4 Ethical Dilemmas in Nursing (2023)

4 Ethical Dilemmas in Nursing (1)

Nursesfrequentlyface ethical dilemmaswhilecaring for their patients. These dilemmas can take different forms, such as how best to respect a patient’s decision to refuse treatment dueto cultural or personal beliefs, or what to do when conflicts arise between patients and their families in making end-of-life care decisions. These kinds of ethical dilemmas often challenge nurses to deliver optimal patient care while also adhering to professional boundaries.

Ethical values are so fundamental to nursing that the American Nurses Association (ANA) established a formal Code of Ethics for Nurses — often referred to simply as “The Code” — in the 1950s to set goals and values for the profession as a whole and to serve as a guide for nurses intheir daily practice.

The Code is a living document, regularly updated to reflect modern-day advancements and challenges, and represents the social contract between nurses and the public. The Code and its accompanying provisions lay out the values and commitments nurses are expected to uphold, identify the boundaries of duty and loyalty, and describe the broader responsibilities nurses have outside of patient care.

An advanced degree, such as anonline Master of Science in Nursing, can help aspiring nurses identify and address manyethical dilemmas in nursing. Below are some common dilemmas that nurses may face and how to navigate them.

(Video) Ethical Dilemmas in Nursing

Dilemma #1: ProtectingPatients’ Rights

The first three provisions of the Code of Ethics for Nurses deal directly with the nurse’s relationship with their patient. The second and third provisions specifically address the nurse’s role in protectingpatients’ rightsand best interests. Patient autonomy — the right of patients to independently make decisions about their care based on their personal or cultural beliefs and values — is a paramount principle of nursing. This includes a patient’s right to refuse medications, treatments, or procedures. In some cases, a patient’s right to autonomy may directly conflict with what nurses or other health care workers believe is best.

Autonomy vs. Beneficence

Autonomy (respecting a patient’s wishes) andbeneficence(doing good), two fundamental ethical principles in nursing, are sometimes inconflict. The nurse’s role is to strike a balance between the two through open discussion, sharing information with the patient, and negotiation. If addressed incorrectly, these situations can present not only ethical or moral issues, but legal ones as well.

The concept of patient autonomy goes beyond merely a philosophical or ethical consideration; it is considered a legal right throughout the Western world. Legal precedents have placed patient autonomy ahead of health care provider beneficence in many cases,arguably making patient autonomy the foremost principle affectingpatients’ rights.

Typically, the only exceptions to the primacy of patient autonomy are if the patient is a minor or if they lack the ability to make informed decisions. In cases where apatient’s wishes conflict with the advice of medical professionals, nurses and other health care workers should make every effort to educate the patient about the implications of their decisions, but ultimately respect their wishes.

Advocacy

Nurses especially are expected to advocate on behalf of patients in these situations. These scenarios can present a quandary for nurses, where they must balance their duty to respect and promote the interests of their patient with their loyalty to their employer or colleagues. However, according to the Code of Ethics for Nurses, the nurse’s primary commitment is to the patient.

The Code’s corresponding interpretive statements explain: “Nurses address such conflicts in ways that ensure patient safety and thatpromote the patient’s best interests while preserving the professional integrity of the nurse and supporting interprofessional collaboration.”

Dilemma #2: Providing InformedConsent to Treatment

Another commonethical dilemma in nursinginvolvesthe concept of informed consent. Informedconsent to treatmentis a process wherein a patient, or their surrogate, grants their health care provider permission to administer treatment or perform a procedure after being advised of its potential benefits andrisks, and informed of alternative treatments. Informed consent is required for many medical procedures, including anesthesia, blood transfusions, chemotherapy, and most surgeries. Informed consent typically requires written documentation, with a signature from the patient.

Exceptions to Informed Consent

Informed consent is not required in certain situations, including those where a patient is incapacitated or in a life-threatening emergency without time to properly obtain consent. Also, minorstypically can’t provide informed consent. In such cases, a parent or guardian must authorize treatments or interventions, which is known as “informed permission.”

(Video) Ethics in Healthcare: Dilemmas, Impact of Morals and Values & Moral Distress | Lecturio Nursing

The Nurse’s Role

Though a nurse’s exact role in the informed consent process may vary by institution, in their capacity as patient advocates, nurses often participate in the process to ensure patient or caregiver comprehension. In some cases, patients and families may feel more comfortable speaking to a nurse than to their doctor becausea nurse can explain complex medical terminology in layman’s terms.

According to the Agency for Healthcare Research and Quality, more than a third of the U.S. population possesseslimited health literacy, and patients often sign consent forms even if theydon’t fully understand a treatment or procedure, which courts have ruled does not constitute informed consent. Therefore, involving nurses in the informed consent process can be valuable.

Consent and the Law

Aside from its implicit ethical value, obtaining informed consent has legal implications as well. An effective informed consent process can prevent lawsuits. Failing to secure adequate informed consent is one of the top 10 leading causes of medical malpractice lawsuits, according to the Agency for Healthcare Research and Quality. Full disclosure is critical to the informed consent process.

To meet legal requirements, health care workers must explain what is involved with treatment, the anticipated benefits and potential risks, and alternatives to the proposed treatment, as well as the possiblebenefits and risks associated with the alternatives, including the option to forgo treatment.

Consent and Improved Patient Outcomes

Evidence also suggests that patients who are educated and feel empowered when it comes to their health care are more likely to follow a treatment plan and experience better outcomes. Additionally, ensuring that patients fully understand all the facets of a proposed treatment can help avoid delayed or cancelled surgeries, which can jeopardize patient health and be costly for hospitals. Nurses and other health care workers must make every effort to assure that patients understand a treatment or procedure and all the possible implications before obtaining informed consent.

Dilemma #3: AddressingAdvanced Care Planning

Ethical dilemmas in nursingoften arise duringadvanced care planning, particularly as it relates to end-of-life care scenarios.Advanced care planningis a process in which patients, often in collaboration with medical professionals, make decisions about their future health care in the event they become incapacitated. This process isn’t only for older patients. Due to the unpredictable nature of medicalcrises — a car accident or sudden illness, for example —advanced care planningis worthwhile for patients of any age, providing an opportunity to make sure they get the medical care they want if they’re unable to speak for themselves.

Advance Directives

During this process, patients often must make difficult decisions regarding the use oflife-savingor life-extending treatments, such as the use of a ventilator or artificial nutrition and hydration (tube feeding, intravenous fluids). This plan isshared with family members, often in the form of an advance directive, a legal document that lays out a patient’s preferences for medical care if they become incapacitated.

The two primary elements of an advance directive are a living will and a power of attorney for health care, but it may also involve other documents such as a do not resuscitate order (DNR), which directs caregivers to forgo measures such as CPR. Patients may also choose more informal methods of conveying their wishes, such as a videomessage to loved ones, though this does not take the place of an advance directive.

(Video) Ethical Dilemmas Issues

The Nurse’s Role

As patient advocates, nurses play a critical role in assisting patients and their families withadvanced care planning. Both the American Nurses Association and the Hospice and Palliative Nurses Association have issued position statements emphasizing the importance of nurse involvement inadvanced care planningand end-of-life care, particularly for the purpose of educating patients and their families.

Nurses can help patients navigate the various decisions they may have to make related to emergency or end-of-life treatments and facilitate conversations between patients and families about these decisions, helping patients compare different treatment options and how they may affect the patient’s individual disease process. Nurses should be equipped to explain the implications of these decisions and mindful ofthe various elements that may influence a patient’s health care decisions, such as race or ethnicity, cultural beliefs, or religion.

Nurses and End-of-Life Care

Because of advances in medicaltechnology, people are living longer and often making health care decisions alone. This reality underscores the important role of medical professionals, particularly nurses, in assisting patients with end-of-life care. Patients can choose from an array oflife-saving and life-extending treatments, and nurses should be able to guide them through the decision-making process.

A nurse’s involvement is also vital to ensuring the preferences laid out in a patient’s advance directive are honored, especially in emergency situations where the patient is incapacitated. Ethical dilemmas can arise if, for example, a patient has requested not to be placed on a ventilator but members of their family object. As in other situations involvingethical dilemmas in nursing, patient autonomy is of utmost importance, and nurses are uniquely positioned to champion a patient’s interests in end-of-life care.

Dilemma #4: SharedPatient Decision-Making

Not that long ago, health care was characterized by a paternalistic mindset: medical professionals acted in what they thought was a patient’s best interests without considering the patient’s wishes. This outdated practice has now been replaced by a far more ethical approach. An extension of patient autonomy, the concept of sharedpatient decision-makingempowers patients by providing the opportunity to work collaboratively with health care professionals to make important decisions regarding care. In shared decision-making, patient and provider work together to make decisions about tests, treatments, procedures, and overall care strategy. In a sense, shared patient decision-making is a form of informed consent, and vice versa. As with informed consent, nurses and others engaged in shared decision-making with patients are responsible for educating them about treatment and discussing various options with them.

Individualized Care

Shared decision-making goes beyond simple information-sharing. Healthcare providers should explore patients’ values, beliefs, and goals and build a relationship based on trust and respect. They should understand a patient’s background and how factors like age and race may influence their decision-making.

Patients who don’t have this kind of relationship with their provider may be more reluctant to communicate and less cooperative. On the other hand, when patients are actively involved in decision-making and have a respectful, compassionate connection with their provider,they are more satisfied with their care and more likely to follow prescribed treatment plans.

The Importance of Educating Patients

As with informed consent, medical professionals must take great care to ensure patients understand the informationbeing shared with them and the implications of their decisions. Various methods exist forimproving patient understanding, including the use of visual aids and teach-back, in which health care professionals have patients repeat back information shared with them.

(Video) Ethical Dilemmas in Nursing

Ethical dilemmas can arise if patients agree to a treatment plan but fail to comprehend its full scope, potentially leading to disputes with medical staff. Here again, nurses play a pivotal role in enhancing the shared decision-making process through their skills as gifted communicators and patient advocates.

Evolving Care

Sharedpatient decision-makingis an ongoing process where both sides continually reflect on previous decisions. Situations may arise where patients are unable or unwilling to follow through on a care decision — either because it proved more challenging than anticipated or wasn’t what they expected — and seek to revisit the issue. A nurse’s job is to support the patient by facilitating ongoing discussion and collaboration.

Leading Ethically by Example

Nursing is consistently ranked as the most ethical profession, with 85% of Americans rating the honesty and ethical standards of nurses as “high” or “very high” in a recent Gallup survey, nearly 20 points higherthan the rating of those in the second-most-trusted profession, engineers. That level of trust is a testament to the nursing profession’s strong ethical backbone, based in the ANA Code of Ethics, which helps nurses cope with the manyethical dilemmas in nursing. Applying ethical principles like patients’ rights, autonomy, and informed consent to health care empowers patients by involving them in their own care, which ultimately improves the patient experience.

Regis College’sonline Master of Science in Nursingdegreeoffersseveralspecializations, including family care, women’s health, pediatrics, psychiatric mental health and primary and acute geriatric care.Coursework in thesespecializations gives nurses a deeper understanding of the ethical principles involved in each type of care. Aspiring nurses interested in the important role ethics plays in their field should explore Regis’s online nursing programsto learn more.

RecommendedReadings

Ethics in Nursing: What Every Nurse Should Know
How to Develop and Maintain Social Justice in Nursing
5 Stress Management Techniques for Nurse Leaders

Sources:

Agency for Healthcare Research and Quality, “Making Informed Consent an Informed Choice: Training for Health Care Professionals”
American Nurses Association, Ethics and Human Rights
American Nurses Association, “Nurses’ Roles and Responsibilities in Providing Care and Support at the End of Life”
Gallup, “Nurses Continue to Rate Highest in Honesty, Ethics”
Healthline, “What You Need to Know About Informed Consent”
Journal of Hospice & Palliative Nursing, “HPNA Position Statement Advance Care Planning”
Medical Records Information, “Top 10 Most Prevalent Ethical Issues in Nursing”
National Institute on Aging, Advance Care Planning: Healthcare Directives
Oncology Nursing Society, “What You Need to Know About Obtaining Informed Consent”
The Open Nursing Journal, “Shared Decision-Making for Nursing Practice: An Integrative Review”
StatPearls, “Informed Consent”
StatPearls, “Nursing Ethical Considerations”
StatPearls, “Patient Rights”
Wolters Kluwer, “A Look at Shared Decision-Making with Patients”

(Video) NLN Nursing EDge Unscripted Scholarship – Episode 4: Ethical Dilemmas for Nursing Students & Faculty

FAQs

What are four 4 common ethical issues faced by nurses today? ›

The 5 Current Ethical Issues in Nursing
  • Informed Consent.
  • Protecting Patient Privacy and Confidentiality.
  • Shared Patient Decision-Making.
  • Addressing Advanced Care Planning.
  • Inadequate resources and staffing.
Sep 8, 2021

What are the 4 ethical dilemmas? ›

In LDRS 111 you were introduced to four different ethical dilemma paradigms: truth vs loyalty, short-term vs long-term, individual vs community, and justice vs mercy.

What are the 4 main ethical theories in nursing? ›

Nurses are advocates for patients and must find a balance while delivering patient care. There are four main principles of ethics: autonomy, beneficence, justice, and non-maleficence. Each patient has the right to make their own decisions based on their own beliefs and values. [4].

How do nurses solve ethical dilemmas? ›

Experts contacted for this article suggested several strategies organizations can implement to address ethical issues and reduce nurses' and other clinicians' moral distress:
  1. Support the nursing code of ethics. ...
  2. Offer ongoing education. ...
  3. Create an environment where nurses can speak up. ...
  4. Bring different disciplines together.
Mar 3, 2014

What is an ethical dilemma for a nurse? ›

An ethical dilemma in nursing is a situation where a nurse must decide between competing values and know that no matter what choice they make, there are consequences. Ethical dilemmas may conflict with the nurse's personal values or with the Code of Ethics for Nurses.

What is an example of an ethical dilemma in healthcare? ›

Examples of ethical dilemmas may include the following: Your critically ill family member is in the hospital and the doctors and nurses are turning to you to make medical decisions on the patient's behalf. You don't know how to decide what to do and could use some guidance.

What are 3 examples of types of ethical issues you might face as a nurse practitioner? ›

The five most frequently-occurring and most stressful ethical and patient care issues were protecting patients' rights; autonomy and informed consent to treatment; staffing patterns; advanced care planning; and surrogate decision-making.

What are the 4 steps for solving ethical dilemmas? ›

A rudimentary framework for how managers engage in the decision making process contains four steps.
  1. 1) Identify the problem.
  2. 2) Generate alternatives.
  3. 3) Decide on a course of action.
  4. 4) Implement.

What is ethical dilemma explain with example? ›

Employees may experience an ethical dilemma when deciding whether to report an incident of workplace harassment or declare a conflict of interest. In the first case, the employee might understand that the harassment is wrong, but feel guilty about getting their colleague in trouble.

Why do nurses face ethical dilemmas? ›

Ethical dilemmas in nursing often arise during advanced care planning, particularly as it relates to end-of-life care scenarios. Advanced care planning is a process in which patients, often in collaboration with medical professionals, make decisions about their future health care in the event they become incapacitated.

What are the 4 principles of informed consent? ›

There are 4 components of informed consent including decision capacity, documentation of consent, disclosure, and competency. Doctors will give you information about a particular treatment or test in order for you to decide whether or not you wish to undergo a treatment or test.

What is an example of ethics in nursing? ›

Nurses have an obligation not to inflict harm and not to allow others to inflict harm. They must also promote good actions on behalf of their patients. Examples of nonmaleficence are always being truthful to patients and never allowing one patient to be harmed for the benefit of another.

What are the 5 code of ethics in nursing? ›

What are the five codes of ethics in nursing? The 5 nursing ethic codes are: nonmaleficence, beneficence, autonomy, justice, and privacy/confidentiality.

What is the first step in solving an ethical dilemma? ›

The first step in solving an ethical dilemma is to identify an ethical situation and ethical issues involved in it. The case is studied and evaluated in the manner that is there any violation of ethical standards that could go wrong or lead to false representation of facts.

What is step one for handling an ethical dilemmas? ›

1. DETERMINE whether there is an ethical issue or/and dilemma. Is there a conflict of values, or rights, or professional responsibilities? (For example, there may be an issue of self-determination of an adolescent versus the well-being of the family.) 2.

How can we avoid ethical dilemmas? ›

Avoiding Ethical Dilemmas
  1. Make sure ethical expectations are clear. Discuss ethical dilemmas with your supervisor before they occur. ...
  2. Don't just say yes. Avoid the knee-jerk reaction to say yes when your supervisor asks you to do something. ...
  3. Learn to say no. ...
  4. Don't be the frog. ...
  5. Don't be nosy. ...
  6. Lead by example.

What are some examples of ethical decision making in healthcare? ›

An example of ethical decision-making in healthcare includes choosing between patient autonomy and beneficence. Another example is choosing between being honest to the patient and withholding information that the patient's close family might have requested.

What is the biggest ethical issue in healthcare today? ›

Patient Confidentiality

One of the biggest legal and ethical issues in healthcare is patient confidentiality which is why 15% of survey respondents noted that doctor-patient confidentiality is their top ethical issue in practicing medicine.

What is an example of personal knowing in nursing? ›

Nurses must be able to evaluate and assess patient needs at any specific point in time, without looking solely to future hopes or goals. For example, a nurse must be empathetic to a patient's pain tolerance level even when she knows the person isn't in any immediate danger and will soon recover.

What are the 7 major ethical issues in nursing practice? ›

The ethical principles that nurses must adhere to are the principles of justice, beneficence, nonmaleficence, accountability, fidelity, autonomy, and veracity.

What are examples of moral dilemmas? ›

No matter what choice you make in these situations, you always end up compromising some moral value. An example of a moral dilemma is having to choose between saving a dog from a fire or saving your sister.

What are six ethical issues in healthcare? ›

5 Ethical Issues in Healthcare
  • Do-Not-Resuscitate Orders. ...
  • Doctor and Patient Confidentiality. ...
  • Malpractice and Negligence. ...
  • Access to Care. ...
  • Physician-Assisted Suicide.

What are the 8 ethical issues related to healthcare? ›

The major 10 ethical issues, as perceived by the participants in order of their importance, were: (1) Patients' Rights, (2) Equity of resources, (3) Confidentiality of the patients, (4) Patient Safety, (5) Conflict of Interests, (6) Ethics of privatization, (7) Informed Consent, (8) Dealing with the opposite sex, (9) ...

What are the top 5 ethical issues in healthcare? ›

5 Ethical Issues in Healthcare
  • Do-Not-Resuscitate Orders. ...
  • Doctor and Patient Confidentiality. ...
  • Malpractice and Negligence. ...
  • Access to Care. ...
  • Physician-Assisted Suicide.

What are the 7 major ethical issues in nursing practice? ›

The ethical principles that nurses must adhere to are the principles of justice, beneficence, nonmaleficence, accountability, fidelity, autonomy, and veracity.

What is an example of an ethical dilemma in healthcare? ›

Examples of ethical dilemmas may include the following: Your critically ill family member is in the hospital and the doctors and nurses are turning to you to make medical decisions on the patient's behalf. You don't know how to decide what to do and could use some guidance.

What are the 8 ethical issues related to healthcare? ›

The major 10 ethical issues, as perceived by the participants in order of their importance, were: (1) Patients' Rights, (2) Equity of resources, (3) Confidentiality of the patients, (4) Patient Safety, (5) Conflict of Interests, (6) Ethics of privatization, (7) Informed Consent, (8) Dealing with the opposite sex, (9) ...

Why do nurses face ethical dilemmas? ›

Ethical dilemmas in nursing often arise during advanced care planning, particularly as it relates to end-of-life care scenarios. Advanced care planning is a process in which patients, often in collaboration with medical professionals, make decisions about their future health care in the event they become incapacitated.

What are the 10 ethical principles in nursing? ›

The search yielded 10 nursing ethical values: Human dignity, privacy, justice, autonomy in decision making, precision and accuracy in caring, commitment, human relationship, sympathy, honesty, and individual and professional competency.

What are the 9 code of ethics for nurses? ›

What Are The 7 Ethical Principles On Which The Nursing Code Of Ethics Is Based? The 7 ethical principles the Nursing Code of Ethics is based upon include beneficence, nonmaleficence, justice, accountability, autonomy, fidelity, and veracity.

What is an ethical dilemma in the workplace? ›

Ethical dilemmas occur regularly in the business environment where employees make decisions that impact the success and profitability of organizations. Employees may experience an ethical dilemma when deciding whether to report an incident of workplace harassment or declare a conflict of interest.

Is lying an ethical issue? ›

Lies are morally wrong, then, for two reasons. First, lying corrupts the most important quality of my being human: my ability to make free, rational choices. Each lie I tell contradicts the part of me that gives me moral worth. Second, my lies rob others of their freedom to choose rationally.

How do you handle ethical issues in the workplace? ›

Build a culture of integrity — from the top down.
  1. Talk about the importance of ethics.
  2. Keep employees adequately informed about issues that impact them.
  3. Uphold promises and commitments to employees and stakeholders.
  4. Acknowledge and reward ethical conduct.
  5. Hold accountable those who violate standards, especially leaders.
Oct 25, 2021

What is an example of ethics in nursing? ›

Nurses have an obligation not to inflict harm and not to allow others to inflict harm. They must also promote good actions on behalf of their patients. Examples of nonmaleficence are always being truthful to patients and never allowing one patient to be harmed for the benefit of another.

What are some examples of ethical dilemmas in the workplace? ›

False accounting, sexual harassment, data privacy, nepotism, discrimination—these are just some of the ethical dilemmas that happen in today's workplace. Many business owners and managers will deal with ethical issues at some point in their career.

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