TOP ETHICAL ISSUES IN NURSING

While a career in nursing is immensely fulfilling, its not without its share of
challenges. Regardless of their area of practice or accreditation, nurses face a
multitude of ethical dilemmas every day. Lets take a closer look at what
ethics mean for todays healthcare professionals, along with some of the
common ethical issues faced by nurses in todays complex healthcare
settings.

A CLOSER LOOK AT ETHICS IN NURSING

While theres no clear-cut right or wrong answer to the often life and death
ethical issues encountered by nurses, there is a set of principles upon which
ethical decision making is based. Regulatory mechanisms are aimed at
ensuring the highest standards of ethics. For example, the International
Council of Nurses ICN Code of Ethics asserts that, in addition to the core
responsibilities of promoting health, preventing illness and easing suffering, a
respect for human rights, including cultural rights, the right to life and choice,
to dignity, and to be treated with respect, is also an inherent part of the job.
While the code further dictates that the nurses primary professional
responsibility is to people requiring nursing care, it also specifies that nurses
not only render services to individuals, but also to families and communities.
This is a tall order when you factor in the many diversities represented in
society today.

COMMON ETHICAL DILEMMAS IN NURSING

So what are some of the most common ethical dilemmas nurses encounter on
the job? They include the following:

Patient Freedom Versus Nurse Control

Nurses are highly educated and therefore aware of the best clinical course of
action when one exists. But what happens when a patient rejects medical
advice and makes a decision that may result in less optimal outcomes? From
deciding whether or not a labor and delivery patient would benefit from pain
medication, to encouraging a patient to eat when they are refusing food,
nurses walk a fine line every day.
While nurses do not sign the Hippocratic Oath, they are stillbound by the
promise to devote themselves to the welfare of the patients committed to the
care, as well as to live up to the standards of the profession.
Reproductive Rights
The pro-choice vs. pro-life argument is an intensely personal one based on an
individual's core set of values and beliefs. If you are pro-life, can you support a

patients right to an abortion? If you are pro-choice, can you respect a

patients choice to continue a pregnancy even if it threatens her own life?
With more than 208 million pregnancies occurring worldwide every year ,
nurses can expect to be confronted with this ethical dilemma on any given
shift.
Honesty vs. Information
Families will often choose to withhold truthful information to protect a
patient from emotional distress. For nurses, this poses another common
ethical dilemma: does a patient have the right to know everything about their
condition, even if sharing the information will cause harm? Is honesty always
best? What if sparing a patient this information can promote happier, less
stressful final days?
Deciding what information will be shared along with how and when to share
it can be a diffi cult part of a nurses responsibilities.
The Minor Dilemma
Working with children presents a unique set of ethical challenges. Not only
must nurses consider the best interests of the patient, but they must balance
this against the wishes, beliefs and values of a family. While patients, families
and physicians may be aligned in the ideal world, in the real world ethical
issues do arise. While parents are tasked with diffi cult decisions too, the
nurses ultimate responsibility is to the patient.
Ethical issues related to privacy can also arise with minors. While they do
have some basic rights to privacy, the law requires disclosure of certain
information to parents. In many cases, this is information that minors do not
want disclosed. In this instance, nurses benefit from an understanding of law,
as well as hospital policy.
The Battle of Beliefs
What is science-based, empirical knowledge to a nurse might be completely
subjective to a patient with a particular set of religious or personal beliefs.
Certain religions forbid medical procedures which can mean the difference
between life and death. For example, in some cultures and religions, blood
transfusions even lifesaving ones are unacceptable. A nurses attempts to
explain the benefits of the procedure weighed against the risks of opting out
can overstep the line. Is it the nurses job to support the patients right to the
decision, or is it their responsibility to do everything in their power to urge
them toward a preventable action?
As science continues its onward march, questions related to ethics and human
rights are only expected to grow, pertaining to everything from stem cell
research to genetic testing.
Resource Management
If a patient is in a medically futile, vegetative state, the cost of maintenance is
high. At what point do you draw the line and redirect these resources to

patients for whom they could be truly life-saving? How do you balance what
may be perceived as a financial decision against what is an entirely personal
decision to a grieving family? After all, when it comes to clinging to hope for
the survival of a loved one, no resource is poorly spent.
Nurses are charged with maintaining a big picture perspective while
simultaneously dealing with intensely personal situations on a day to day
basis.

GUIDANCE ALONG THE WAY

While these ethical dilemmas are an inherent part of the nursing profession,
nurses arent without access to help. The American Nursing Association (ANA)
offers ethics and human rights position statements on everything from DNRs
to capital punishment to aid nurses in addressing specific ethical challenges.
Furthermore, hospitals have their own ethics committees where nurses can
voice their concerns and gain access to helpful resources.
Ultimately, nurses are a highly valued part of the healthcare system because
they care. In fact, year after year they receive the highest ratings from the
American public in terms of honesty and ethical standards besting medical
doctors, pharmacists, police offi cers and members of the clergy. This trust not
only comes with great responsibility, but remains the bedrock upon which the
American healthcare system is built.
http://elearning.loyno.edu/masters-nursing-degree-online/resource/ethical-issues-innursing

Ethical Theories of Nursing Essay

When a person meets the unfortunate circumstance of being admitted to a hospital for an
illness they are depending on healthcare personnel to have their best interest in mind and
make them better. When people think of who it is taking care of them and making them
better they specifically think of Doctors and Nurses. As Doctors and more specifically
Registered Nurses it is their duty to have a clients best interest in mind and always act in
their benefit. This raises the question, what guides Nurses to maintain this mindset of
always putting the patient first? The
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answer is their ethical duty, meaning every nurse is guided by ethical theories and principles
which help guide them as a patient advocate. It is these ethics that make a nurse so
valuable to clients and ultimately makes a nurse the clients best advocate. In this paper the
core ethical theories and principles will be discussed and how exactly this helps RNs be the
best possible advocate and what benefits the clients themselves derive from these ethical
theories. In order to properly understand the ethical theories of nursing one must first know
what the core ethical principles and theories in nursing are. The ethical principles of nursing
are Autonomy, Beneficence, Fidelity, Informed consent, Integrity, Justice, Nonmaleficence,
Paternalism, Veracity, as well as Privacy and confidentiality. Some ethical theories that
influence nursing practice are Consequentialism, Deontology, Ethical Relativism,
Utilitarianism theory, Teleology , Virtue ethics, and Justice and equity.
To a layperson some of these words may make sense and others may not. In order to better
understand how these theories and principles shape the practice of nursing you must better
understand what they mean. A brief description of some of these terms will be given before
their influence on nurses is discussed. Autonomy refers to the patients own rights to make
decisions about their healthcare, health, and lives without the interference from healthcare
personnel such as the physician, the nurse, or other team members. This means the nurse
would have to resist the urge to interject his or her own feelings, values or beliefs onto the
patient. This principle was made more evident with the passing of the Patient Self
Determination Act by Congress in 1990 (Ethical Principles, n.d., para. 2). Beneficence is
very simple, it is referring to always doing what is beneficial to the patient and therefore in
their best interest (Silva & Ludwick, 1999). T his principle also involves taking actions to help
benefit others and prevent both physical and mental harm of the patient. Fidelity is
synonymous with faithfulness and is therefore achieved by remaining loyal, fair, and truthful
to patient and encompassing the idea of being a patient advocate.
An example of fidelity would be keeping a promise to a patient of coming back to check on
them even if they become slammed with a heavy workload. Informed consent is directly
related to autonomy in the fact that it allows the patient to make an informed decision about
their treatment (Daly, 2009). This means that accurate information must be provided to the
patient in order to make an informed decision. Three elements involved in informed consent
are Informed, Competent, and Voluntary. What this means is the patient has all the accurate
information, they are in a stable and competent mindset to make the decision, and that they
are voluntarily making the decision. Justice is simply referring to fairness and equality. It is
applied to healthcare by providing equitable access to nursing care. Nonmaleficence literally
translates to do no harm and is a concept that originated from the Hippocratic Oath.
Nurses apply this principle by not causing injury , being either physical, psychological,
emotiona, or financial (Ethical Principles, n.d., para. 16).
Paternalism is a negative principle of nursing and is implied when a nurse does not respect
the patients right to autonomy by making decisions for the patient because he or she thinks
she knows whats best for that patient (Sliva & Ludwick, 1999). Privacy and Confidentiality is
relating to maintaining the security of a patients information and only sharing that
information on a need-to-know basis with other healthcare members involved with that
patients care and act to prevent breaches of confidentiality. Veracity as a word is associated
with truthfulness. In nursing it is a duty to disclose pertinent information and the obligation
to respect confidentiality at the same time. This means giving truthful information about the

risks of a procedure while still respecting the patients confidentiality. These are the main
principles of ethics as far as it pertains to nursing and knowing this information is vital to
understanding ethical theorie s and how to better apply them as a practicing nurse.
As mentioned earlier some of the Ethical theories are Consequentialism, Deontology, Ethical
Relativism, Teleology, Virtue ethics, and Justice and equity. It is important for Nurses to
understand the definition of each of these, as well as how to apply them, and how it benefits
the patient. It is pivotal for nurses because it will ensure that they are preforming their jobs
and duties with the highest regard to patient advocacy and maintain the ethics which
nursing is based on. Consequentialism, also referred to as utilitarianism, seems simple
enough to understand as the word consequence is evident. Consequentialist ethics refers
to the idea that the correct moral response is always going to be related to the outcome, or
consequence, of the act.
This idea can also be thought of in a way that if a decision must be made it would be wisest
to make the decision with the central aim of doing the maximum amount of greatest good
for the greatest number of people. The actual good that is being referred to can be
expressed in numerous ways such as referring to values such as happiness, being pain or
symptom free, or another life enhancing outcome (Ethical Theories, n.d., para. 2). There
can be a backside to this theory however which can cause acts that would be contrary to the
rights of individuals if the end result is one that would improve care for many others, this is
referring back to the theory of doing the greatest good for the greatest amount of people.
Deontology is simply following the moral theory of doing unto others as you would want
them to do unto you. This theory is placing more value on the intentions of the individual as
opposed to the actual outcome of any action. It also focuses on rules, obligations, and
duties. In order to follow the theory of deontology it requires absolute adherence to these
obligations and acting from duty is viewed as acting ethically. An ethical person must always
follow the rules, even if doing so causes a less desirable outcome. Since with this theory it is
the motives of the actor that determine the value of the act a bad outcome may be
acceptable if the intent of the actor was good. On the back side of this theory there is a
criticism in healthcare that applying a strictly deontological approach to healthcare can lead
to conflicts of interest between equally entitled individuals which can be difficult or even
seemingly impossible to resolve (Ethical Theories, n.d. para. 4).
Teleology is a theory that is opposite to deontology in a sense. Whereas with deontology it is
the intent of the decision made that determines the value as opposed to the outcome, with
teleology it is the outcome that determines whether the act is good or of value and that
achievement of a good outcome justifies using a less desirable means to attain the end.
Ethical relativism takes into account for the variability in what is considered to be normal or
acceptable to any given culture. What this is saying is that every culture has their own set of
norms and therefore certain behaviors that may be acceptable in one culture may not be
acceptable in others. A nurse must keep in mind that ethical standards are relative to
person, place, time, and culture. The nurse must take on the fact that whatever a person
thinks is right, is right. Right and wrong is not definite in most cases as there are no absolute
truths. While there are no universal truths in ethical relativism there are few topics that are
not open to debate, such as incest (American Nurses Association, 2011). Although this
theory has been largely rejected it is still valuable for a nurse to consider when caring for

their patients. If a nurse is better educated on the culture of their client and what is
considered normal or taboo they will be better equipped to provide excellent care in that
persons eyes without infringing on their culture or having a biased opinion of them.
Virtue ethics is different from other ethical theories in that it places much less emphasis on
which rules people should follow and instead focuses on helping people develop good
character traits, such as kindness and generosity. These character traits will, in turn, allow a
person to make the correct decisions later on in life. Virtue theorists also emphasize the
need for people to learn how to break bad habits of character, such as greed or anger. These
are called vices and stand in the way of becoming a good person. This theory, while having
the patients best interest in mind, focuses on the healthcare provider and asking them to
learn good habits while breaking bad habits in order to predispose them to making the
correct decision automatically while providing care to their clients. It requires the nurse to
take a look at his or herself and make judgments on their character and work to change
whatever is deemed unethical about themselves for the gre ater good of their patients. This
is an essential process of becoming a nurse as nobody is perfect and allowing oneself to be
open minded about change will allow them to be the best nurse possible. Justice and equity
is simple, it refers to being fair and equal to all patients no matter their socioeconomic
status or resources at their disposal.
This ethical theory is meant to protect the less privileged people in society and give them
access to fair and equal healthcare access without bias from the healthcare members caring
for them. The theory states that a veil of ignorance should be worn regarding who is
affected by a decision and should be used by all decision makers because it allows for
unbiased decision making. An ethical person should choose the action that is fair to all,
including both the advantaged and disadvantaged groups in society. This theory is in place
to protect those less fortunate people and is essential to all of society to keep the balance
and fairness when it comes to healthcare. Now that all of the ethical principles have been
defined it is easier to make sense of how the ethical theories came about for our healthcare
system and all the members of the healthcare team taking care of the patients.
It is essential for these theories to be understood and applied by nurses all across the world
in order to attain the best results for patients and the future of our healthcare system. It is
essential of nurses to be well versed in the ethical principles and even more so in ethical
theories to help guide them in their decision making when caring for clients. A nurse who
knows the ethical theories and furthermore applies them in the field will have better client
outcomes and prevent errors that can cause harm to a client in any way shape or form.
These theories truly help protect not only the patients being cared for but also the nurses
caring for those patients.

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