What is an ethical dilemma?
An ethical dilemma is a situation in which there are two or more competing ethical principles, and no clear right or wrong answer. Ethical dilemmas can be difficult to resolve, as they often require nurses to weigh the potential risks and benefits of different options, and to consider the values of all stakeholders involved.
Why are ethical dilemmas common in nursing?
Nurses work in a complex environment where they must balance the needs of their patients, their colleagues, their employers, and the healthcare system as a whole. This can lead to ethical dilemmas, as nurses may sometimes have to make decisions that benefit one group of people at the expense of another.
Examples of ethical dilemmas in nursing
Here are a few examples of ethical dilemmas that nurses may face:
- A patient with a terminal illness refuses to receive life-sustaining treatment.
- A patient is unable to make their own decisions and their family members disagree about what treatment to pursue.
- A nurse is asked to participate in a research study that they believe is unethical.
- A nurse sees a colleague making a mistake that could harm a patient.
- A nurse is asked to ration scarce resources, such as ventilators or ICU beds.
How to make ethical decisions in nursing
When faced with an ethical dilemma, nurses should:
- Identify the ethical principles involved. What are the competing ethical principles in this situation?
- Gather relevant information. What are the patient’s wishes? What are the risks and benefits of each option? What are the values of all stakeholders involved?
- Consider your own values. What is important to you in this situation?
- Weigh the options. What are the potential consequences of each option?
- Make a decision. Choose the option that you believe is most ethical, given all of the factors involved.
Autonomy
Autonomy is the right of individuals to make their own decisions about their lives. In healthcare, autonomy is the right of patients to make decisions about their own care. Nurses respect patient autonomy by providing patients with information about their options and by supporting their decisions, even if they disagree with them.
Challenges to autonomy
There are a number of challenges to autonomy in healthcare. For example, patients may be unable to make their own decisions due to mental incompetence or a terminal illness. In these cases, nurses must work with the patient’s family or other surrogate decision-makers to uphold the patient’s autonomy as much as possible.
How to uphold patient autonomy
Nurses can uphold patient autonomy by:
- Providing patients with information about their options in a way that is clear and understandable.
- Respecting patients’ decisions, even if they disagree with them.
- Supporting patients’ right to refuse treatment.
- Advocating for patients’ rights and autonomy with other healthcare professionals.
Beneficence
Beneficence is the principle of acting in the best interests of others. In healthcare, beneficence is the principle of acting in the best interests of the patient. Nurses promote beneficence by providing patients with the care that they need and by working to prevent harm.
Challenges to beneficence
There are a number of challenges to beneficence in healthcare. For example, nurses may have to choose between two or more treatment options that each have their own risks and benefits. Additionally, nurses may have to balance the patient’s best interests with the interests of other stakeholders, such as the patient’s family or the healthcare system as a whole.
How to balance beneficence with other ethical principles
When faced with a conflict between beneficence and other ethical principles, nurses should:
- Weigh the potential risks and benefits of each option.
- Consider the values of all stakeholders involved.
- Make a decision that they believe is most ethical, given all of the factors involved.
Justice
Justice is the principle of fairness and equity. In healthcare, justice is the principle of providing all patients with the care that they need, regardless of their race, ethnicity, socioeconomic status, or other factors. Nurses promote justice by providing care to all patients in a fair and equitable manner.
How to promote justice in nursing
Nurses can promote justice in nursing by:
- Providing care to all patients in a fair and equitable manner, regardless of their race, ethnicity, socioeconomic status, or other factors.
- Advocating for equal access to healthcare resources for all patients.
- Challenging stigma and discrimination in healthcare.
Nonmaleficence
Nonmaleficence is the principle of avoiding harm. In healthcare, nonmaleficence is the principle of avoiding harm to patients. Nurses promote nonmaleficence by providing safe care and by working to prevent complications.
Challenges to nonmaleficence
There are a number of challenges to nonmaleficence in healthcare. For example, all medical procedures carry some risk of harm. Additionally, nurses may have to make difficult decisions about whether to provide certain treatments, such as life-sustaining treatment, when the risks outweigh the potential benefits.
How to avoid harming patients
Nurses can avoid harming patients by:
- Following evidence-based practice and safety guidelines.
- Being aware of the risks and benefits of all medical procedures.
- Communicating the risks and benefits of treatment options to patients and their families.
- Obtaining informed consent before performing any medical procedures.
- Monitoring patients for complications and taking steps to prevent them.
Conclusion
Ethical dilemmas are common in nursing, but nurses can develop the skills to make ethical decisions by understanding the ethical principles involved, gathering relevant information, considering their own values, weighing the options, and making a decision that they believe is most ethical, given all of the factors involved.
Resources for further learning
- American Nurses Association (ANA) Code of Ethics for Nurses
- ANA Center for Ethics and Human Rights
- The Hastings Center
- The Greenwall Foundation Bioethics Program at Johns Hopkins University
FAQs
Q.What should I do if I face an ethical dilemma in nursing?
If you face an ethical dilemma in nursing, you should talk to your nurse manager or another trusted colleague. You may also want to consult the ANA Code of Ethics for Nurses or seek advice from a clinical ethicist.
Q.Who can I talk to about an ethical dilemma?
You can talk to your nurse manager or another trusted colleague about an ethical dilemma. You may also want to consult the ANA Code of Ethics for Nurses or seek advice from a clinical ethicist.
Q.What are the legal implications of making ethical decisions in nursing?
Nurses have a legal duty to act in the best interests of their patients. Nurses also have a legal duty to respect patient autonomy and confidentiality. Nurses may be held liable for their actions if they make unethical decisions.
