suddenly cooler. To be a critical thinker, then, one needs to be habitually attentive to one’s surroundings, noticing not only what one senses but also sources of perplexity in messages received and in one’s own beliefs and attitudes (Facione 1990a: 25; Facione, Facione, & Giancarlo 2001).
Habit of inquiry : Inquiry is effortful, and one needs an internal push to engage in it. For example, the student in Bubbles could easily have stopped at idle wondering about the cause of the bubbles rather than reasoning to a hypothesis, then designing and executing an experiment to test it. Thus willingness to think critically needs mental energy and initiative. What can supply that energy? Love of inquiry, or perhaps just a habit of inquiry. Hamby (2015) has argued that willingness to inquire is the central critical thinking virtue, one that encompasses all the others. It is recognized as a critical thinking disposition by Dewey (1910: 29; 1933: 35), Glaser (1941: 5), Ennis (1987: 12; 1991: 8), Facione (1990a: 25), Bailin et al. (1999b: 294), Halpern (1998: 452), and Facione, Facione, & Giancarlo (2001).
Self-confidence : Lack of confidence in one’s abilities can block critical thinking. For example, if the woman in Rash lacked confidence in her ability to figure things out for herself, she might just have assumed that the rash on her chest was the allergic reaction to her medication against which the pharmacist had warned her. Thus willingness to think critically requires confidence in one’s ability to inquire (Facione 1990a: 25; Facione, Facione, & Giancarlo 2001).
Courage : Fear of thinking for oneself can stop one from doing it. Thus willingness to think critically requires intellectual courage (Paul & Elder 2006: 16).
Open-mindedness : A dogmatic attitude will impede thinking critically. For example, a person who adheres rigidly to a “pro-choice” position on the issue of the legal status of induced abortion is likely to be unwilling to consider seriously the issue of when in its development an unborn child acquires a moral right to life. Thus willingness to think critically requires open-mindedness, in the sense of a willingness to examine questions to which one already accepts an answer but which further evidence or reasoning might cause one to answer differently (Dewey 1933; Facione 1990a; Ennis 1991; Bailin et al. 1999b; Halpern 1998, Facione, Facione, & Giancarlo 2001). Paul (1981) emphasizes open-mindedness about alternative world-views, and recommends a dialectical approach to integrating such views as central to what he calls “strong sense” critical thinking. In three studies, Haran, Ritov, & Mellers (2013) found that actively open-minded thinking, including “the tendency to weigh new evidence against a favored belief, to spend sufficient time on a problem before giving up, and to consider carefully the opinions of others in forming one’s own”, led study participants to acquire information and thus to make accurate estimations.
Willingness to suspend judgment : Premature closure on an initial solution will block critical thinking. Thus willingness to think critically requires a willingness to suspend judgment while alternatives are explored (Facione 1990a; Ennis 1991; Halpern 1998).
Trust in reason : Since distrust in the processes of reasoned inquiry will dissuade one from engaging in it, trust in them is an initiating critical thinking disposition (Facione 1990a, 25; Bailin et al. 1999b: 294; Facione, Facione, & Giancarlo 2001; Paul & Elder 2006). In reaction to an allegedly exclusive emphasis on reason in critical thinking theory and pedagogy, Thayer-Bacon (2000) argues that intuition, imagination, and emotion have important roles to play in an adequate conception of critical thinking that she calls “constructive thinking”. From her point of view, critical thinking requires trust not only in reason but also in intuition, imagination, and emotion.
Seeking the truth : If one does not care about the truth but is content to stick with one’s initial bias on an issue, then one will not think critically about it. Seeking the truth is thus an initiating critical thinking disposition (Bailin et al. 1999b: 294; Facione, Facione, & Giancarlo 2001). A disposition to seek the truth is implicit in more specific critical thinking dispositions, such as trying to be well-informed, considering seriously points of view other than one’s own, looking for alternatives, suspending judgment when the evidence is insufficient, and adopting a position when the evidence supporting it is sufficient.

Some of the initiating dispositions, such as open-mindedness and willingness to suspend judgment, are also internal critical thinking dispositions, in the sense of mental habits or attitudes that contribute causally to doing a good job of critical thinking once one starts the process. But there are many other internal critical thinking dispositions. Some of them are parasitic on one’s conception of good thinking. For example, it is constitutive of good thinking about an issue to formulate the issue clearly and to maintain focus on it. For this purpose, one needs not only the corresponding ability but also the corresponding disposition. Ennis (1991: 8) describes it as the disposition “to determine and maintain focus on the conclusion or question”, Facione (1990a: 25) as “clarity in stating the question or concern”. Other internal dispositions are motivators to continue or adjust the critical thinking process, such as willingness to persist in a complex task and willingness to abandon nonproductive strategies in an attempt to self-correct (Halpern 1998: 452). For a list of identified internal critical thinking dispositions, see the Supplement on Internal Critical Thinking Dispositions .

Some theorists postulate skills, i.e., acquired abilities, as operative in critical thinking. It is not obvious, however, that a good mental act is the exercise of a generic acquired skill. Inferring an expected time of arrival, as in Transit , has some generic components but also uses non-generic subject-matter knowledge. Bailin et al. (1999a) argue against viewing critical thinking skills as generic and discrete, on the ground that skilled performance at a critical thinking task cannot be separated from knowledge of concepts and from domain-specific principles of good thinking. Talk of skills, they concede, is unproblematic if it means merely that a person with critical thinking skills is capable of intelligent performance.

Despite such scepticism, theorists of critical thinking have listed as general contributors to critical thinking what they variously call abilities (Glaser 1941; Ennis 1962, 1991), skills (Facione 1990a; Halpern 1998) or competencies (Fisher & Scriven 1997). Amalgamating these lists would produce a confusing and chaotic cornucopia of more than 50 possible educational objectives, with only partial overlap among them. It makes sense instead to try to understand the reasons for the multiplicity and diversity, and to make a selection according to one’s own reasons for singling out abilities to be developed in a critical thinking curriculum. Two reasons for diversity among lists of critical thinking abilities are the underlying conception of critical thinking and the envisaged educational level. Appraisal-only conceptions, for example, involve a different suite of abilities than constructive-only conceptions. Some lists, such as those in (Glaser 1941), are put forward as educational objectives for secondary school students, whereas others are proposed as objectives for college students (e.g., Facione 1990a).

The abilities described in the remaining paragraphs of this section emerge from reflection on the general abilities needed to do well the thinking activities identified in section 6 as components of the critical thinking process described in section 5 . The derivation of each collection of abilities is accompanied by citation of sources that list such abilities and of standardized tests that claim to test them.

Observational abilities : Careful and accurate observation sometimes requires specialist expertise and practice, as in the case of observing birds and observing accident scenes. However, there are general abilities of noticing what one’s senses are picking up from one’s environment and of being able to articulate clearly and accurately to oneself and others what one has observed. It helps in exercising them to be able to recognize and take into account factors that make one’s observation less trustworthy, such as prior framing of the situation, inadequate time, deficient senses, poor observation conditions, and the like. It helps as well to be skilled at taking steps to make one’s observation more trustworthy, such as moving closer to get a better look, measuring something three times and taking the average, and checking what one thinks one is observing with someone else who is in a good position to observe it. It also helps to be skilled at recognizing respects in which one’s report of one’s observation involves inference rather than direct observation, so that one can then consider whether the inference is justified. These abilities come into play as well when one thinks about whether and with what degree of confidence to accept an observation report, for example in the study of history or in a criminal investigation or in assessing news reports. Observational abilities show up in some lists of critical thinking abilities (Ennis 1962: 90; Facione 1990a: 16; Ennis 1991: 9). There are items testing a person’s ability to judge the credibility of observation reports in the Cornell Critical Thinking Tests, Levels X and Z (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005). Norris and King (1983, 1985, 1990a, 1990b) is a test of ability to appraise observation reports.

Emotional abilities : The emotions that drive a critical thinking process are perplexity or puzzlement, a wish to resolve it, and satisfaction at achieving the desired resolution. Children experience these emotions at an early age, without being trained to do so. Education that takes critical thinking as a goal needs only to channel these emotions and to make sure not to stifle them. Collaborative critical thinking benefits from ability to recognize one’s own and others’ emotional commitments and reactions.

Questioning abilities : A critical thinking process needs transformation of an inchoate sense of perplexity into a clear question. Formulating a question well requires not building in questionable assumptions, not prejudging the issue, and using language that in context is unambiguous and precise enough (Ennis 1962: 97; 1991: 9).

Imaginative abilities : Thinking directed at finding the correct causal explanation of a general phenomenon or particular event requires an ability to imagine possible explanations. Thinking about what policy or plan of action to adopt requires generation of options and consideration of possible consequences of each option. Domain knowledge is required for such creative activity, but a general ability to imagine alternatives is helpful and can be nurtured so as to become easier, quicker, more extensive, and deeper (Dewey 1910: 34–39; 1933: 40–47). Facione (1990a) and Halpern (1998) include the ability to imagine alternatives as a critical thinking ability.

Inferential abilities : The ability to draw conclusions from given information, and to recognize with what degree of certainty one’s own or others’ conclusions follow, is universally recognized as a general critical thinking ability. All 11 examples in section 2 of this article include inferences, some from hypotheses or options (as in Transit , Ferryboat and Disorder ), others from something observed (as in Weather and Rash ). None of these inferences is formally valid. Rather, they are licensed by general, sometimes qualified substantive rules of inference (Toulmin 1958) that rest on domain knowledge—that a bus trip takes about the same time in each direction, that the terminal of a wireless telegraph would be located on the highest possible place, that sudden cooling is often followed by rain, that an allergic reaction to a sulfa drug generally shows up soon after one starts taking it. It is a matter of controversy to what extent the specialized ability to deduce conclusions from premisses using formal rules of inference is needed for critical thinking. Dewey (1933) locates logical forms in setting out the products of reflection rather than in the process of reflection. Ennis (1981a), on the other hand, maintains that a liberally-educated person should have the following abilities: to translate natural-language statements into statements using the standard logical operators, to use appropriately the language of necessary and sufficient conditions, to deal with argument forms and arguments containing symbols, to determine whether in virtue of an argument’s form its conclusion follows necessarily from its premisses, to reason with logically complex propositions, and to apply the rules and procedures of deductive logic. Inferential abilities are recognized as critical thinking abilities by Glaser (1941: 6), Facione (1990a: 9), Ennis (1991: 9), Fisher & Scriven (1997: 99, 111), and Halpern (1998: 452). Items testing inferential abilities constitute two of the five subtests of the Watson Glaser Critical Thinking Appraisal (Watson & Glaser 1980a, 1980b, 1994), two of the four sections in the Cornell Critical Thinking Test Level X (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005), three of the seven sections in the Cornell Critical Thinking Test Level Z (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005), 11 of the 34 items on Forms A and B of the California Critical Thinking Skills Test (Facione 1990b, 1992), and a high but variable proportion of the 25 selected-response questions in the Collegiate Learning Assessment (Council for Aid to Education 2017).

Experimenting abilities : Knowing how to design and execute an experiment is important not just in scientific research but also in everyday life, as in Rash . Dewey devoted a whole chapter of his How We Think (1910: 145–156; 1933: 190–202) to the superiority of experimentation over observation in advancing knowledge. Experimenting abilities come into play at one remove in appraising reports of scientific studies. Skill in designing and executing experiments includes the acknowledged abilities to appraise evidence (Glaser 1941: 6), to carry out experiments and to apply appropriate statistical inference techniques (Facione 1990a: 9), to judge inductions to an explanatory hypothesis (Ennis 1991: 9), and to recognize the need for an adequately large sample size (Halpern 1998). The Cornell Critical Thinking Test Level Z (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005) includes four items (out of 52) on experimental design. The Collegiate Learning Assessment (Council for Aid to Education 2017) makes room for appraisal of study design in both its performance task and its selected-response questions.

Consulting abilities : Skill at consulting sources of information comes into play when one seeks information to help resolve a problem, as in Candidate . Ability to find and appraise information includes ability to gather and marshal pertinent information (Glaser 1941: 6), to judge whether a statement made by an alleged authority is acceptable (Ennis 1962: 84), to plan a search for desired information (Facione 1990a: 9), and to judge the credibility of a source (Ennis 1991: 9). Ability to judge the credibility of statements is tested by 24 items (out of 76) in the Cornell Critical Thinking Test Level X (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005) and by four items (out of 52) in the Cornell Critical Thinking Test Level Z (Ennis & Millman 1971; Ennis, Millman, & Tomko 1985, 2005). The College Learning Assessment’s performance task requires evaluation of whether information in documents is credible or unreliable (Council for Aid to Education 2017).

Argument analysis abilities : The ability to identify and analyze arguments contributes to the process of surveying arguments on an issue in order to form one’s own reasoned judgment, as in Candidate . The ability to detect and analyze arguments is recognized as a critical thinking skill by Facione (1990a: 7–8), Ennis (1991: 9) and Halpern (1998). Five items (out of 34) on the California Critical Thinking Skills Test (Facione 1990b, 1992) test skill at argument analysis. The College Learning Assessment (Council for Aid to Education 2017) incorporates argument analysis in its selected-response tests of critical reading and evaluation and of critiquing an argument.

Judging skills and deciding skills : Skill at judging and deciding is skill at recognizing what judgment or decision the available evidence and argument supports, and with what degree of confidence. It is thus a component of the inferential skills already discussed.

Lists and tests of critical thinking abilities often include two more abilities: identifying assumptions and constructing and evaluating definitions.

In addition to dispositions and abilities, critical thinking needs knowledge: of critical thinking concepts, of critical thinking principles, and of the subject-matter of the thinking.

We can derive a short list of concepts whose understanding contributes to critical thinking from the critical thinking abilities described in the preceding section. Observational abilities require an understanding of the difference between observation and inference. Questioning abilities require an understanding of the concepts of ambiguity and vagueness. Inferential abilities require an understanding of the difference between conclusive and defeasible inference (traditionally, between deduction and induction), as well as of the difference between necessary and sufficient conditions. Experimenting abilities require an understanding of the concepts of hypothesis, null hypothesis, assumption and prediction, as well as of the concept of statistical significance and of its difference from importance. They also require an understanding of the difference between an experiment and an observational study, and in particular of the difference between a randomized controlled trial, a prospective correlational study and a retrospective (case-control) study. Argument analysis abilities require an understanding of the concepts of argument, premiss, assumption, conclusion and counter-consideration. Additional critical thinking concepts are proposed by Bailin et al. (1999b: 293), Fisher & Scriven (1997: 105–106), Black (2012), and Blair (2021).

According to Glaser (1941: 25), ability to think critically requires knowledge of the methods of logical inquiry and reasoning. If we review the list of abilities in the preceding section, however, we can see that some of them can be acquired and exercised merely through practice, possibly guided in an educational setting, followed by feedback. Searching intelligently for a causal explanation of some phenomenon or event requires that one consider a full range of possible causal contributors, but it seems more important that one implements this principle in one’s practice than that one is able to articulate it. What is important is “operational knowledge” of the standards and principles of good thinking (Bailin et al. 1999b: 291–293). But the development of such critical thinking abilities as designing an experiment or constructing an operational definition can benefit from learning their underlying theory. Further, explicit knowledge of quirks of human thinking seems useful as a cautionary guide. Human memory is not just fallible about details, as people learn from their own experiences of misremembering, but is so malleable that a detailed, clear and vivid recollection of an event can be a total fabrication (Loftus 2017). People seek or interpret evidence in ways that are partial to their existing beliefs and expectations, often unconscious of their “confirmation bias” (Nickerson 1998). Not only are people subject to this and other cognitive biases (Kahneman 2011), of which they are typically unaware, but it may be counter-productive for one to make oneself aware of them and try consciously to counteract them or to counteract social biases such as racial or sexual stereotypes (Kenyon & Beaulac 2014). It is helpful to be aware of these facts and of the superior effectiveness of blocking the operation of biases—for example, by making an immediate record of one’s observations, refraining from forming a preliminary explanatory hypothesis, blind refereeing, double-blind randomized trials, and blind grading of students’ work. It is also helpful to be aware of the prevalence of “noise” (unwanted unsystematic variability of judgments), of how to detect noise (through a noise audit), and of how to reduce noise: make accuracy the goal, think statistically, break a process of arriving at a judgment into independent tasks, resist premature intuitions, in a group get independent judgments first, favour comparative judgments and scales (Kahneman, Sibony, & Sunstein 2021). It is helpful as well to be aware of the concept of “bounded rationality” in decision-making and of the related distinction between “satisficing” and optimizing (Simon 1956; Gigerenzer 2001).

Critical thinking about an issue requires substantive knowledge of the domain to which the issue belongs. Critical thinking abilities are not a magic elixir that can be applied to any issue whatever by somebody who has no knowledge of the facts relevant to exploring that issue. For example, the student in Bubbles needed to know that gases do not penetrate solid objects like a glass, that air expands when heated, that the volume of an enclosed gas varies directly with its temperature and inversely with its pressure, and that hot objects will spontaneously cool down to the ambient temperature of their surroundings unless kept hot by insulation or a source of heat. Critical thinkers thus need a rich fund of subject-matter knowledge relevant to the variety of situations they encounter. This fact is recognized in the inclusion among critical thinking dispositions of a concern to become and remain generally well informed.

Experimental educational interventions, with control groups, have shown that education can improve critical thinking skills and dispositions, as measured by standardized tests. For information about these tests, see the Supplement on Assessment .

What educational methods are most effective at developing the dispositions, abilities and knowledge of a critical thinker? In a comprehensive meta-analysis of experimental and quasi-experimental studies of strategies for teaching students to think critically, Abrami et al. (2015) found that dialogue, anchored instruction, and mentoring each increased the effectiveness of the educational intervention, and that they were most effective when combined. They also found that in these studies a combination of separate instruction in critical thinking with subject-matter instruction in which students are encouraged to think critically was more effective than either by itself. However, the difference was not statistically significant; that is, it might have arisen by chance.

Most of these studies lack the longitudinal follow-up required to determine whether the observed differential improvements in critical thinking abilities or dispositions continue over time, for example until high school or college graduation. For details on studies of methods of developing critical thinking skills and dispositions, see the Supplement on Educational Methods .

12. Controversies

Scholars have denied the generalizability of critical thinking abilities across subject domains, have alleged bias in critical thinking theory and pedagogy, and have investigated the relationship of critical thinking to other kinds of thinking.

McPeck (1981) attacked the thinking skills movement of the 1970s, including the critical thinking movement. He argued that there are no general thinking skills, since thinking is always thinking about some subject-matter. It is futile, he claimed, for schools and colleges to teach thinking as if it were a separate subject. Rather, teachers should lead their pupils to become autonomous thinkers by teaching school subjects in a way that brings out their cognitive structure and that encourages and rewards discussion and argument. As some of his critics (e.g., Paul 1985; Siegel 1985) pointed out, McPeck’s central argument needs elaboration, since it has obvious counter-examples in writing and speaking, for which (up to a certain level of complexity) there are teachable general abilities even though they are always about some subject-matter. To make his argument convincing, McPeck needs to explain how thinking differs from writing and speaking in a way that does not permit useful abstraction of its components from the subject-matters with which it deals. He has not done so. Nevertheless, his position that the dispositions and abilities of a critical thinker are best developed in the context of subject-matter instruction is shared by many theorists of critical thinking, including Dewey (1910, 1933), Glaser (1941), Passmore (1980), Weinstein (1990), Bailin et al. (1999b), and Willingham (2019).

McPeck’s challenge prompted reflection on the extent to which critical thinking is subject-specific. McPeck argued for a strong subject-specificity thesis, according to which it is a conceptual truth that all critical thinking abilities are specific to a subject. (He did not however extend his subject-specificity thesis to critical thinking dispositions. In particular, he took the disposition to suspend judgment in situations of cognitive dissonance to be a general disposition.) Conceptual subject-specificity is subject to obvious counter-examples, such as the general ability to recognize confusion of necessary and sufficient conditions. A more modest thesis, also endorsed by McPeck, is epistemological subject-specificity, according to which the norms of good thinking vary from one field to another. Epistemological subject-specificity clearly holds to a certain extent; for example, the principles in accordance with which one solves a differential equation are quite different from the principles in accordance with which one determines whether a painting is a genuine Picasso. But the thesis suffers, as Ennis (1989) points out, from vagueness of the concept of a field or subject and from the obvious existence of inter-field principles, however broadly the concept of a field is construed. For example, the principles of hypothetico-deductive reasoning hold for all the varied fields in which such reasoning occurs. A third kind of subject-specificity is empirical subject-specificity, according to which as a matter of empirically observable fact a person with the abilities and dispositions of a critical thinker in one area of investigation will not necessarily have them in another area of investigation.

The thesis of empirical subject-specificity raises the general problem of transfer. If critical thinking abilities and dispositions have to be developed independently in each school subject, how are they of any use in dealing with the problems of everyday life and the political and social issues of contemporary society, most of which do not fit into the framework of a traditional school subject? Proponents of empirical subject-specificity tend to argue that transfer is more likely to occur if there is critical thinking instruction in a variety of domains, with explicit attention to dispositions and abilities that cut across domains. But evidence for this claim is scanty. There is a need for well-designed empirical studies that investigate the conditions that make transfer more likely.

It is common ground in debates about the generality or subject-specificity of critical thinking dispositions and abilities that critical thinking about any topic requires background knowledge about the topic. For example, the most sophisticated understanding of the principles of hypothetico-deductive reasoning is of no help unless accompanied by some knowledge of what might be plausible explanations of some phenomenon under investigation.

Critics have objected to bias in the theory, pedagogy and practice of critical thinking. Commentators (e.g., Alston 1995; Ennis 1998) have noted that anyone who takes a position has a bias in the neutral sense of being inclined in one direction rather than others. The critics, however, are objecting to bias in the pejorative sense of an unjustified favoring of certain ways of knowing over others, frequently alleging that the unjustly favoured ways are those of a dominant sex or culture (Bailin 1995). These ways favour:

reinforcement of egocentric and sociocentric biases over dialectical engagement with opposing world-views (Paul 1981, 1984; Warren 1998)
distancing from the object of inquiry over closeness to it (Martin 1992; Thayer-Bacon 1992)
indifference to the situation of others over care for them (Martin 1992)
orientation to thought over orientation to action (Martin 1992)
being reasonable over caring to understand people’s ideas (Thayer-Bacon 1993)
being neutral and objective over being embodied and situated (Thayer-Bacon 1995a)
doubting over believing (Thayer-Bacon 1995b)
reason over emotion, imagination and intuition (Thayer-Bacon 2000)
solitary thinking over collaborative thinking (Thayer-Bacon 2000)
written and spoken assignments over other forms of expression (Alston 2001)
attention to written and spoken communications over attention to human problems (Alston 2001)
winning debates in the public sphere over making and understanding meaning (Alston 2001)

A common thread in this smorgasbord of accusations is dissatisfaction with focusing on the logical analysis and evaluation of reasoning and arguments. While these authors acknowledge that such analysis and evaluation is part of critical thinking and should be part of its conceptualization and pedagogy, they insist that it is only a part. Paul (1981), for example, bemoans the tendency of atomistic teaching of methods of analyzing and evaluating arguments to turn students into more able sophists, adept at finding fault with positions and arguments with which they disagree but even more entrenched in the egocentric and sociocentric biases with which they began. Martin (1992) and Thayer-Bacon (1992) cite with approval the self-reported intimacy with their subject-matter of leading researchers in biology and medicine, an intimacy that conflicts with the distancing allegedly recommended in standard conceptions and pedagogy of critical thinking. Thayer-Bacon (2000) contrasts the embodied and socially embedded learning of her elementary school students in a Montessori school, who used their imagination, intuition and emotions as well as their reason, with conceptions of critical thinking as

thinking that is used to critique arguments, offer justifications, and make judgments about what are the good reasons, or the right answers. (Thayer-Bacon 2000: 127–128)

Alston (2001) reports that her students in a women’s studies class were able to see the flaws in the Cinderella myth that pervades much romantic fiction but in their own romantic relationships still acted as if all failures were the woman’s fault and still accepted the notions of love at first sight and living happily ever after. Students, she writes, should

be able to connect their intellectual critique to a more affective, somatic, and ethical account of making risky choices that have sexist, racist, classist, familial, sexual, or other consequences for themselves and those both near and far… critical thinking that reads arguments, texts, or practices merely on the surface without connections to feeling/desiring/doing or action lacks an ethical depth that should infuse the difference between mere cognitive activity and something we want to call critical thinking. (Alston 2001: 34)

Some critics portray such biases as unfair to women. Thayer-Bacon (1992), for example, has charged modern critical thinking theory with being sexist, on the ground that it separates the self from the object and causes one to lose touch with one’s inner voice, and thus stigmatizes women, who (she asserts) link self to object and listen to their inner voice. Her charge does not imply that women as a group are on average less able than men to analyze and evaluate arguments. Facione (1990c) found no difference by sex in performance on his California Critical Thinking Skills Test. Kuhn (1991: 280–281) found no difference by sex in either the disposition or the competence to engage in argumentative thinking.

The critics propose a variety of remedies for the biases that they allege. In general, they do not propose to eliminate or downplay critical thinking as an educational goal. Rather, they propose to conceptualize critical thinking differently and to change its pedagogy accordingly. Their pedagogical proposals arise logically from their objections. They can be summarized as follows:

Focus on argument networks with dialectical exchanges reflecting contesting points of view rather than on atomic arguments, so as to develop “strong sense” critical thinking that transcends egocentric and sociocentric biases (Paul 1981, 1984).
Foster closeness to the subject-matter and feeling connected to others in order to inform a humane democracy (Martin 1992).
Develop “constructive thinking” as a social activity in a community of physically embodied and socially embedded inquirers with personal voices who value not only reason but also imagination, intuition and emotion (Thayer-Bacon 2000).
In developing critical thinking in school subjects, treat as important neither skills nor dispositions but opening worlds of meaning (Alston 2001).
Attend to the development of critical thinking dispositions as well as skills, and adopt the “critical pedagogy” practised and advocated by Freire (1968 [1970]) and hooks (1994) (Dalgleish, Girard, & Davies 2017).

A common thread in these proposals is treatment of critical thinking as a social, interactive, personally engaged activity like that of a quilting bee or a barn-raising (Thayer-Bacon 2000) rather than as an individual, solitary, distanced activity symbolized by Rodin’s The Thinker . One can get a vivid description of education with the former type of goal from the writings of bell hooks (1994, 2010). Critical thinking for her is open-minded dialectical exchange across opposing standpoints and from multiple perspectives, a conception similar to Paul’s “strong sense” critical thinking (Paul 1981). She abandons the structure of domination in the traditional classroom. In an introductory course on black women writers, for example, she assigns students to write an autobiographical paragraph about an early racial memory, then to read it aloud as the others listen, thus affirming the uniqueness and value of each voice and creating a communal awareness of the diversity of the group’s experiences (hooks 1994: 84). Her “engaged pedagogy” is thus similar to the “freedom under guidance” implemented in John Dewey’s Laboratory School of Chicago in the late 1890s and early 1900s. It incorporates the dialogue, anchored instruction, and mentoring that Abrami (2015) found to be most effective in improving critical thinking skills and dispositions.

What is the relationship of critical thinking to problem solving, decision-making, higher-order thinking, creative thinking, and other recognized types of thinking? One’s answer to this question obviously depends on how one defines the terms used in the question. If critical thinking is conceived broadly to cover any careful thinking about any topic for any purpose, then problem solving and decision making will be kinds of critical thinking, if they are done carefully. Historically, ‘critical thinking’ and ‘problem solving’ were two names for the same thing. If critical thinking is conceived more narrowly as consisting solely of appraisal of intellectual products, then it will be disjoint with problem solving and decision making, which are constructive.

Bloom’s taxonomy of educational objectives used the phrase “intellectual abilities and skills” for what had been labeled “critical thinking” by some, “reflective thinking” by Dewey and others, and “problem solving” by still others (Bloom et al. 1956: 38). Thus, the so-called “higher-order thinking skills” at the taxonomy’s top levels of analysis, synthesis and evaluation are just critical thinking skills, although they do not come with general criteria for their assessment (Ennis 1981b). The revised version of Bloom’s taxonomy (Anderson et al. 2001) likewise treats critical thinking as cutting across those types of cognitive process that involve more than remembering (Anderson et al. 2001: 269–270). For details, see the Supplement on History .

As to creative thinking, it overlaps with critical thinking (Bailin 1987, 1988). Thinking about the explanation of some phenomenon or event, as in Ferryboat , requires creative imagination in constructing plausible explanatory hypotheses. Likewise, thinking about a policy question, as in Candidate , requires creativity in coming up with options. Conversely, creativity in any field needs to be balanced by critical appraisal of the draft painting or novel or mathematical theory.

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A Crash Course in Critical Thinking

What you need to know—and read—about one of the essential skills needed today..

Posted April 8, 2024 | Reviewed by Michelle Quirk

In research for "A More Beautiful Question," I did a deep dive into the current crisis in critical thinking.
Many people may think of themselves as critical thinkers, but they actually are not.
Here is a series of questions you can ask yourself to try to ensure that you are thinking critically.

Conspiracy theories. Inability to distinguish facts from falsehoods. Widespread confusion about who and what to believe.

These are some of the hallmarks of the current crisis in critical thinking—which just might be the issue of our times. Because if people aren’t willing or able to think critically as they choose potential leaders, they’re apt to choose bad ones. And if they can’t judge whether the information they’re receiving is sound, they may follow faulty advice while ignoring recommendations that are science-based and solid (and perhaps life-saving).

Moreover, as a society, if we can’t think critically about the many serious challenges we face, it becomes more difficult to agree on what those challenges are—much less solve them.

On a personal level, critical thinking can enable you to make better everyday decisions. It can help you make sense of an increasingly complex and confusing world.

In the new expanded edition of my book A More Beautiful Question ( AMBQ ), I took a deep dive into critical thinking. Here are a few key things I learned.

First off, before you can get better at critical thinking, you should understand what it is. It’s not just about being a skeptic. When thinking critically, we are thoughtfully reasoning, evaluating, and making decisions based on evidence and logic. And—perhaps most important—while doing this, a critical thinker always strives to be open-minded and fair-minded . That’s not easy: It demands that you constantly question your assumptions and biases and that you always remain open to considering opposing views.

In today’s polarized environment, many people think of themselves as critical thinkers simply because they ask skeptical questions—often directed at, say, certain government policies or ideas espoused by those on the “other side” of the political divide. The problem is, they may not be asking these questions with an open mind or a willingness to fairly consider opposing views.

When people do this, they’re engaging in “weak-sense critical thinking”—a term popularized by the late Richard Paul, a co-founder of The Foundation for Critical Thinking . “Weak-sense critical thinking” means applying the tools and practices of critical thinking—questioning, investigating, evaluating—but with the sole purpose of confirming one’s own bias or serving an agenda.

In AMBQ , I lay out a series of questions you can ask yourself to try to ensure that you’re thinking critically. Here are some of the questions to consider:

Why do I believe what I believe?
Are my views based on evidence?
Have I fairly and thoughtfully considered differing viewpoints?
Am I truly open to changing my mind?

Of course, becoming a better critical thinker is not as simple as just asking yourself a few questions. Critical thinking is a habit of mind that must be developed and strengthened over time. In effect, you must train yourself to think in a manner that is more effortful, aware, grounded, and balanced.

For those interested in giving themselves a crash course in critical thinking—something I did myself, as I was working on my book—I thought it might be helpful to share a list of some of the books that have shaped my own thinking on this subject. As a self-interested author, I naturally would suggest that you start with the new 10th-anniversary edition of A More Beautiful Question , but beyond that, here are the top eight critical-thinking books I’d recommend.

The Demon-Haunted World: Science as a Candle in the Dark , by Carl Sagan

This book simply must top the list, because the late scientist and author Carl Sagan continues to be such a bright shining light in the critical thinking universe. Chapter 12 includes the details on Sagan’s famous “baloney detection kit,” a collection of lessons and tips on how to deal with bogus arguments and logical fallacies.

Clear Thinking: Turning Ordinary Moments Into Extraordinary Results , by Shane Parrish

The creator of the Farnham Street website and host of the “Knowledge Project” podcast explains how to contend with biases and unconscious reactions so you can make better everyday decisions. It contains insights from many of the brilliant thinkers Shane has studied.

Good Thinking: Why Flawed Logic Puts Us All at Risk and How Critical Thinking Can Save the World , by David Robert Grimes

A brilliant, comprehensive 2021 book on critical thinking that, to my mind, hasn’t received nearly enough attention . The scientist Grimes dissects bad thinking, shows why it persists, and offers the tools to defeat it.

Think Again: The Power of Knowing What You Don't Know , by Adam Grant

Intellectual humility—being willing to admit that you might be wrong—is what this book is primarily about. But Adam, the renowned Wharton psychology professor and bestselling author, takes the reader on a mind-opening journey with colorful stories and characters.

Think Like a Detective: A Kid's Guide to Critical Thinking , by David Pakman

The popular YouTuber and podcast host Pakman—normally known for talking politics —has written a terrific primer on critical thinking for children. The illustrated book presents critical thinking as a “superpower” that enables kids to unlock mysteries and dig for truth. (I also recommend Pakman’s second kids’ book called Think Like a Scientist .)

Rationality: What It Is, Why It Seems Scarce, Why It Matters , by Steven Pinker

The Harvard psychology professor Pinker tackles conspiracy theories head-on but also explores concepts involving risk/reward, probability and randomness, and correlation/causation. And if that strikes you as daunting, be assured that Pinker makes it lively and accessible.

How Minds Change: The Surprising Science of Belief, Opinion and Persuasion , by David McRaney

David is a science writer who hosts the popular podcast “You Are Not So Smart” (and his ideas are featured in A More Beautiful Question ). His well-written book looks at ways you can actually get through to people who see the world very differently than you (hint: bludgeoning them with facts definitely won’t work).

A Healthy Democracy's Best Hope: Building the Critical Thinking Habit , by M Neil Browne and Chelsea Kulhanek

Neil Browne, author of the seminal Asking the Right Questions: A Guide to Critical Thinking, has been a pioneer in presenting critical thinking as a question-based approach to making sense of the world around us. His newest book, co-authored with Chelsea Kulhanek, breaks down critical thinking into “11 explosive questions”—including the “priors question” (which challenges us to question assumptions), the “evidence question” (focusing on how to evaluate and weigh evidence), and the “humility question” (which reminds us that a critical thinker must be humble enough to consider the possibility of being wrong).

Warren Berger is a longtime journalist and author of A More Beautiful Question .

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Educating for Professional Responsibility: From Critical Thinking to Deliberative Communication, or Why Critical Thinking Is Not Enough

First Online: 22 June 2016

Cite this chapter

Tone Dyrdal Solbrekke 6 ,
Tomas Englund 7 ,
Berit Karseth 6 &
Eevi E. Beck 6

Part of the book series: Professional and Practice-based Learning ((PPBL,volume 17))

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Complexity and challenges characterise twenty-first century western democratic societies, and our everyday lives are highly dependent on well-qualified professionals. We need to trust that professionals perform in a competent and responsible way within the uncertainty of current societies and work life. Realising this calls for deliberate professionals who are able to understand and cope with the unforeseen. Thus, students in higher education qualifying for work must not only learn and critically evaluate the knowledge of their profession, but also develop an awareness of the relationship between theoretical knowledge, practical skills, and the moral and social dimensions and implications of and in professional work. To develop the capacity needed, critical thinking is often referred to as an important learning outcome of higher education. In this chapter, we review the ways in which different meanings of critical thinking are articulated within some of the highly ranked research literature on higher education. We argue that critical thinking, as an individual capacity, is necessary yet insufficient for learning and enacting professional responsibility and propose an extended mode. Deliberative communication provides a more adequate model for building the necessary collective capability for making nuanced judgments and decisions tailored to individual circumstances.

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A Model of Critical Thinking in Higher Education

The Knowledge Practices of Critical Thinking

Critical Thinking in Students’ Ethical Reasoning: A Reflection on Some Examples from the Swedish National Tests in Religious Education

For other perspectives on Bildung , including applying it to professional education, see Beck, Solbrekke, Sutphen, and Fremstad ( 2014 ).

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Tone Dyrdal Solbrekke, Berit Karseth & Eevi E. Beck

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Solbrekke, T.D., Englund, T., Karseth, B., Beck, E.E. (2016). Educating for Professional Responsibility: From Critical Thinking to Deliberative Communication, or Why Critical Thinking Is Not Enough. In: Trede, F., McEwen, C. (eds) Educating the Deliberate Professional. Professional and Practice-based Learning, vol 17. Springer, Cham. https://doi.org/10.1007/978-3-319-32958-1_3

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Critical thinking

Advice and resources to help you develop your critical voice.

Developing critical thinking skills is essential to your success at University and beyond. We all need to be critical thinkers to help us navigate our way through an information-rich world.

Whatever your discipline, you will engage with a wide variety of sources of information and evidence. You will develop the skills to make judgements about this evidence to form your own views and to present your views clearly.

One of the most common types of feedback received by students is that their work is ‘too descriptive’. This usually means that they have just stated what others have said and have not reflected critically on the material. They have not evaluated the evidence and constructed an argument.

What is critical thinking?

Critical thinking is the art of making clear, reasoned judgements based on interpreting, understanding, applying and synthesising evidence gathered from observation, reading and experimentation. Burns, T., & Sinfield, S. (2016) Essential Study Skills: The Complete Guide to Success at University (4th ed.) London: SAGE, p94.

Being critical does not just mean finding fault. It means assessing evidence from a variety of sources and making reasoned conclusions. As a result of your analysis you may decide that a particular piece of evidence is not robust, or that you disagree with the conclusion, but you should be able to state why you have come to this view and incorporate this into a bigger picture of the literature.

Being critical goes beyond describing what you have heard in lectures or what you have read. It involves synthesising, analysing and evaluating what you have learned to develop your own argument or position.

Critical thinking is important in all subjects and disciplines – in science and engineering, as well as the arts and humanities. The types of evidence used to develop arguments may be very different but the processes and techniques are similar. Critical thinking is required for both undergraduate and postgraduate levels of study.

What, where, when, who, why, how?

Purposeful reading can help with critical thinking because it encourages you to read actively rather than passively. When you read, ask yourself questions about what you are reading and make notes to record your views. Ask questions like:

What is the main point of this paper/ article/ paragraph/ report/ blog?
Who wrote it?
Why was it written?
When was it written?
Has the context changed since it was written?
Is the evidence presented robust?
How did the authors come to their conclusions?
Do you agree with the conclusions?
What does this add to our knowledge?
Why is it useful?

Our web page covering Reading at university includes a handout to help you develop your own critical reading form and a suggested reading notes record sheet. These resources will help you record your thoughts after you read, which will help you to construct your argument.

Reading at university

Developing an argument

Being a university student is about learning how to think, not what to think. Critical thinking shapes your own values and attitudes through a process of deliberating, debating and persuasion. Through developing your critical thinking you can move on from simply disagreeing to constructively assessing alternatives by building on doubts.

There are several key stages involved in developing your ideas and constructing an argument. You might like to use a form to help you think about the features of critical thinking and to break down the stages of developing your argument.

Features of critical thinking (pdf)

Features of critical thinking (Word rtf)

Our webpage on Academic writing includes a useful handout ‘Building an argument as you go’.

Academic writing

You should also consider the language you will use to introduce a range of viewpoints and to evaluate the various sources of evidence. This will help your reader to follow your argument. To get you started, the University of Manchester's Academic Phrasebank has a useful section on Being Critical.

Academic Phrasebank

Developing your critical thinking

Set yourself some tasks to help develop your critical thinking skills. Discuss material presented in lectures or from resource lists with your peers. Set up a critical reading group or use an online discussion forum. Think about a point you would like to make during discussions in tutorials and be prepared to back up your argument with evidence.

For more suggestions:

Developing your critical thinking - ideas (pdf)

Developing your critical thinking - ideas (Word rtf)

Published guides

For further advice and more detailed resources please see the Critical Thinking section of our list of published Study skills guides.

Study skills guides

This article was published on 2024-02-26

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