essay on ethical dilemma in nursing

Common Ethical Dilemmas in Nursing and their Solutions

Healthcare professionals, including nurses, face ethical dilemmas fairly regularly. Most of the dilemmas are usually serious and very stressful because when faced with a dilemma, a nurse must make a decision, which is easier said than done.

As a nursing student, you might be assigned to write an essay where you identify, analyze, and resolve an ethical dilemma. We have noticed over the years that many students struggle with writing an ethical dilemma nursing essay. If that sounds like you, read this post that comprehensively explores ethical dilemmas in nursing, including their examples and solutions.

In most cases, essays about ethical dilemmas in nursing take the reflective essay approach, where you reflect on real, researched, or imagined clinical scenario or encounter. It could be during your placement, clinical rotations, or shadowing experiences. As you do so, you will borrow from various ethical theories and decision-making models.

If you could use some help, our experienced online nursing essay writers can help you get a bespoke ethical dilemma essay at an affordable fee.

Let's get started with the basics to more advanced concepts.

What is an Ethical Dilemma in Nursing?

An ethical dilemma is a scenario where it is not easy to decide one way or another. Nurses are faced with ethical dilemmas almost every day. They have to make serious and difficult decisions fairly regularly. The decisions can sometimes mean life or death. Therefore, as a student nurse, it is vital to learn about ethical dilemmas nurses face, how to identify them, and how to solve them correctly.

When facing an ethical dilemma, you should always follow the nursing code of ethics . This is because most dilemmas can be solved by following the nursing code of ethics. The nursing code of ethics is a bunch of rules nurses has to follow to provide quality, safe, and unquestionable care to those who need it.

While most dilemmas can be solved by following the code of ethics in nursing, some dilemmas cannot be solved in this manner. The reason is that the nursing code does not guide every ethical dilemma or situation.

If faced with a situation that makes it difficult for you to follow the nursing code of ethics, you should use your judgment to weigh the pros and cons of both decisions to make the right decision.

Examples of ethical dilemmas nurses face regularly include: how to deal with a non-compliant patient, how to deal with a patient that is refusing treatment, and whether to disclose confidential information to help a patient.

Ethical Dilemma Versus Moral Dilemma

The terms ethical and moral are often used interchangeably in speech. However, the two terms do not always mean the same thing. For example, there is a slight difference between ethical and moral dilemmas.

An ethical dilemma involves two morally correct choices, but one is slightly more ethically problematic than the other. In contrast, a moral dilemma is a situation with two morally correct choices, but neither is preferable. For the moral dilemmas, the nurses know the right action yet might be limited to acting by forces outside their control.

As a nurse, you are more likely to face ethical dilemmas than moral dilemmas. Because ethical dilemmas are anticipated, a code of conduct has been created to help you always make the right decision.

Reasons Nurses Face Ethical Dilemmas in Healthcare

There are many reasons why nurses face ethical dilemmas frequently when providing care to patients. The following are the eight main ones:

• Inadequate staffing. When a healthcare facility has fewer staff than it needs to function optimally, nurses sometimes must make a tough decision. They have to decide whether to work longer to care for patients or to prioritize their mental and physical health and work only as much as possible.
• Incompetent peers. As a registered nurse, you will have a big dilemma if you notice a colleague showing incompetence. You will have to choose one of two options – to ignore your colleague's incompetence because they are a friend and they probably will not do it again, or report your colleague to a supervisor to ensure high standards are maintained. This is an ethical dilemma since the former is more ethically problematic than the latter.
• Religious/cultural beliefs. Your religious or cultural beliefs may present an ethical dilemma as a practicing nurse. For instance, you might be given a nursing assignment that contradicts your religious beliefs, e.g., you are asked to clean up the private parts of a male patient after a procedure as a Muslim female nurse (this is forbidden according to Islam). It is easy to see how this situation would present an ethical dilemma.
• Patient refusing treatment. There are occasionally situations when patients refuse treatment. As a nurse, you know what is best for the patient. However, you also know that they have the right to make their own decision. So when a patient refuses treatment, this will always present you with an ethical dilemma – do you insist and look for ways to ensure they get the treatment or grant them their wish?
• Artificial nutrition and hydration. Some patients and older adults do not want to be fed or hydrated using a tube. This presents a huge ethical dilemma for nurses. This is because nurses are trained to care for people who need it. Therefore, they feel bad about it when they see the need to provide artificial nutrition and hydration and get stopped because of a patient's wishes. They feel so bad because they know there is something they can do, yet they are asked not to do it.
• Providing futile care. Being asked by a patient's family to continue providing care despite a patient's continued decline is one of the biggest ethical dilemmas nurses face. This is especially true for critical care nurses. Being trained medical staff, they can see when it is not in a patient's best interest to continue receiving aggressive interventions. However, most of the time, patient families don't want to give up on their loved ones. Therefore, they insist that interventions continue presenting nurses with a big ethical dilemma.
• Opioid crisis. The opioid crisis across the United States presents nurses with several ethical dilemmas. For example, many nurses do not want to give patients opioid pain medications, especially when they believe they risk getting addicted. Now imagine knowing that a patient can benefit from a medication yet at the same time feeling like it could lead to them getting addicted to it
• Anti-vaccine stance. Nurses who do not mind vaccines face a dilemma whenever they interact with those against vaccines. This is because, on the one hand, they know they have to provide care to everyone without discrimination. Yet, on the other hand, they know that people against vaccines pose a serious public health hazard.

Identifying Ethical Dilemmas in Nursing

As evident in the section above, ethical dilemmas can arise virtually anywhere in the nursing world. It is up to you as a nurse to identify dilemmas when they arise and deal with them as expected by the ANA code of conduct. In this section, we are going to focus on how to identify ethical dilemmas in nursing.

Here are the main indicators of ethical dilemmas in nursing.

• Harm potential. When you face a healthcare situation that has the potential to impact a patient negatively, you are most likely facing an ethical dilemma. If it were so easy to spare the patient from the negative impact, the situation wouldn't be a dilemma because this is the option you would take.
• Conflict of interests. When you face a healthcare situation with a conflict of interests between you and the patient or you and the case management team, it is likely an ethical dilemma.
• Uncertainty. This is perhaps one of the biggest indicators of ethical dilemmas and dilemmas. When you face a healthcare situation in which you are unsure what to decide, you are most likely facing an ethical dilemma. Nurses are trained to judge situations and make decisions quickly. When you cannot do these things as a nurse, something is holding you back, and the situation is likely a dilemma.
• Cautiousness. When you face a healthcare situation in which you are cautious about the outcome of the options you can take, you are most likely facing an ethical dilemma. People are cautious when making ethical dilemma decisions because they do not want to see negative consequences (if any) caused by their decision(s).
• Delay. When you have a decision to make at work and keep delaying the decision-making, you are most likely facing an ethical dilemma. People delay making ethical dilemma decisions because they fear the consequences.

Principles of Nursing Ethics

Principles of nursing ethics were formulated to help nurses consistently make the right decisions when faced with ethical situations. There are many principles of nursing ethics, but the main ones are non-maleficence, beneficence, autonomy, and justice. These are the ones that are always integrated into nursing training programs to help nurses make the right decisions whenever they are faced with difficult situations.

1. Nonmaleficence

Nonmaleficence is probably the most well-known ethical principle in the healthcare world. It applies to nurses, doctors, and other medical professionals.

This principle teaches nurses that it is their responsibility to provide care, treatment options, and/or case management in a manner that does not harm the patient. When you internalize this principle as a nurse, you will always choose to provide care and treat patients safely.

Non-maleficence is an important part of providing patients with safe and quality care. Exercising this principle means doing everything possible as a nurse to provide care while ensuring the highest degree of patient safety.

An excellent example of non-maleficence in nursing practice is withholding the administration of a powerful medication until you get confirmation on whether a patient is allergic to it or not. Another example of maleficence in nursing practice is discontinuing medication when you notice signs of adverse reactions.

When a nurse lacks this principle, it can result in dire consequences for patients. More specifically, a lack of nonmaleficence can lead to reduced patient safety. And, of course, this can mean patient injury or even death. Patient injury or death resulting from lack of nonmaleficence can cause mental trauma, job loss, and even legal consequences.

Therefore, it is imperative to internalize and adhere to this nursing principle.

2. Beneficence

Beneficence is another important nursing principle. This principle is characterized by charity and kindness. It is basically all about ensuring your actions are guided by compassion and maximum consideration of the welfare of those you serve.

While some people choose to pursue nursing for the money or job security, most people in nursing are in it out of their love for serving others. Therefore, this beneficence principle is almost always naturally ingrained in the minds of most nurses.

The best way to apply this nursing ethical principle is to always act in the patient's best interest regardless of the circumstances. Practicing this principle regularly will ensure the patient is always cared for in the best way possible. You will also automatically improve positive patient outcomes.

An excellent example of beneficence in nursing practice is offering to sit with a patient to console them after giving them bad news about their situation. Another superb example of beneficence is drawing curtains to protect a patient's and his family's privacy when exchanging final goodbyes.

Lack of beneficence can result in poor nurse-patient relationships and reduced patient safety. When a patient realizes you are not kind or acting in their best interest, they will not be very interested in showing you kindness or respect. This can result in poor nurse-patient relationships and adverse patient outcomes.

As mentioned above, a lack of beneficence can also lead to reduced patient safety. When you don't act in the patient's best interest, it can lead to safety issues such as failure to record vital info, failure to use protective measures when providing care, and medication errors.

It is easy to see how following this principle can make it easier for nurses to provide quality care and make more ethical decisions.

3. Autonomy

Autonomy is a fundamental nursing ethical principle. It recognizes the right of the patient to make their own decisions. Nurses must never forget this right to avoid imposing their will or self-interest on the patient. 

Of course, there is a right way to recognize patients' independence and ability to make their own decisions. This right way involves offering the patient all the necessary information to make the best decisions. This information includes available treatment options and the pros and cons of each option.

Once a nurse has offered a patient all the correct information, they have to respect whatever decisions the patient makes, even if they disagree.

Autonomy is essential in nursing practice because it helps nurses adhere to the patient's wishes. It is also important because it passes responsibility for some major care decisions to the patient they will affect the most.

A good example of autonomy is when a nurse agrees to respect a patient's choice not to get treatment, even if they believe the treatment benefits the patient. Another excellent example of autonomy is a nurse respecting a patient's wish to be seen or attended to by a nurse of the same sex for religious reasons.

When a nurse doesn't practice this ethical principle, they can make decisions that make patients feel disrespected. They can also make decisions that can lead to a breakdown of the nurse-patient relationship. Thus, it is always essential to have this ethical principle in mind.

Justice is a fundamental ethical principle. It is all about nurses showing fairness in the way they provide care. Nurses must provide quality care to patients regardless of their appearance, age, financial history, religious preference, race, and gender.

Even when faced with a situation that involves healthcare for a convicted murderer or any other criminal, a nurse must still offer the best care they can provide.

This nursing ethical principle is crucial because it ensures fairness and equity in nursing. In other words, it provides patients care regardless of who they are. This usually has the effect of making patients feel valued. This, in turn, usually has the effect of enhancing patient outcomes.

A good example of justice in nursing practice is providing care to a known anti-vaccine campaigner when they get COVID or any other vaccine-preventable illness. This is justice and fairness because it allows the person to become well again without considering the negative influence of vaccine use.

A nurse lacking this ethical principle can act in ways that make a patient feel rejected, leading to adverse patient outcomes. It can also lead to unfair prioritization in care provision, resulting in dire consequences for the patient.

By following the nursing ethical principles discussed above and adhering to the ANA code of conduct, you can handle different ethical dilemmas correctly and without serious negative consequences.

Examples of Ethical Dilemmas in Healthcare

Understanding some ethical dilemma scenarios you can write an essay about as a nursing student is essential. Remember, there is never a right or wrong answer; in the same way, there is no small or big ethical issue. As long as it impacts healthcare, it falls within nursing practice or medical ethics.

The following are some of the most common ethical dilemmas in nursing.

1. Pro-choice versus pro-life.

The pro-choice versus pro-life dilemma is common in nursing. For example, when a patient wishes to have an abortion because they do not want a baby, yet a nurse is pro-life because of religious beliefs, it becomes a big dilemma.

SOLUTION : Respect the wishes of the patient.

2. Religious beliefs versus science.

This dilemma is common in nursing practice. For example, it can occur when a patient refuses a specific procedure or treatment because of religious beliefs, yet a nurse knows what science says is best in the situation.

SOLUTION : Respect patient autonomy and do as they wish.

3. Beneficence versus autonomy.

As a nurse, you must practice beneficence (kindness and charity). You are also required to respect the patient's autonomy. Now imagine you have been ordered to give a patient medication to ease pain and suffering, yet they insist on not taking it to stay awake and spend their last minutes with their loved ones. This presents a great beneficence vs. autonomy dilemma.

SOLUTION : Obey the patient's wishes as long as they are conscious and can make their own decisions

4. Anti-vaccine stance.

As a nurse, you must follow exactly what the guardian wants for a child unless it is required by law to do otherwise. Now imagine a situation where a parent refuses to let their child get vaccinated, yet you know at the back of your mind that vaccines benefit children. You know what you must do, yet a guardian insists you must not do it. This is a significant ethical dilemma.

SOLUTION : Obey the guardian's wishes for their child.

5. Withholding information versus being honest.

Nurses are ethically expected to be open and transparent with patients. However, there are cases when you may feel as a nurse that explaining the gravity of a situation to a patient will worsen their stress and anxiety. You may, therefore, think it is more appropriate to withhold some information from them. This presents a big dilemma.

SOLUTION: Always be honest, especially when the situation is complex. Patients deserve to know the truth.

6. Limited resources versus healthcare needs.

Nurses occasionally face situations where their resources are not optimal for the people they serve. Remember the COVID-ventilator issue? Doctors and nurses had to decide whom to give ventilators initially at the start of the pandemic when there were not enough ventilators.

SOLUTION: When the resources are limited, choosing patients based on severity is recommended.

7. Questionable orders.

Doctors and other medical professionals are not perfect. They make mistakes from time to time. Therefore, you will have a big dilemma when a doctor prescribes treatment, and you feel it is not the best treatment in the back of your mind. Do you fulfill the doctor's order or intercede and question it?

SOLUTION: When you feel something wrong is about to happen, you should speak up to protect the patient's interest.

How to Address Ethical Dilemmas in Nursing

The best way to address ethical dilemmas is to internalize and follow the nursing ethical principles and the ANA code of conduct. However, not everyone constantly has the time and energy to review nursing ethical principles and the ANA code of conduct.

For this reason, we have shared the tips below to help you correctly address ethical dilemmas in nursing.

1. A Problem Shared Is a Problem Halved

When you feel uneasy about an ethical situation, you should share it with a trusted colleague or a supervisor. Communicating the problem with someone else invites a fresh perspective to the problem and increases the likelihood of arriving at a better decision.

2. Internalize Patient Autonomy

Remembering and recognizing patient autonomy or the right to make their own decisions is always important. It doesn't matter what you think is best for a patient – what they want is what you should do as long as it is legal and within your nursing responsibilities. Of course, you should present the patient with all the information they need to decide. So if you ever have to grapple with an ethical situation that makes you feel like ignoring patient autonomy, you shouldn't do it. You should choose the option that ensures patient autonomy.

3. Respect the Right to Privacy

Every patient has a right to privacy. This means you should treat their information as confidential and only to be shared with them or with persons they approve. It is not in your place to share patient information, especially when it is sensitive. You can only share info when given consent. Therefore, if you ever have a dilemma about sharing information, remember to respect the right to privacy and ask for consent to share info if you think it is necessary.

4. Transparency is Key

You should always be open and honest with patients. Doing this will help you to avoid many ethical situations. It will also make it easy for you to make ethical decisions. Therefore, whenever necessary, please share all the information you can share with patients to help them understand what is happening. Share with them the pros and cons of every treatment or management option. Let them be fully aware of the benefits and risks of everything.

5. Ask Yourself What Is in The Best Interest of the Patient

Whenever you need to make an ethical decision, in addition to all your other considerations, you should ask yourself what is in the patient's best interest. Asking yourself this question will help you act in a way that ensures the patient's best interests are taken into account. It will also force you to involve the patient in decision-making to know what they want or wish for. You can never go wrong by acting in a patient's best interest.

6. Stay Up-To-Date with Ethical Guidelines

Ethical guidelines change regularly. Therefore, to ensure you are always making the right ethical decisions, you should stay up to date with ethical guidelines (both professional guidelines and institution-specific guidelines). It is not always easy to do this, but you can subscribe to nursing blogs that discuss ethical guidelines. This will ensure you always have the latest information you need to make good ethical decisions. You can also stay up to date by enrolling in at least one online ethical nursing training program or course. This will help you to refresh your ethical principles knowledge and to be aware of the latest ethical issues in nursing.

7. Always Do Something as Soon as You Can

When faced with an ethical situation, never do anything and hope the situation will resolve itself. Always do something as soon as possible. This will ensure either the issue is solved or starts getting solved. When you ignore an ethical situation, it has the risk of snowballing and becoming a much bigger issue down the line. Therefore, please do something about an issue whenever you can do it quickly.

8. Negotiating Never Hurts Anybody

One of the best things you can do when facing a nursing ethical dilemma is to negotiate with the parties involved. When you do this respectfully and fairly, you can easily resolve most ethical situations. For example, if a patient refuses a specific treatment for religious reasons, you can convince them to accept it using various persuasion techniques. Of course, you should respect the patient's decision if they insist on a certain stance or position.

9. Talk to Somebody Higher Up

As a nurse, some ethical decisions are not yours; they are above your pay grade. In such a case, they should be referred to somebody higher up, e.g., the nurse manager or the nurse supervisor. Because the manager or supervisor is usually more experienced, they are often in a much better position to handle ethical decisions and teach you what to do when faced with the same situation again.

Consequences of Failing to Address Ethical Dilemmas in Nursing Properly

When you fail to address ethical dilemmas in nursing correctly, there are often negative consequences. The most common negative consequences nurses have to deal with include the following:

1. Loss of License

When you are faced with an ethical decision, you must make sure you act in the way expected of you according to the nursing code of conduct. Failure to act in the manner that is expected of you in the nursing code of conduct can lead to loss of licensure. This is especially true when your decision in an ethical situation is an egregious violation of the nursing code of conduct or the ethical principles of nursing. Therefore, when faced with an ethical decision, it is best to consider the options carefully and to act in the way that is expected of you.

2. Legal Issues

You could face legal issues when you fail to adequately address certain ethical dilemmas in nursing. As a nurse, you have specific responsibilities. You are also expected to adhere to the nursing code of conduct. If you fail to address ethical issues correctly, e.g., you leak confidential information about a celebrity patient for money to the public, you could face legal issues, including a lawsuit and/or criminal charges. Hence it is crucial to think long and hard about some ethical issues before deciding what to do.

3. Job Suspension or Termination

Most hospitals have a code of conduct that nurses and other healthcare professionals must sign when hired. They expect nurses to follow the code to the letter. Most hospitals also expect nurses to follow the ANA code of conduct and to always adhere to the ethical principles of nursing. So when faced with an ethical situation and failing to act correctly, you could end up before the ethics committee of your hospital, and they could recommend your suspension or the termination of your job contract.

4. Stress and Burnout

Ethical situations can cause a lot of stress and mental burnout. They can make it almost impossible for you to continue operating normally. When you ignore them or make the wrong decision, you can potentially make them worse. This can lead to even more stress and even physical burnout. Consequently, it is important to make the right decisions quickly when faced with ethical problems or issues.

5. Negative Patient Outcomes

The worse thing that could happen if you don't address ethical issues correctly is an adverse patient outcome, such as patient deterioration, patient injury, or death. It is always painful for nurses to realize or discover that their decisions caused an adverse patient outcome. It can lead to stress, loss of self-confidence, and so on. Of course, an adverse patient outcome can also lead to legal issues, job suspension, and job loss. So it is best to make the correct decision whenever faced with an ethical dilemma.

Takeaway about Ethical Dilemmas in Nursing Practice

Nursing training is all-rounded in anticipation of all the issues a trained nurse would experience in typical clinical settings. Learning about ethical dilemmas and how to solve them can be a stepping stone toward excellence as a nurse or medical/healthcare practitioner. You will be dealing with many ethical dilemmas in the workplace and an experience on how to solve them can always help you avert adverse situations.

Related Readings:

• List of hot controversial topics for nursing issue papers

If you have an ethical dilemma assignment, paper, essay, or coursework troubling you, you should hire a nursing writer from NurseMyGrade to help you. We are a team of professional nursing writers offering assignment help and coursework help for busy nursing students and nurses worldwide.

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10 Examples of Ethical Dilemmas in Nursing

When caring for human lives, the decisions you have to make as a nurse are anything but black and white. In addition to taking vital signs and doing dressing changes, there are a realm of tough choices and ethical dilemmas that nurses have to face every day.

Picture this: a nurse finds himself torn between respecting a patient's right to refuse treatment and their deteriorating health. Moral puzzles like these leave even the most experienced nurses scratching their heads and feeling caught between a rock and a hard place. However, understanding how to handle ethical dilemmas isn't just a theoretical exercise. It's a crucial skill that nurses need to have in their toolkits. 

The nursing code of ethics acts as a guide for nurses to help in these decisions, but it can be helpful to see actual examples of ethical dilemmas in nursing and what a nurse should do with each of them. That’s exactly what this article is about. 

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10 common ethical dilemmas in nursing .

While there are many different situations in which a nurse may find themselves dealing with an ethical dilemma, here are 10 common ethical dilemmas in nursing to consider and how a nurse might deal with them:

1. Patient Autonomy vs. Beneficence

Balancing a patient's right to make decisions about their own care with the nurse's duty to promote their overall well-being.

Let's say a patient diagnosed with diabetes refuses to take insulin, despite it being essential for controlling their blood sugar levels and preventing serious complications. 

In dealing with this situation, a nurse should follow the nursing code of ethics and take the following steps:

Respect Autonomy: Respect the patient's right to make decisions about their own care, even if they disagree with those decisions. 

Provide Information: Ensure the patient has accurate and comprehensive information about the treatment, including its benefits, risks, and alternatives. This allows the patient to make an informed decision.

Assess Understanding: Engage the patient in open and non-judgmental communication to assess their understanding of the treatment and the potential consequences of refusing it. 

Collaborative Decision-Making: Engage the patient in collaborative decision-making. Involve them in discussions and explore alternatives that align with their values and preferences. This approach fosters a sense of working together and mutual respect.

Seek Additional Perspectives: If the patient's decision still conflicts with the nurse's professional judgment and poses a significant risk to the patient's health, the nurse should seek guidance from the healthcare team and the nurse manager or supervisor they report to.

Document the Process: Throughout the decision-making process, carefully document all discussions, assessments, and the patient's decisions. This documentation serves as evidence that the nurse has fulfilled their ethical and professional responsibilities.

>> Related: What is Autonomy in Nursing?

2. Confidentiality vs. Duty to Warn 

Struggling with maintaining patient confidentiality while also considering the potential harm to others if vital information is not shared.

Imagine a scenario where a nurse working in a mental health facility becomes aware that a patient with a history of violent behavior has confided in the nurse about their plan to cause harm to their former partner. 

The nurse finds themselves in a challenging ethical dilemma: on one hand, they have a duty to maintain the confidentiality of the patient's personal information, and on the other hand, they have an obligation to protect other people from harm.

To deal with this situation, the nurse should take the following steps:

Evaluate the Severity of the Threat: Carefully assess the level of risk involved in the patient's intentions. Is there an immediate and credible threat to the safety of the potential victim? Consider factors such as the patient's history, current mental state, and access to means for carrying out the harm.

Engage in a Therapeutic Relationship: Explore the underlying issues and reasons behind the patient's harmful intentions. Attempt to address any underlying issues or triggers that may contribute to their behavior and encourage them to seek alternative ways to cope.

Seek Supervision and Consultation: It’s important for the nurse to consult with their supervisor or team members about the appropriate course of action to ensure the safety of the potential victim.

Follow Legal and Ethical Guidelines: Be aware of local laws and regulations regarding the duty to warn or protect. If there is a legal obligation to disclose information in order to prevent harm, the nurse should adhere to those requirements while minimizing the breach of confidentiality to the extent possible.

Document the Process: Document all steps taken, including the patient's disclosure, assessments, consultations, and decisions made. This documentation serves as evidence that the nurse acted ethically, responsibly, and in line with professional standards.

3. End-of-Life Care

Managing the ethical complexities around decisions about withdrawing or withholding life-sustaining treatment, considering the patient's wishes, quality of life, and family dynamics.

For example, consider the situation where a nurse is caring for an elderly patient with a terminal illness. The patient expresses the desire to die a peaceful death without aggressive interventions. However, the patient’s family opposes this and wants “everything medically possible” to be done to save the patient’s life. 

The nurse finds themselves in a complex ethical dilemma, torn between honoring the patient's wishes and respecting the concerns of the family.

Here’s how the nurse might address this situation:

Communication and Education: Engage in open and compassionate communication with both the patient and the family about the patient's medical condition. Discuss the patient’s prognosis, available treatment options, and the potential benefits and downsides of continuing or discontinuing life-sustaining measures. 

Respect for Autonomy: Advocate for the patient's right to self-determination and respect their wishes regarding end-of-life care.

Collaboration and Mediation: Facilitate a respectful and open dialogue, promoting a collaborative decision-making process. The nurse can involve the healthcare team, including palliative care specialists and social workers, to provide support, guidance, and mediation to resolve this situation.

Consider Ethical Decision-Making Frameworks: The nurse should use ethical principles in the nursing code of ethics, such as beneficence, non-maleficence, autonomy, and justice, to analyze the situation and guide their actions. By considering the patient's values, goals, and potential impact on their quality of life, the nurse can advocate for the most ethically appropriate course of action.

Supportive Care: Regardless of the final decision made, the nurse should provide holistic and supportive care to the patient and their family. This includes addressing physical, emotional, and spiritual needs, ensuring optimal comfort, and facilitating open communication to foster a sense of trust and understanding.

4. Resource Allocation

Facing the difficult task of distributing limited resources fairly and ethically among patients, especially during times of scarcity or emergencies.

Consider this scenario: During a severe flu outbreak, a nurse working in a hospital emergency department faces the ethical dilemma of resource allocation. The hospital is overwhelmed with patients and the available resources, such as beds, ventilators, and medications are limited. The nurse must make decisions about which patients receive the resources, balancing the needs of the patients in their care while also considering the needs of other patients in the hospital.

The nurse should manage this situation with fairness and transparency, using the following steps:

Prioritization and Triage: Follow established guidelines and protocols for triaging patients based on the severity of their condition and their likelihood of benefiting from the available resources. This ensures that decisions are made based on clinical needs rather than personal biases.

Open Communication: Maintain open and transparent communication with patients and their families. Explain the challenges faced due to limited resources and the criteria being used for resource allocation. This promotes understanding and trust, even in difficult circumstances.

Collaboration and Consultation: Work collaboratively with the healthcare team, including physicians and hospital administrators, to make informed decisions about resource allocation. Seeking input from multiple perspectives helps ensure fairness and accountability.

Consider Ethical Decision-Making Frameworks: Use the ethical principles of fairness and justice in the nursing code of ethics to guide the nurse’s actions. By considering factors like the potential benefits, risks, and overall impact on patients and the community, the nurse can strive to allocate resources in an equitable and ethical manner.

Advocacy and Support: Advocate for the well-being and rights of their patients, even when difficult decisions must be made. 

5. Informed Consent

Ensuring patients have a clear understanding of the risks, benefits, and alternatives of proposed treatments or procedures before they provide consent.

Here’s an example of how this ethical dilemma could occur: A nurse assists a physician who is rushing to obtain informed consent for a surgical procedure, despite the patient's pain and anxiety. However, the nurse quickly recognizes the patient's limited understanding of the procedure’s implications, raising ethical dilemmas regarding informed consent.

To handle this situation, the nurse should follow these steps:

Ensure Adequate Information: Intervene respectfully but assertively and ask the physician to slow down and provide the patient with complete information about the procedure, risks, benefits, potential outcomes, and available alternatives. 

Clarify Patient Understanding: Speak with the patient and assess their understanding of the information provided. Encourage the patient to ask questions and address any concerns they may have. 

Advocate for Time and Support: If the patient appears overwhelmed or is struggling to comprehend the information, the nurse should advocate for additional time or resources, such as involving a family member or providing educational materials or an interpreter (if appropriate) to support the patient in making an informed decision. 

Document the Process: Document the steps taken to address the concerns related to informed consent. Be sure to include any discussions, explanations provided, patients' questions, and their ultimate decision. Accurate documentation demonstrates the nurse's commitment to upholding ethical standards and professional accountability.

6. Cultural and Religious Beliefs

Navigating conflicts between a patient's cultural or religious values and the standard practices or protocols of healthcare.

In a multicultural society, nurses often encounter ethical dilemmas when a patient's cultural or religious beliefs clash with the standard practices or protocols of healthcare. An example is when a nurse is caring for a patient from a cultural background who strongly believes in traditional healing methods and is hesitant to accept Western medicine.

In this situation, the nurse should have a culturally sensitive discussion with the patient and demonstrate respect for diversity. Here are the steps the nurse should take:

Culturally Competent Assessment: Conduct a culturally competent assessment to understand the patient's cultural and religious beliefs, values, and preferences regarding healthcare. This requires active listening, open-mindedness, and avoiding assumptions or stereotypes.

Establish Trust and Rapport: Build a trusting relationship with the patient by acknowledging and respecting their cultural and religious beliefs. This can be achieved through effective communication, empathy, and demonstrating cultural humility.

Collaborative Decision-Making: Engage the patient and their family in collaborative decision-making regarding their healthcare. Respectfully discuss the patient's beliefs and preferences, and explore opportunities to integrate traditional healing practices with evidence-based Western medicine. 

Consultation and Education: If there are concerns about the patient's well-being or the appropriateness of certain traditional healing methods, the nurse should seek guidance from a cultural consultant, interpreter, or healthcare team. 

Advocacy and Liaison: Serve as an advocate for the patient, ensuring their cultural and religious rights are respected within the healthcare system. This may involve facilitating communication between the patient and healthcare providers, ensuring the provision of culturally competent care, and addressing any cultural or religious barriers that may arise.

7. Impaired Colleague

Grappling with the ethical responsibility of reporting concerns about a colleague's impairment due to substance abuse or mental health issues.

This situation might occur when a nurse becomes aware that a nursing colleague is impaired while on duty. The impaired nurse exhibits erratic behavior and smells strongly of alcohol. The nurse who witnesses this behavior finds themselves in a challenging ethical dilemma, torn between their duty to ensure patient safety and their loyalty to their colleague.

Nevertheless, the nurse needs to prioritize patient safety and act professionally by following these steps:

Immediate Concern for Patient Safety: The nurse's primary responsibility is to ensure the safety and well-being of patients. If they observe signs of impairment in their colleague that could compromise patient safety, they should take immediate action.

Reporting: The nurse should report their observations and concerns to the appropriate authority within the healthcare facility, such as the nurse manager or supervisor. This report should be made objectively without personal judgments or assumptions and with a focus on patient safety.

Confidentiality and Professionalism: Maintain confidentiality throughout the reporting process, being mindful not to disclose personal details of the impaired colleague unless necessary for the investigation.

Collaboration and Support: Collaborate with the healthcare team and support the impaired colleague's well-being by encouraging them to seek appropriate help and support, such as employee assistance programs or counseling services. 

Ethical Obligation: Nurses have an ethical obligation to protect the welfare of patients and maintain the standards of the nursing profession. This includes recognizing and addressing impairment issues among colleagues to ensure safe and quality care.

8. Professional Boundaries

Striking a balance between providing compassionate care and maintaining appropriate professional boundaries, particularly when it comes to personal relationships with patients.

In this example, let’s look at a scenario where a nurse develops a close friendship with a patient and begins sharing too many personal details about their own life unrelated to the patient’s healthcare needs.

When the nurse realizes what’s happening, they need to prioritize maintaining professional boundaries and act in the best interest of the patient by following these steps:

Recognize the Boundary Issue: Use personal reflection to recognize when professional boundaries are being crossed or compromised. Acknowledging this ethical dilemma is the first step toward resolving it.

Reflect on the Nurse-Patient Relationship: The nurse should remind themselves of their professional role, the duty of care, and the need to maintain objectivity and professional distance.

Reestablish Boundaries: Take appropriate actions to reestablish and reinforce professional boundaries with the patient. This may involve redirecting conversations back to the patient's healthcare needs, avoiding personal disclosures, and focusing on the patient's well-being.

Seek Guidance and Supervision: If the situation becomes challenging to resolve alone, the nurse should seek help from a supervisor, nurse manager, or experienced nursing team member. Consulting with experienced professionals can provide valuable insights and support in addressing this ethical dilemma.

Continuous Professional Development: Engage in ongoing professional development and education regarding nursing ethics and setting professional boundaries. Staying current on ethical guidelines and participating in discussions and training on maintaining professional boundaries can help prevent future boundary issues with patients.

9. Whistleblowing

Facing the ethical dilemma of reporting concerns about wrongdoing or unethical practices within the healthcare system, despite potential professional and personal repercussions.

An example of whistleblowing would be when a nurse becomes aware that a colleague is stealing controlled substances from the medication supply. The nurse decides to report this to their supervisor because it compromises patient safety and violates professional and legal standards. However, the nurse is worried about their colleague being disciplined and possibly losing their license.

Here are the steps the nurse should follow:

Gather Evidence: Collect factual evidence such as documentation discrepancies in medication records, witnessing the colleague's actions, or capturing any other supporting documentation. 

Consult with Colleagues: Seek advice from trusted colleagues, supervisors, or mentors within the healthcare organization. Discuss the situation and determine the best course of action. It’s important to maintain confidentiality during these discussions to protect both the patient and the nurse making the report.

Follow the Proper Chain of Command: Follow the established reporting channels within their healthcare organization. This typically involves reporting concerns to a supervisor, nurse manager, or a designated ethics or compliance hotline. Ensure that the report is made in writing and contains all relevant details and evidence.

Protection and Confidentiality: Be familiar with the whistleblower protection policies and laws in their jurisdiction. The nurse should ensure that their report is treated confidentially and that appropriate steps are taken to protect them from retaliation.

Documentation: Keep a detailed record of all actions taken, including the date and time of the incident, any conversations or consultations, and copies of the report submitted. This documentation helps demonstrate the nurse's commitment to reporting and acting in accordance with professional and ethical standards.

10. Ethical Use of Technology

Considering the ethical implications of using technology in healthcare, such as maintaining patient privacy and security, avoiding biases in algorithms, and ensuring equitable access to care.

An example of this ethical dilemma could occur when a nurse becomes concerned about potential biases in an algorithm and decides to report this to her supervisor. She recognizes that an algorithm where she works may disproportionately allocate resources based on patient factors such as age, race, and gender, resulting in inequitable access to care.

The nurse should advocate for equitable care by taking these steps:

Investigate and Evaluate: Become familiar with the AI algorithm being used and investigate its development process. Assess whether the algorithm has been validated and tested for biases and fairness. 

Raise Concerns: If the nurse identifies biases or inequities in the algorithm, they should communicate their concerns to the appropriate individuals, such as nurse leaders, healthcare administrators, or the technology implementation team. 

Collaborate for Improvement: Engage in collaborative discussions with the healthcare team, including the nursing supervisor, IT specialists, and data scientists. Work with the team to develop strategies to eliminate biases and ensure equitable use of the technology for all patients.

Promote Patient Advocacy: Advocate for the rights and well-being of the patients who may be affected by the technology. This involves ensuring informed consent and transparency regarding the use of AI algorithms. Patients should have the opportunity to understand and discuss the potential biases and their impact on their care.

Continuous Evaluation: Advocate for ongoing evaluation and monitoring of all AI technology being used in patient care to identify and resolve biases or unintended consequences. 

Ethical dilemmas are common in nursing and can be difficult to deal with. But you don’t have to make the decisions about these issues alone. Seek out the support and input of your nursing colleagues, supervisor, or nurse manager. By doing so, you will feel more comfortable and confident about how to handle the ethical dilemma you find yourself in.

*This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease.

Leona Werezak BSN, MN, RN is the Director of Business Development at NCLEX Education. She began her nursing career in a small rural hospital in northern Canada where she worked as a new staff nurse doing everything from helping deliver babies to medevacing critically ill patients. Learning much from her patients and colleagues at the bedside for 15 years, she also taught in baccalaureate nursing programs for almost 20 years as a nursing adjunct faculty member (yes! Some of those years she did both!). As a freelance writer online, she writes content for nursing schools and colleges, healthcare and medical businesses, as well as various nursing sites.

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20 Common Examples of Ethical Dilemmas in Nursing + How to Deal With Them

If you are a nurse, chances are you have faced situations where you had to make decisions based on your belief of whether something is right or wrong, safe or unsafe. This type of decision is based upon a system of ethical behavior. It is essential that all nurses develop and implement ethical values into nursing practice. If this sounds familiar, you may be asking, "What are the common examples of ethical dilemmas in nursing?" There are many things that could be considered an ethical dilemma in nursing, and it is important for nurses to know how to address them when they occur. In this article, I will share the 20 most common examples of ethical dilemmas in nursing and offer some insight into handling them.

What Is An Ethical Dilemma In Nursing?

5 main reasons why nurses face with ethical dilemmas in nursing.

1. Patients or their loved ones must make life or death decisions 2. The patient refuses treatment 3. Nursing assignments may contradict cultural or religious beliefs 4. Nursing peers demonstrate incompetence 5. Inadequate staffing

How To Identify Ethical Dilemmas In Nursing?

What are the common examples of ethical dilemmas in nursing, example #1: pro-life vs. pro-choice, ethical dilemma:, how to deal with this ethical dilemma:, example #2: protecting the adolescent’s right to privacy, example #3: empirical knowledge vs. religious beliefs, example #4: parent refuses to vaccinate child, example #5: personal and professional boundaries related to social media, example #6: nurse is instructed to have patient with low literacy level to sign consent for treatment, example #7: end-of-life decision-making, example #8: inadequate resources to provide care, example #9: former patients - to date or not to date, example #10: informed consent, example #11: inadequate staffing, example #12: spirituality vs. science, example #13: patient addicted to prescription pain medication, example #14: duty and compassion do not align with facility safety protocols, example #15: patient does not have an advanced directive, example #16: incompetence among nursing peers, example #17: disclosing the seriousness of medical conditions, example #18: questioning physician orders, example #19: asked to work in a department without training, example #20: beneficence vs. autonomy, 4 consequences of avoiding ethical dilemmas in nursing, 1. nurses can quickly experience burnout., 2. avoiding ethical dilemmas in nursing can lead to legal issues., 3. nurses who avoid ethical dilemmas could lose their jobs., 4. loss of licensure:, my final thoughts.

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Nursing ethical considerations.

Lisa M. Haddad ; Robin A. Geiger .

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Last Update: August 14, 2023 .

• Definition/Introduction

Ethical values are essential for any healthcare provider. Ethics comes from the Greek word “ethos,” meaning character. Ethical values are universal rules of conduct that provide a practical basis for identifying what kinds of actions, intentions, and motives are valued. [1]  Ethics are moral principles that govern how the person or a group will behave or conduct themselves. The focus pertains to the right and wrong of actions and encompasses the decision-making process of determining the ultimate consequences of those actions. [2]  Each person has their own set of personal ethics and morals. Ethics within healthcare are important because workers must recognize healthcare dilemmas, make good judgments and decisions based on their values while keeping within the laws that govern them. To practice competently with integrity, nurses, like all healthcare professionals, must have regulation and guidance within the profession. [3]  The American Nurses Association (ANA) has developed the Code of Ethics for this purpose.

• Issues of Concern

The onset of nursing ethics can be traced back to the late 19 century. At that time, it was thought that ethics involved virtues such as physician loyalty, high moral character, and obedience. [3]  Since that early time, the nursing profession has evolved, and nurses are now part of the healthcare team and are patient advocates. The first formal Code of Ethics to guide the nursing profession was developed in the 1950’s. Developed and published by the ANA, it guides nurses in their daily practice and sets primary goals and values for the profession. Its function is to provide a succinct statement of the ethical obligations and duties of every individual who enters the nursing profession. It provides a nonnegotiable ethical standard and is an expression of nursing’s own understanding of its commitment to society. The Code of Ethics has been revised over time. The current version represents advances in technology, societal changes, expansion of nursing practice into advanced practice roles, research, education, health policy, and administration, and builds and maintains healthy work environments. [3]

The Code of Ethics for Nurses is divided into nine provisions to guide the nurse. The following is a summary of the American Nurses Association Code of Ethics for Nurses: 

Provision 1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. 

The nurse must have a high level of respect for all individuals, and allow dignity in regards to dealings in care and communication. It's important that patient's families are also treated with respect for their relationship to the patient. Nurses must understand the professional guidelines in communications and work with colleagues and patient families. It's important to understand the proper professional relationship that should be maintained with families and patients. All individuals, whether patients or co-workers have the right to decide on their participation in care and work.

Provision 2. The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.

The patient should always be a first and primary concern. The nurse must recognize the need for the patient to include their individual thought into care practices. Any conflict of interest, whether belonging to external organizations, or the nurse's habits or ideals that conflict with the act of being a nurse, should be shared and addressed to not impact patient care. Collaboration with internal and external teams to foster best patient care is a necessity. Understanding professional boundaries and how they relate to patient care outcomes is important.

Provision 3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.

It is important for the nurse to understand all privacy guidelines with regards to patient care and patient identifiers. Nurses involved in research must understand all aspects of participation including informed consent and full disclosure to the patient of all aspects required to participate in the study. The nurse must understand any institutional standards set in place to review his/her performance; this includes measurements of progress and the need for further review or study to meet performance standards. To become a nurse, competence must be demonstrated in clinical and documentation prowess. Standards of competence will continue at institutions and academic organizations that employ the nurse. If there is witness or recognition of questionable healthcare practice, it is important that the patient is protected by reporting any misconduct or potential safety concern. And finally, the nurse will not provide patient care while under the influence of any substance that may impair thought or action, this includes prescription medication.

Provision 4 . The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to provide optimal patient care.

As a nurse, it's inherent that accountability for all aspects of care aligns with responsible decision making. Use of authority must be professional and about all aspects of individualism and patient, ethical concerns. Nursing decisions must be well thought, planned, and purposefully implemented responsibly. Any delegation of nursing activities or functions must be done with respect for the action and the ultimate results to occur. 

Provision 5 . The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.

A nurse must also demonstrate care for self as well as others. An ideal nurse, will have self-regard towards healthcare practices and uphold safe practice within the care setting and at home. It's important for a nurse to have a high regard for care as an overall inert ability once the profession is entered. A character becoming a nurse would include integrity. Nurses should be concerned for personal growth in regards to continued learning of the profession. The ability to grow as a nurse with improvements to care, changes or trends in care should be adapted to maintain competence and allow growth of the profession.

Provision 6. The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.

As a nursing profession, standards should be outlined within and external to institutions of work that dictate ethical obligations of care and need to report any deviations from appropriateness. It's important to understand safety, quality and environmental considerations that are conducive to best patient care outcomes.

Provision 7 . The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.

Nurse education should include principles of research, and each nurse should understand how to apply scholarly work and inquiry into practice standards. Nurse committees and board memberships are encouraged to contribute to health policy and professional standards. The ability to maintain professional practice standards should continue, changing and enhancing as developments in practice may over time.

Provision 8. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. 

Through collaboration within the discipline, maintaining the concept that health is a right for all individuals will open the channels of best practice possibilities. The nurse understands the obligation to continue to advance care possibilities by committing to constant learning and preparation. The ability of the nurse to practice in various healthcare settings may include unusual situations that require continued acts of diplomacy and advocacy.

Provision 9. The profession of nursing, collectively through its professional organization, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

Nurses must continue to gather for committees and organize groups where they may share and evaluate values for accuracy and continuation of the profession. It is within these organizations that nurses may join in strength to voice for social justice. There is a need for continued political awareness to maintain the integrity of the nursing profession. The ability of the nurse to contribute to health policy should be shared among the profession, joining nurses throughout the world for a unified voice.

American Nurses Association. (2015). Code of ethics with interpretative statements. Silver Spring, MD

• Clinical Significance

Ethical values are essential for all healthcare workers. Ethical practice is a foundation for nurses, who deal with ethical issues daily. Ethical dilemmas arise as nurses care for patients. These dilemmas may, at times, conflict with the Code of Ethics or with the nurse's ethical values. 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] . This is known as autonomy. A patient's need for autonomy may conflict with care guidelines or suggestions that nurses or other healthcare workers believe is best. A person has a right to refuse medications, treatment, surgery, or other medical interventions regardless of what benefit may come from it. If a patient chooses not to receive a treatment that could potentially provide a benefit, the nurse must respect that choice.

Healthcare workers have a duty to refrain from maltreatment, minimize harm, and promote good towards patients. [4]  This duty of particular treatment describing beneficence. Healthcare workers demonstrate this by providing a balance of benefits against risks to the patient. Assisting patients with tasks that they are unable to perform on their own, keeping side rails up for fall precautions, or providing medications in a quick and timely manner are all examples of beneficence.

All patients have a right to be treated fair and equally by others. Justice involves how people are treated when their interest competes with others. [5] . A current hot topic that addresses this is the lack of healthcare insurance for some. Another example is with patients in rural settings who may not have access to the same healthcare services that are offered in metropolitan areas.

Patients have a right to no harm. Non-maleficence requires that nurses avoid causing harm to patients. [6]  This principle is likely the most difficult to uphold. Where life support is stopped or patients have chosen to stop taking medication that can save their lives, the nurse is put in a morally challenging position.

Nurses should know the Code of Ethics within their profession and be aware and recognize their own integrity and moral character. Nurses should have a basic and clear understanding of key ethical principles. The nursing profession must remain true to patient care while advocating for patient rights to self-identify needs and cultural norms. Ethical considerations in nursing, though challenging, represent a true integration of the art of patient care.

Nurses have a responsibility to themselves, their profession, and their patients to maintain the highest ethical principals. Many organizations have ethics boards in place to review ethical concerns. Nurses at all levels of practice should be involved in ethics review in their targeted specialty area. It is important to advocate for patient care, patient rights, and ethical consideration of practice. Ethics inclusion should begin in nursing school and continue as long as the nurse is practicing.

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Disclosure: Lisa Haddad declares no relevant financial relationships with ineligible companies.

Disclosure: Robin Geiger declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

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Ethical Dilemmas in Nursing Practice

Introduction, the ethical dilemma, aspects of the dilemma, ethical decision-making model, application of the model in resolution of dilemma.

Nurses constantly face ethical dilemmas in the course of their duties, for they advocate for patients’ interest in spite of the imposing interests from doctors, relatives, and physicians. Usually, ethical dilemmas occur in nursing when ethical principles appear to contradict each other in that obeying one ethical principle will result into transgression of another ethical principle. According to Nasae, Suttharangsee, Ray, and Lynn (2008), ethical dilemmas in nursing emanate from contradiction of ethical principles such as beneficence and autonomy (p.471). Situations that cause ethical dilemmas are extraordinarily complex, and taxing to the mind because; either course of the decision seems immoral. The option that only remains in the instances of ethical dilemma is to consider other ethical factors while at the same time overlooking others. Resolution of ethical dilemmas requires a rigorous process of decision-making, which enables nurses to address ethical dilemmas for exclusive interests of patients, since they are patients’ advocates. Proper resolution of ethical dilemmas requires consideration of an ethical nature of actions and their consequences. To explore the resolution of ethical dilemmas, this essay examines an ethical dilemma and explains how bioethical model of decision-making is applicable in its resolution.

Given that nurses are advocates of patients, they must always ensure that decisions and actions that they make should be in tandem with ethical principles that guard the interest of patients and protect them against any harm. However, ethical dilemmas do arise that compels nurses to either act in beneficence and nonmaleficence or respecting autonomy of patients and act in veracity. Thus, since ethical dilemmas emanate from application of contradicting ethical principles in a certain scenario, a dilemma that involves a contradiction of varied ethical principles is appropriate to illustrate the complexity of the dilemma and its resolution. According to College and Association of Registered Nurses of Alberta (2005), as advocates of patients, nurses should provide relevant information concerning diagnosis, treatment, and management of condition in accordance with ethical principles (p.7). Thus, rationale for choosing the dilemma is that it entails treatment of patient and disclosure of appropriate information regarding diagnosis and prognosis of a disease.

As an example of ethical dilemma, a doctor admits a fifty-year-old woman after diagnosing that she has gastric carcinoma. The woman has been complaining of indigestion, weight loss and vomiting in which lead doctor to conduct an investigation to determine the cause of her condition. By use of gastroscopy and barium x-ray, diagnosis indicates that the woman is suffering from gastric carcinoma that threatens her life if the doctor does not perform appropriate medical intervention. As appropriate medical intervention, the doctor recommends that the woman must undergo a palliative operation to alleviate pain and stenosis. Since the woman is so distressed and has fears about cancer, the doctor decides that no one should disclose information regarding prognosis of gastric carcinoma for six months and confides with her husband that he should not disclose any information to his wife. However, during the course of treatment, the woman confronts the nurse who is on duty and inquires for the truth since she feels that the doctor and her husband are hiding some vital information from her. Thus, the nurse is in a dilemma of whether to disclose information regarding diagnosis and prognosis of her condition or keep the information confidential and save the patient from experiencing a vast deal of trauma and stress.

The nurse is in a dilemma because, she can either act in accordance with ethical principle of respecting patient’s autonomy by giving informed consent regarding form of treatment that she is undergoing, or act according to ethical principles of beneficence and nonmaleficence. In the first option, the nurse has the ethical responsibility of ensuring that patients receive informed consent concerning the nature of their condition and treatment methods that doctors employ so that they can make informed choice regarding form of treatment that they prefer. In the case scenario, the doctor and her husband decide to compel the nurse not to disclose critical information of diagnosis, treatment and prognosis of gastric carcinoma because the woman is so distressed and cannot withstand reality of her condition. Hence, the nurse cannot act in respect to patient’s autonomy because the doctor and the husband restrict her from obeying ethical principle of informed consent. In the second option, the nurse has the ethical responsibility of ensuring that decisions and actions have a basis on ethical principles of beneficence and nonmaleficence. Ethical principle of beneficence ensures that decisions and actions of nurses do promote lives of patients, while nonmaleficence guards nurses from causing deliberate harm to patients. Hence, the nurse is in a dilemma of whether to respect the patient’s autonomy or act in accordance with ethical principles of beneficence and nonmaleficence.

By denying the woman the information regarding diagnosis, treatment, and prognosis of gastric carcinoma, the nurse positively acts according to ethical principles of beneficence and nonmaleficence. The ethical principle of beneficence requires nurses to make decisions and perform actions that promote health status of patients. The doctor examines the condition of the woman and notes that disclosure of information regarding diagnosis, treatment, and prognosis for a period of six months will aggravate the condition of the women, hence confides with her husband not to reveal any information. According to Wilson-Barnett (1986), although the nurse needs to provide informed consent to the patient, the nurse examines that the woman has immense fears of cancer and notes that disclosure may elicit severe distress and worsen her health condition (p.126). Hence, the nurse cannot be in a position to grant the woman informed consent concerning diagnosis, treatment, and prognosis of gastric carcinoma. Moreover, the nurse acts according to the principle of nonmaleficence by protecting the woman from severe stress. Ethical principle of nonmaleficence prevents nurses from inflicting unnecessary harm on patients. In the case scenario, disclosure of information to the woman may cause severe distress that can aggravate her condition. Thus, the nurse weighs harm versus benefits of disclosure and decides not to disclose information regarding diagnosis, treatment, and prognosis.

The negative aspect of the dilemma is that, the nurse actions are against ethical principles of autonomy and veracity. Ethical principle of autonomy demands that, nurses should provide relevant information to patients concerning diagnosis and available options of treatment, so that they can make informed decisions regarding treatment. Patients have the autonomy to make decisions according to their own interests; thus, ethical principle of autonomy requires nurses to respect patients’ decisions. In nursing, patients’ interests should take precedence over the interests of relatives, nurses, or doctors. Hence, nurses need to protect patients from compelling interests of relatives and doctors. However, in the case scenario, the nurse violates ethical principle of autonomy by denying the woman critical information regarding diagnosis, treatment and prognosis of gastric carcinoma, a condition that the doctor diagnoses in her. Nasae, Suttharangsee, Ray, and Lynn (2008) explain that, to offer quality care to the patients, nurses usually avoid conflicts, for they have noble duty of promoting nursing profession by collaborating with others (p.477). The nurse violates ethical principle of autonomy because she does not want to conflict with the doctor and the husband. Moreover, the nurse violates ethical principle of veracity, which compels nurses to tell the truth to the patients. Although the woman has a right to obtain true information, the nurse denies her instead. Hence, negative aspects of the dilemma are a violation of ethical principles of autonomy and veracity.

The ethical dilemma is an extremely complex because it involves stakeholders such as doctors, the husband, the nurse, and the woman. Realizing that health condition of the woman is deteriorating due to stress and phobia associated with cancer, the doctor decides to conceal information pertaining to diagnosis, treatment, and prognosis of gastric carcinoma. Concealing of medical information is essential because its disclosure will cause immense distress that can aggravate the condition of the woman. The husband as one of the stakeholders confides with the doctor not to disclose pertinent information to the woman. Since the husband is a close person to the woman, the doctor should discuss her medical conditions with him, and plan appropriate strategy of treatment and prognosis of gastric carcinoma that makes her sick. Since the nurse is an advocate of patients and conducts treatment and prognosis of the woman for a period of six months, she is a critical stakeholder who can participate in decision-making and implementation. Additionally, the woman is also another stakeholder because she deserves to know her medical condition in terms of diagnosis, treatment, and prognosis. Hence, appropriate resolution of the ethical dilemma requires consideration of all stakeholders in the decision-making process.

Bioethics entails study and formulation of nursing ethics that are applicable in healthcare. Bioethical decision-making model is a nursing model, which helps nurses to make appropriate decisions when faced with complex dilemmas that require rigorous process of decision-making to resolve them. According to Husted and Husted (2008), for nurses to employ bioethical model of decision-making, they must understand the nature and interests of stakeholders who participate in decision-making and reaching agreements (p.5). Hence, according to bioethical decision-making model, nurses should strive to understand the patient’s desires, way of reasoning, nature of life, purpose of living and resilience amidst challenges. Understanding of patients is imperative because, it enables nurses to formulate and apply appropriate ethical principles whenever they face ethical dilemmas, which are exceedingly complex for a simple resolution to suffice. The model holds that resolution of ethical dilemmas is a matter of experience because ethical issues have no specified solution. Even though ethical dilemmas may appear similar, the model can differentiate the various circumstances that surround the occurrence of a given dilemma, thus providing a unique way of resolving it. Hence, the model provides nurses with a wide range of tools that are critical in resolution of complex dilemmas according to their unique occurrence among patients and circumstances.

Bioethical decision-making model arose from bioethics in 1970s when health care transformed from mechanistic approach, which involves treatment of diseases, to the holistic approach that entails treatment patients. Due to the advancement of knowledge and technology, medical professionals began to recognize that patients have inherent interests that require protection through application of ethical principles and theories. In 1985, Joyce Thompson and Henry Thompson developed bioethical decision-making model based on ethical principles and reasoning, which have ten-steps that guide nurses in resolving ethical dilemmas that are extremely complex. According to McGonigle and Mastrian (2011), bioethical decision-making model emanated from fundamental basis of understanding of human nature, importance of health care system in upholding human dignity and cultural dynamics of society (p.71). Thus, bioethics focus on the importance of individuals attributes as the basis of ethics. In its development, the model has incorporated various individual attributes into ethical process of decisions making since patients play a significant role in determining the nature of decisions in the process of resolving complex ethical dilemmas. Bioethics, as a health care discipline, empowers nurses to understand varied dilemmas in health care and enable them to guide patients in making appropriate decisions regarding their medical condition. Currently, the model is effective in resolution of complex dilemmas that involve stakeholders such as patients, nurses, relatives, and doctors.

Bioethical decision-making model originates from bioethics, which is a discipline in health care that involves the study and formulation of ethics that guide healthcare professionals in their duties. Given that ethical theories can satisfactorily resolve ethical dilemmas in accordance with ethical principle, bioethics provides a means through which nurses can learn different attributes of patients and make unique ethical decisions that suit their needs. As a discipline in 1970s, bioethics mainly involved formulation of ethical principles and analysis of various dilemmas that nurses do encounter in the course of their duties. According to Husted and Husted (2008), as ethics evolved, bioethics began focusing on motivation of human actions and attaching ethical values of nursing practices and human conditions (p.9). Then, bioethics attempted to define human actions in terms of right or wrong, but they became complex with time due to the advancement in technology and application of ethical principles in various circumstances. As knowledge and technology expanded in health care, medical professionals came to realize that ethics ought to have practical aspect in their application. Thus, bioethics focused on formulating ethics that enhance patients, doctors, nurses, and families to make appropriate decisions in resolution of ethical dilemmas.

Bioethical decision-making model is an effective model of decision-making in nursing because; it guides and aids nurses in resolution of complex ethical dilemmas that require rigorous process of resolution. Currently, the model is particularly significant because it provides for participation of all stakeholders in decision-making. The model recognizes that every stakeholder has indispensable responsibility in the decision-making process, and thus requires consideration of numerous factors that surround ethical dilemmas. Monagle and Thomasma (2004) argue that, stakeholders involved in decision-making must be in a position to collaborate with doctors, nurses, family members, health care system, and the entire community for effective implementation of bioethical decision (p.567). Thus, the model is currently applicable in health care because when nurses and doctors encounter ethical dilemmas, they consult widely to arrive at appropriate decision that befits all stakeholders. Gilliland (2010) argues that, bioethical decision-making model provides a systemic approach of resolving ethical dilemmas that are extraordinarily complex to define them in terms of right or wrong (p.18). Hence, the model is applicable in resolving complex ethical dilemmas, which involve various stakeholders that nurses interact with in their profession.

Bioethical decision-making model is an effective model of resolving complex ethical dilemmas because it has ten-steps that guide and aid nurses in the decision-making process. The first step of the model requires a nurse to review a situation under which an ethical dilemma occurred. In review, a nurse should be in a position to evaluate and identify health problems that a patient is facing, ethical components, and stakeholders involved. In the case scenario, fifty-year-old woman is suffering from gastric carcinoma according to diagnosis of the doctor. Since the woman has extensive fears regarding cancer and is already in trauma, the doctor decides that no one should disclose information of diagnosis, treatment, and prognosis of six months to save her from undue stress. The decision of the doctor puts the nurse in a dilemma as it creates contradiction in ethical principles of autonomy versus beneficence and nonmaleficence. The second step of the model entails gathering enough information regarding ethical dilemma. In this step, the nurse needs to find out why the doctor recommends that no one should disclose information regarding diagnosis, treatment, and prognosis. Consultation with the doctor and the husband will give critical information that may be relevant in understanding conditions that predispose the woman to trauma.

The third step of the model involves identification of ethical issues that are causing the dilemma. Susceptibility of the woman to trauma compels the doctor and the nurse to violate ethical principle of autonomy. As an advocate of patients, nurses have noble responsibility of ensuring that patients receive relevant information concerning diagnosis, treatment, and prognosis. In the case scenario, the nurse must ensure that the woman understands that diagnosis of her condition is gastric carcinoma and treatment is palliative operation that relieves pain. Moreover, the nurse needs to tell the woman that she will undergo treatment for a period six months according to prognosis of the doctor. However, due to susceptibility of the woman to trauma the nurse must act in accordance with ethical principles of beneficence and nonmaleficence. Ethical principle of beneficence demands that nurses should make decisions that promote health conditions of patients, while nonmaleficence ensures that nurses do not make decisions or perform actions that harm patients.

The fourth step in decision-making involves identification of personal and professional values that stakeholders hold regarding the dilemma. According to Gilliland (2010), ethical values are attitudes, beliefs, and opinions that influence how people perceive a given ethical dilemma (p.18). In the dilemma, the nurse believes that denying the woman information regarding her medical condition violates ethical principle of autonomy, which requires nurses to give essential information to patients so that they can make informed choices concerning their treatment. However, the nurse also has fears that disclosure of medical information to the woman may aggravate her condition since she is prone to trauma.

After identifying personal and professional values, the fifth step of decision-making involves consideration of the moral positions of stakeholders. The nurse must consider moral positions of other stakeholders before making conclusive decision. The moral position of the doctor is that disclosure of medical information as per stipulation of ethical principle of autonomy is detrimental to health status of the woman. Likewise, the husband also believes that disclosure can cause more harm than good to his wife. However, the woman feels that the husband and the doctor are hiding some vital information from her, and thus she believes that the truth will let her make informed choice about her illness and enhance her recovery.

Consideration of moral positions of stakeholders is essential in ascertaining sources of conflicts, which is the purpose of step six. In ethical dilemmas, conflicts can occur between or among individuals involved in dilemma. In the case scenario, the conflicts occur among the doctor, the woman, the nurse, the woman and the husband. One form of conflict occurs between the doctor and nurse. While the doctor believes that disclosure of medical information to the woman may aggravate her health condition because she has extensive fears of cancer and that she is prone to trauma, the nurse thinks that minimal disclosure of prognosis is essential to make the woman comfortable. Thus, interests of the doctor and the nurse are conflicting, hence complicating resolution of ethical dilemma. Moreover, there is a conflict between the nurse and the woman. The woman has immense fears of cancer, as she is not afraid of dying except that her condition is not due to cancer. Hence, she wants the nurse to reveal information of diagnosis, treatment, and prognosis, of which the nurse cannot reveal due to fear of traumatizing her more. Another conflict is between the husband and the woman because she feels that the doctor confides with the husband not to reveal some information to her.

Steps 7 and 8 enable nurses to pinpoint causes of ethical dilemmas and identify ways of resolving them. Step 7 entails determination of decision-makers. The doctor has the responsibility of determining the type and nature of treatment that a patient deserves while, on the other hand, the nurse has responsibility of determining the nature of care that befits the patient. Moreover, while the husband can play a significant role in convincing the wife to accept a given form of treatment, the wife has autonomy of choosing a certain form of treatment when given appropriate information regarding her condition. In step eight, the nurse needs to examine various outcomes of the numerous decisions that stakeholders support. In this step, the nurse should analyze outcomes to determine which among varied outcomes have minimal harm or prevent the occurrence of more harm.

Step 9 is the decisive step of decision-making. In this step, the nurse must critical examine varied outcomes and choose a decision that has greatest positive outcome. In this case, concealing of pertinent medical information is appropriate because it will improve recovery of the woman and prevent her from suffering undue stress due disclosure of shocking news regarding diagnosis, treatment and prognosis of gastric carcinoma. Ultimately, the last step is the evaluation of the outcomes of the decision taken to establish if the condition of the woman is improving or she still has some anxiety and trauma due to diagnosis, treatment, and prognosis of gastric carcinoma.

Nurses continually grapple with ethical dilemmas in the course of their profession because they have a noble role of advocating for the interests of patients. Despite the fact that ethical principles are there to guide nurses in resolving ethical dilemmas, complex ethical dilemmas require rigorous process of decision-making to resolve them effectively. In complex ethical dilemmas that involve patients, nurses, doctors and family members, bioethical decision-making model is appropriate for resolving them. The model is effective because it has a ten-step process that guides nurses to make appropriate decisions when resolving complex ethical dilemmas. Thus, a bioethical decision-making model is applicable in the resolution of complex ethical dilemmas that involve many stakeholders.

College and Association of Registered Nurses of Alberta. (2005). Ethical Decision-Making for Registered Nurses in Alberta: Guidelines and Recommendations. Alberta Association for Registered Nurses, 1-32. Web.

Gilliland, M. (2010). A Systemic Approach to Ethical Decision-Making for Nurses Confronted with Ethical Problems Involving Elder Abuse. University Health System , 16-23. Web.

Husted, J., & Husted, G. (2008). Ethical Decision Making in Nursing and Health Care:  The Symphonological Approach. New York: Springer Publishing Company.

McGonigle, D., & Mastrian, K. (2011). Book Only: Nursing Informatics and the  Foundation of Knowledge . New York: Jones & Bartlett Publishers.

Monagle, J., & Thomasma, D. (2004). Health Care Ethics: Critical Issues for the 21 st  Century . New York: Jones & Bartlett Learning.

Nasae, T., Suttharangsee, W., Ray, M., & Lynn, C. (2008). Ethical Dilemmas and Ethical Decision Making in Nursing Administration Experienced by Head Nurses from Regional Hospitals in South Thailand. Songkla Medical Journal , 26 (5), 469-479.

Wilson-Barnett, J. (1986). Ethical Dilemmas in Nursing. Journal of Medical Ethics , 12,  123-135.

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Ethical Dilemma in Nursing Case Study

This essay about ethical challenges in nursing focuses on a hypothetical case involving an elderly woman named Jane, who prefers palliative care over aggressive treatment for her terminal cancer, contrary to her family’s wishes for continued medical intervention. The narrative explores the role of nurses in balancing patient autonomy with the desires of the patient’s family, highlighting the complexities of ethical decision-making in healthcare settings. Nurses often act as mediators in these situations, advocating for the patient’s wishes while also addressing the family’s concerns through effective communication and ethical deliberation. The essay underscores the importance of respecting patient rights and maintaining compassionate, patient-centered care amidst emotionally charged family dynamics. This discussion serves to illuminate the broader implications for nursing ethics and the essential ongoing dialogue within the profession about handling such conflicts.

How it works

In the heart of every hospital, ethical questions weave through the corridors just as surely as the doctors and nurses who rush from room to room. One such question sits heavily on the shoulders of those in the nursing profession: How do they balance patient autonomy with family desires, especially in end-of-life care scenarios? To explore this, we look into a hypothetical yet all too common situation faced by those in the medical field.

Imagine a scenario involving an elderly woman, let’s call her Jane, who is battling terminal cancer.

Jane has clearly expressed her wish to forego aggressive treatments that would only prolong her suffering. Instead, she chooses palliative care, hoping to spend her remaining days in peace and dignity at home surrounded by loved ones. However, Jane’s family, grappling with impending grief, insists on pursuing every possible medical intervention, driven by a mix of hope, denial, and perhaps guilt.

This dichotomy presents a profound ethical challenge for the nurses involved. On one hand, there’s the ethical duty to honor the patient’s wishes, an aspect central to the nursing code which respects patient autonomy. On the other, there is a pressing need to empathize with Jane’s family, who are not ready to let go and might view the cessation of aggressive treatment as akin to giving up.

Nurses find themselves navigating these treacherous waters, often serving as mediators between what the patient wants and what her family thinks is best. The situation calls for nurses to use their professional judgment and interpersonal skills to handle the delicate balance of providing care that respects Jane’s wishes while compassionately communicating the realities and limitations of medical treatment to her family.

Such situations are fertile ground for ethical deliberation, often involving discussions with ethics committees, multiple team meetings, and sometimes legal advice. These processes are integral to ensuring that decisions are made in the best interests of the patient while considering the emotional and ethical standpoint of the family.

The case of Jane highlights the indispensable role of nurses as advocates for their patients’ wishes. It also underscores the importance of having clear and open communication channels within families and between families and medical professionals. These discussions are never easy, but they are necessary to navigate the complex interplay between medical possibilities, ethical responsibilities, and human emotions.

In conclusion, understanding and managing ethical dilemmas like this one is crucial for maintaining the integrity of the nursing profession and ensuring patient care remains compassionate and patient-centered. Each case, while unique, adds to the broader understanding and ongoing conversation about the best practices in nursing ethics, particularly in how to handle conflicts between patient rights and family wishes effectively.

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Ethical Dilemma in Nursing: Case Study Presentation

Learning objectives, introduction, clinical ethical situation, ethical dilemma characteristics, ethical principle(s) violated, barrier(s) to ethical practice, ethical theory, self-reflection.

At the end of this presentation the learner will:

• Learn more about ethical problems inherent in health care;
• Identify the key components of ethical theories;
• Find out how complex ethical issues can be mitigated;
• Be able to reflect on their approach to the ethical issue.

• Being a nurse is a rather complex task in terms of a variety of social, political, and medical implications (Hamric, Hanson, Tracy, & O’Grady, 2013).
• The rationale behind this presentation is the analysis of a case that involved an ethical dilemma.

Today, being a nurse is associated with a number of complexities due to the need to comply with diverse obligations in social, political, and healthcare segments (Hamric, Hanson, Tracy, & O’Grady, 2013). It remains apparent that concepts such as fidelity are the core definers of nurses’ actions and behavior, as a nurse plays a role of a mediator between the management of the hospital, healthcare system, patients, and their relatives (Hamric et al., 2013).

• The patient had cancer with low chance of being cured;
• She (the patient) stopped taking any medications and refused any of the procedures that were vital for her survival (such as insertion of urinary catheter).

Ethical dilemmas in nursing are rather common. Thus, one of the cases incurred at my workplace in the recent past. The situation took place at the hospital, where one of the patients was transferred due to some health problems. Thus, after organizing a series of tests, it was revealed that a patient had a type of cancer with a low chance of being cured. The thirty-year-old woman (the patient) was informed about her condition by her family doctor after being released home from the hospital. Thus, it could be said that she lost hope as her condition continued to worsen; she stopped taking prescribed medication and accepting the required treatment. Procedures such as insertion of urinary catheter were essential for the maintenance of her organs and survival, but she continued to refuse them.

• The patient’s relatives convinced her to stay at the hospital;
• The doctors discovered that the patient was terminally ill but reached an agreement with her relatives and did not let the patient know that she was terminally ill;
• The patient died without knowing that she was terminally ill while the nurses had to lie to her.

Apart from the patient’s confrontation, her relatives were able to convince her to stay at the hospital since there was a small chance of being cured. Meanwhile, the doctors discovered that she was terminally ill and informed her family about this condition. Relatives, in collaboration with the medical personnel of the hospital, agreed not to inform the patient about her state, as they believed that it would help her regain hope. To support this scenario, family members started planning vacations after her release from the hospital. Unfortunately, the outcome of this situation was rather negative, as the patient died without knowing about her actual medical condition. Overall, the described situation involved relatives, medical professionals, and the patient as the main actors. It could be said that catering the needs of the family created ethical dilemmas for nurses, as they had to lie and be dishonest to the patient. This type of problem often takes place, but it is still unclear whether physicians should disclose the diagnosis to the terminally ill patients or not since it has its both advantages and disadvantages.

• Communication issues (Luz et al., 2015);
• Concealing the truth (Safaris, Tsounis, Malliarou, & Lahana, 2014);
• Multiple commitments dilemma.

The situation described above can be viewed as one of the examples of communication problems. It could be discovered as the most common issues, for example, in oncology, along with other matters that nurses have to pay substantial attention to (Luz et al., 2015). Not being able to consider clarity of communication of paramount importance will trigger the development of insecurity and destroy the well-developed bond between patients and medical professionals (Luz et al., 2015).

Nonetheless, miscommunication is not always the case. For example, sometimes nurses and physicians chose to conceal the truth from terminally ill patients (Safaris, Tsounis, Malliarou, & Lahana, 2014). In the context of the presented case study, the medical personnel did it since they wanted not only to help the patient to regain hope for being cured but also cater the needs and desires of her family.

At the same time, it is possible to identify that the situation has some characteristics of multiple commitments dilemma. The assessment of the case shows that communication issue highly interferes with the need to satisfy the needs of several parties including other nurses, physicians, relatives, and patients (Hamric et al., 2013).

• Ignoring patient’s autonomy;
• Ignoring the rule of veracity (Hamric et al., 2013);
• Ignoring the rules of confidentiality and privacy.

Due to the common occurrence of ethical dilemmas, it is easy to depict the core matters that were violated. In the first place, one of them is ignoring patient’s autonomy, as any nurse is obliged to respect everyone’s freedoms and liberties (Hamric et al., 2013). In this case, the patient had a right to decide whether to continue receiving treatment or not, as only in this instance, her rights and freedoms would be respected.

At the same time, it is evident that apart from a distinct violation of patient’s autonomy, the rule of veracity was also disrespected. This concept implies that a nurse should tell the truth to a patient and provide only relevant information about his/her medical condition (Hamric et al., 2013).

In turn, the presented situation is more complicated than it seems, as the actions of the medical personnel also did not comply with the rules of confidentiality and privacy. These aspects are the defining principles of the nursing profession, as nurses have to keep all confidential information in order, avoid its leakage, and do not transfer information to third parties (Hamric et al., 2013).

• There are numerous internal and external factors (such as patient-provider barriers) that can impact the decision-making process;
• Another barrier is the obligation to provide health care services in line with the patients’ needs (Butkus, 2014);
• Non-adherence within the patient-provider relationships is also a serious ethical barrier;
• The last barrier is inherent in interprofessional misunderstanding and inability to showcase ethical decision-making.

There are several matters that can be viewed as the barriers to ethical practice. For example, Hamric et al. (2013) state that there is a plethora of external and internal factors that may have a substantial impact on the selection and implementation of ethical theories and decision-making process. In the first place, it is crucial to consider patient-provider barriers, as these stakeholders may have entirely different perceptions concerning appropriate medical treatment and other beliefs (Hamric et al., 2013).

One of the clearest examples of patient-provider barriers is the need to cater patient’s and relatives’ wishes and desires while aligning the practice with the nursing principles (Butkus, 2014).

It could be stated that another barrier that is highly linked to the obstacles of the patient-provider relationship is non-adherence (Hamric et al., 2013). This concept implies that a patient may not have the desire to improve his/her wellbeing and psychological and physical condition.

Lastly, many theorists highlight various interprofessional barriers that tend to have a strong effect on ethical decision-making. The main idea of this concept pertains to the fact that different professionals such as nurses and physicians have dissimilar understandings of the same situation and interpret acceptable ethical behavior differently (Hamric et al., 2013).

• Casuistry was found to be the most appropriate ethical theory because its followers have different outlooks regarding the act of lying (Butts, 2015);
• Lying should be seen as an opportunity to improve patient-provider relationships and a potential benefit to the health care practice;
• This ethical theory considers both practical and ethical sides of the question as it takes into account the exceptions that may transpire (Marcus & Mott, 2014).

The case shows that telling the truth to the patient may not always be good due to its potential ability to cause harm, and disregarding related controversies, deceiving a terminally ill patient may be viewed as an ethical action. To support the rationale behind this decision-making, it is reasonable to refer to casuistry, as its followers have different perceptions towards lying (Butts, 2015). This theory implies that deceiving patient may be discovered as a professional duty and obligation while being viewed as a potential benefit for both sides of patient-provider relationship (Butts, 2015). After that, the decision has to be thoroughly discussed with the representatives of different professions since it will help explain reasons for this solution, identify gaps in it, and minimize stress levels. Based on the steps provided above, casuistry theory is the most appropriate method, as it will help avoid bias by considering practical side of ethics and the existence of potential exceptions (Marcus & Mott, 2014).

• The case was thoroughly reviewed;
• Ethical decisions were made on the basis of the existing information;
• Several ethical theories were evaluated so as to apply the gathered data in the most efficient manner;
• The learning objectives were achieved.

• Health care specialists are always under pressure and have to make ethical decisions at all times;
• Informing a terminally ill patient about their illness should not be an option;
• Strictly following the guidelines of nursing ethics is not always the answer;
• The more information the nurse can obtain, the more informed decision will be made regarding when and how to lie to a patient.

Overall, it could be said that the selected case is only one of the examples of ethical dilemmas faced by nurses in the modern world. Medical professionals have to constantly be under pressure and decide whether they should disclose the truth to the patients or conceal the important details of their diagnoses and medical conditions. In this scenario, nurses chose to take the side of the family and did not inform the patient about her terminally ill condition while the patient died in ignorance.

I can freely claim that this case assisted me in understanding that strictly following ethical guidelines might not always be appropriate. When facing a similar situation in future, I will employ the concepts of casuistry theory, as it states that every decision is highly dependent on the characteristics of the situation. Meanwhile, every case has to be discovered individually while referring to practical examples from the past. Collecting and evaluating the most important details of the case will help unveil whether deceiving patient is appropriate. Apart from the complexity of the decision-making process and the necessity to consider a plethora of factors, I will rely on this theory, as it will help design a logical solution while taking into account the preferences of different participants.

Butkus, M. (2014). Compassionate deception: Lying to dementia patients. Philosophical Practice: Journal of the American Philosophical Practitioners Association, 9 (2), 1388-1396.

Butts, J. (2015). Nursing ethics: Across the curriculum and into practice. Burlington, MA: Jones & Bartlett Learning.

Hamric, A., Hanson, C., Tracy, M., & O’Grady, E. (2013). Advanced nursing practice: An integrative approach. St. Louis, MI: Elsevier Saunders.

Luz, K., Vargas, M., Schmidtt, P., Barlem, E., Tomaschewski-Barlem, J., & Rosa, L. (2015). Ethical problems experienced by oncology nurses. Revista Latino-Americana de Enfermagem , 23 (6), 1187-1194.

Marcus, J., & Mott, F. (2014). Difficult conversations from diagnosis to death. The Ochsner Journal, 14 (4), 712-717.

Safaris, P., Tsounis, A., Malliarou, M., & Lahana, E. (2014). Disclosing the truth: A dilemma between instilling hope and respecting patients’ autonomy in everyday clinical practice. Global Journal of Health Science, 6 (2), 128-137.

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IvyPanda . "Ethical Dilemma in Nursing: Case Study." May 13, 2024. https://ivypanda.com/essays/ethical-dilemma-in-nursing-case-study/.

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Ethical Dilemmas in Nursing (Essay Sample)

Table of Contents

Instructions:

Write a paper of 750-1,000 words in which you describe your professional moral compass. As you write your paper, include the following:

• What personal, cultural, and spiritual values contribute to your worldview and philosophy of nursing?
• How do these values shape or influence your nursing practice?
• Define values, morals, and ethics in the context of your obligation to nursing practice. Explain how your personal values, philosophy, and worldview may conflict with your obligation to practice, creating an ethical dilemma.
• Reflect and share your own personal thoughts regarding the morals and ethical dilemmas you may face in the health care field.
• How do your personal views affect your behavior and your decision making?

Do not be concerned with the use of ethical terminology for this paper.

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Introduction

Dilemmas, as far as they go, exist in virtually every type of profession. All fields of work come about with some form of exceptionalities which comprehensively eliminate the aspect of a perfect profession. To a greater extent, ethical dilemmas complement each profession. On an outer look, nursing is perceived as one of the most fulfilling professions around the globe. Challenges in any profession are inevitable. Nursing from an inner look is faced with challenges and most profoundly the ethical dilemmas on a daily basis. Ethics in any profession are a set of regulations or principles through which decisions based on ethics are made. The major purpose of these mechanisms is the fostering of ethics of very high standards. The core business of nursing includes health promotion, easing of pain and illness prevention. The code of ethics, however, dictates that apart from that, the respect to human life must be part of the job. Respect to human life means cultural rights, right to choice and life and respectful and dignified treatment among others.

The nursing profession, like the larger medical field, is compounded with various dilemmas. Ethical dilemmas make nurses encounter moral distress. This is because, in most situations, they feel that they failed or were restricted to do what they consider ‘right’ (Wood, 2014). Some nurses, on the encounter of this, dare to speak it out with the colleagues or the management while others don’t. Such a scenario is often compounded by the Hippocratic Oath that these individuals have to take when commencing their careers. They often heave under such challenges, but again cannot be allowed to speak about them. Here are some of the most common ethical dilemmas that nurses encounter while performing their duties and what can be done.

Honesty in controversial to information

Nurses need to acquire information about the patient’s history to attain quality care. At the same time, they need to give the information about the patient’s condition with the patient or the family of the patient. This becomes a hurdle because they are not sure of the kind of information, the time and the manner in which they can present it to the parties in question (Carlise & Zoboli, 2015). The dilemma comes in if they should tell the patient’s condition or if they should let the patient enjoy a stress-free life during their last days. It is therefore up to the intelligence and common sense of the nurse to determine and ascertain the best course of action to take under such circumstances. This, is never easy. Families, on the other hand, withdraw or fail to provide truthful information about the patient for the purposes of protecting them. The misinformation may lead to adverse outcomes which lead to unethical conduct to the respective nurse.

The Nurse Control against the Freedom of the Patient

This is one of the most common ethical dilemmas in the nursing profession. Incorporated in the principles of ethics is the right to choice and cultural rights. The two give the patient the freedom of rejection of the medical advice given by the nurse or the physician. Remember, nurses are highly educated and experienced professionals who understand the most efficient and profound clinical course to tackling an action. If the patient refuses their advice, doesn’t that mean that they will have to comply with the course the patient wants even if it gives the less optimal outcome? But again, what can ,and should the nurse do, when it gets to this?

Closely related to this are personal, religious or cultural beliefs of a patient in controversial to a nurse’s empirical and science-based knowledge (Shapira, 2009. Even though it is a matter of life and death, some religious or cultural beliefs forbid some of the medical procedures. For instance, blood transfusion; there are some cultures and religions that forbid it.  In case of such an incidence that the nurse will have nothing but to watch a patient die, builds up moral distress.

The Reproductive Rights

This is another huge dilemma faced by nurses. The argument is seen between the pro-life and the pro-choice individuals. If the nurse is pro-life, it will be hard for them to respect the decision of a patient who wants to terminate a pregnancy. The other side’s hurdle comes in, in the manner that a patient wants to keep a pregnancy yet from the assessment, it threatens their life. The pro-choice nurses are faced with the dilemma of if they should support the patient’s decision or not. Once again, it is up to the nurse’s discretion to try and choose what would be the best course of action to take under such circumstances.

The Management of Resources

This usually happens when the cost of treatment is too high due to the patient’s critical conditions which can be described as the vegetative or futile state. The resources to save the lives of these patients could be costly, and it thus becomes a very difficult decision for the nurses to redirect the costs to the patients. It becomes nigh hard to draw a line of this decision from being personal to financial. The family is grieving, and when it comes to ensuring that a loved one’s life is saved, there is no resource that is not well spent. The nurse thus takes this decision, but they are eventually charged with the ‘big picture’ maintenance perspective while in real senses, they are dealing with critical personal situations.

The ethical challenges in nursing have mostly been taken as part of the job. In one way or the other, there is nothing normal with what makes one uncomfortable. Nurses, therefore, do not have to sit back but should seek for help. There are organizations that help nurses with ethical dilemma issues, for instance, the American Nursing Association. The organization offers statements on human rights and ethics. The statements could help nurses to overcome their challenges. Other hospitals have organized committees to deal with such (Wood, 2014). Nurses are very important part of the healthcare system-they care.

• Carlise, N. R. D., Vieira, M & Zoboli, P. C. L. E. (2015). Ethical Problems Experienced by Nurses in Primary Health Care. Retrieved fromhttp://www.scielo.br/scielo.php?script=sci_arttext&pid=S1983-14472015000100112
• Shapira, L. O. (2009). Ethical Dilemma in Nursing: The Experiences of Israel Nurses. Retrieved from http://education.biu.ac.il/files/education/shared/QHR_FINAL_ORLY_SHAPIRA.pdf
• Wood, D. (2014). 10 Best Practices for Addressing Ethical Issues and Moral Distress. Retrieved from https://www.amnhealthcare.com/latest-healthcare-news/10-best-practices-addressing-ethical-issues-moral-distress/

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Ethical Lapses in the Medical Profession

More from our inbox:, don’t cave, columbia, a florida book oasis, balloon release ban.

To the Editor:

Re “ Moral Dilemmas in Medical Care ” (Opinion guest essay, May 8):

It is unsettling, and dismaying, to read Dr. Carl Elliott’s account of moral lapses continuing to exist, if not thrive, in medical education. As a neurology resident in the early 1970s, I was assigned a patient who was scheduled to have psychosurgery.

He was a prisoner who had murdered a nurse in a hospital basement, and the surgery to remove part of his brain was considered by the department to be a therapeutic and even forward-looking procedure. This was despite its being widely discredited, and involving a prisoner who could not provide truly informed consent.

A fellow resident and I knew that refusing would almost certainly result in suspension or dismissal from the residency, so we anonymously contacted our local newspapers, whose reporting resulted in an overflow protest meeting, cancellation of the psychosurgery and legislative action placing conditions on the acceptance of informed consent by prisoners.

It is lamentable that even though bioethics programs are widely incorporated into medical education, moral and ethical transgressions remain a stubborn problem as part of medical structures’ groupthink.

As Richard Feynman has emphasized , doubt, uncertainty and continued questioning are the hallmarks of scientific endeavor. They need to be an integral element of medical education to better prepare young doctors for the inevitable moral challenges that lie ahead.

Robert Hausner Mill Valley, Calif.

I would like to thank Carl Elliott for exposing the “Moral Dilemmas in Medical Care.” There is a medical school culture that favors doctors as privileged persons over patients.

I can remember multiple patient interactions in medical school in which I thanked a patient for allowing me to examine them and apologized for hurting them during my exam of their painful conditions.

I was then criticized by attending physicians for apologizing to the patients. I was told, on multiple occasions, that the patient should be thanking me for the privilege of assisting in my education.

Medical training, in a medical school culture that favors the privilege of the medical staff over the rights and feelings of patients, needs to be exposed and changed.

Doug Pasto-Crosby Nashville The writer is a retired emergency room physician.

As a psychiatrist and medical ethicist, I commend Dr. Carl Elliott for calling attention to several egregious violations of medical ethics, including failure to obtain the patient’s informed consent. Dr. Elliott could have included a discussion of physician-assisted suicide and the slippery slope of eligibility for this procedure, as my colleagues and I recently discussed in Psychiatric Times .

For example, as reported in The Journal of Eating Disorders , three patients with the eating disorder anorexia nervosa were prescribed lethal medication under Colorado’s End-of-Life Options Act. Because of the near-delusional cognitive distortions present in severe anorexia nervosa, it is extremely doubtful that afflicted patients can give truly informed consent to physician-assisted suicide. Worse still, under Colorado law, such patients are not required to avail themselves of accepted treatments for anorexia nervosa before prescription of the lethal drugs.

Tragically, what Dr. Elliott calls “the culture of medicine” has become increasingly desensitized to physician-assisted suicide, nowadays touted as just another form of medical care. In the anorexia cases cited, informed consent may have been one casualty of this cultural shift.

Ronald W. Pies Lexington, Mass. The writer is on the faculty of SUNY Upstate Medical University and Tufts University School of Medicine, but the views expressed are his own.

Carl Elliot’s article on medical ethics was excellent. But it is not just in the medical profession that there exists the “subtle danger” that assimilation into an organization will teach you to no longer recognize what is horrible.

Businesses too have a culture that can “transform your sensibility.” In many industries executives check their consciences at the office door each morning. For example, they promote cigarettes; they forget they too breathe the air as they lobby against clean-air policies; they forget they too have children or grandchildren as they fight climate-friendly policies or resist gun-control measures. The list could go on.

In every organization, we need individuals to say no to policies and actions that may benefit the organization but are harmful, even destructive, to broader society.

Colin Day Ann Arbor, Mich.

Re “ Columbia’s Protests Also Bring Pressure From a Private Donor ” (front page, May 11):

Universities are meant to be institutions of higher learning, research and service to the community. They are not items on an auction block to be sold to the highest bidder.

Universities that sell off their policy platform to spoiled one-issue donors who threaten to throw a tantrum no longer deserve our respect. Grant-making foundations should not be grandstanding online. Give money, or don’t, but don’t call a news conference about it.

If Columbia caves, why should prospective students trust it as a place where they can go to become freethinkers and explore their own political conscience as they begin to contemplate the wider world and issues of social justice?

This is a real test of Columbia and its leadership. I do not envy its president, Nemat Shafik, who has few good choices and no way to make everyone happy. What she should not sell is her integrity, or the university’s. She should stand up to these selfish donors. Learn to say, “Thanks, but no thanks.”

Carl Henn Marathon, Texas

Re “ Book Bans? So Open a Bookstore ” (Arts, May 13):

Deep respect for the American novelist Lauren Groff and her husband, Clay Kallman, for opening the Lynx, their new bookstore in Gainesville, Fla. The store focuses on offering titles among the more than 5,100 books that were banned in Florida schools from July 2021 through December 2023.

To all the book clubbers and haters of bans: Order straight from the Lynx.

Fight evil. Read books.

Ted Gallagher New York

Re “ Keep a Firm Grip on Those Mickey Mouse Balloons. It’s the Law ” (front page, May 9):

Balloons are some of the deadliest ocean trash for wildlife, as mentioned in your article about Florida’s expected balloon release ban.

Plastic balloon debris poses a significant threat to marine life, often mistaken for food or becoming entangled in marine habitats, leading to devastating consequences for our fragile ocean ecosystems.

As the founder of Clean Miami Beach, an environmental conservation organization, I’m concerned about the impact of plastic pollution on Florida’s wildlife and coastal areas. Florida’s stunning beaches and diverse marine life are not only treasures to us locals but also draw millions of tourists each year.

Because of the dangers, intentional balloon releases have been banned in many cities and counties across the state. A poll released by Oceana showed that 87 percent of Florida voters support local, state and national policies that reduce single-use plastic. Gov. Ron DeSantis must waste no time in signing this important piece of legislation into law.

Our elected officials should continue to work together to address environmental issues so Floridians and tourists can enjoy our beautiful state without its being marred by plastic pollution.

Sophie Ringel Miami Beach

‘So much death and upset’: the nurses quitting the NHS after Covid – a photo essay

Working as a nurse in the NHS through the Covid pandemic gave Hannah Grace Deller a unique perspective on the hardship faced by her profession. She has photographed several nurses as they decided post-Covid to leave the service

H annah Grace Deller works as a paediatric matron at St Mary’s hospital in Paddington, central London. She is also a trained photographer, and during the Covid crisis she began to photograph the conditions in which she and her nursing colleagues were working. Some of her images were published widely and exhibited at the time, earning praise from Grayson Perry, Martin Parr and others, and inspiring an album by Chris Difford, of Squeeze.

She has now published a book, Working on the Frontline , documenting the experiences of nurses and the reaction of the public during the crisis and since.

Hannah Grace Deller and her team.

Before the pandemic, I had never really taken photographs at work – just a few snaps if someone was leaving to say goodbye, that kind of thing. I had never really looked at my job in that way at all. Work was work, and my camera came out when I left the hospital as my way to relax. It’s like a form of meditation for me.

Then one day at the start of the pandemic, I was responding to a bleep when I saw a cleaner, in full PPE, trapped behind a door, and asked to take his picture . After that I thought, something is beginning here. We didn’t know how long it would last, I thought maybe a month. But, with permission from my colleagues, I thought I would document what was happening. I didn’t bring in a camera, that wouldn’t have been appropriate; I’d just take pictures on my phone and use my real camera outside work to document everything else.

The photographs, including this of nurse Steffie, are the first taken by Deller inside a hospital.

This was around the time that people were clapping for NHS workers, and that was sweet – though most nurses didn’t get out of work before 8pm to hear it. As time went on, I think lots of nurses began to wonder how much that goodwill was worth.

Nurses started protesting about pay and recognition during the pandemic. At one fair pay protest I started chatting with a nurse who said: “I’ve had enough, I’m going”. We’d had a pay offer of 1% and she said: “Surely, after everything, we are worth more than 1%.”

Thousands of nurses protested on 29 July 2020 to call for a pay rise, saying workers had been ‘on their knees’ during the pandemic.

I’ve always had an interest in photographing protests. It’s that spirit that you see in people, regardless of whether I agree with what they are protesting about. But with the nursing protests, it felt a bit different.

I began talking to other nurses on the protests, from all different hospitals, who had had enough. One of the people I spoke to was Camille, who is French but had lived in Britain for ever. With Brexit and then the pandemic, it was like a double insult to her, and she told me she was leaving nursing completely.

Nurse Camille moved to France post-Covid. She said: ‘What with Brexit, Covid and the lack of appreciation in the UK for nurses from the government, I’m done.’ She now runs an Airbnb in France with her wife and son.

We arranged that after taking her picture I would take her uniforms back as she had moved out of London, but when I got to her house, she had decided to burn them; she said it felt really therapeutic. There is a lot of trauma that can be held in clothing. A lot of the stains you just can’t get out of the uniforms, no matter how hot you wash them. As she was turning them she said: “There’s a lot of blood, sweat and tears in that fire.”

Nurse Anna left the NHS and moved to New Zealand. She wanted to fold her uniform and bring it back to her workplace to say goodbye.

Nurse Natasha used to play the cello to the Covid patients.

Nurse Natasha left after the pandemic because of burnout and disappointment around the pay dispute with the government. She decided to travel with her husband. She washed her uniforms and hung them on the line as if for the last time. Natasha used to play her instrument to the Covid patients and sometimes when someone was dying she would play music on the ward.

Nurse Mila hangs her ‘RIP’ nursing dress.

There was also Mila – she wrote “RIP nursing” on the back of her dress. She now works on Portobello Road, in London, selling jewellery.

Ellie also worked through the pandemic but had had enough; I took a few pictures of her handing her nursing uniform back. She was in her 20s and she said: “I’m just too young to experience this, so much death and upset. I just want to go to Australia and lie on the beach.” There are so many untold stories like this.

Nurse Ellie brought her uniform to her job and handed it back to be put in the bin.

There is an image of nurses in which we are expected to be submissive and sweet, never raising our voices, just getting on with the job. We are not supposed to get angry, to speak up. But there is a lot of anger in these photographs.

Nurses throw their uniforms outside No 10 Downing Street to protest against the vaccine mandates in January 2022. ‘Clapped and sacked’ was the mantra; many felt they wanted to make their own decisions around vaccines.

Of course I feel that way too sometimes, but if I’m ever upset, or feel that I want to leave, I’ll often just go round and chat to the patients on the ward. And then I’ll remember, ah, that’s why I’m here.

Hannah Grace Deller was speaking to Esther Addley

Working on the Front Line is published by Image and Reality, and can be ordered through Kickstarter .

• The Guardian picture essay
• Coronavirus
• Public services policy
• Public sector pay

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