We all know that ancient Greeks enjoyed contemplating many aspects of life. Plato, Socrates, Aristotle, and Hippocrates, among others, raised issues to which we continue to seek answers, such as “How should one live?” This topic is at the heart of ethics, communicating centuries’ worth of argument from philosophers, authors, and others as they attempt to make decisions based on a system of moral principles, beliefs, and values that help us distinguish right from wrong and fulfill our responsibilities.
A portion of a person’s responsibilities is their profession. Many occupations are directly tied to moral and ethical principles. This article will focus on ethical issues and dilemmas that arise in the nursing profession. Read on to learn more about nurses’ ethical awareness, ethical dilemmas in nursing, how to handle such situations, and the consequences of violating a nurse’s code of ethics.
Nursing Code of Ethics
A Nurse’s Code of Ethics is a collection of broad standards or values published by the American Nurses Association (ANA) to instruct all nursing professionals operating on their behalf on how they should operate. All nurses are expected to respect and uphold the association’s morals, values, and priorities as stated in such a code.
The Code of Ethics for Nurses with Interpretive Statements (the Code) is a pamphlet that sets the ethical standards for nursing and offers clear guidance for ethical analysis and decision-making. The Code contains nine provisions, which are explained below:
- First provision – Nurses must demonstrate compassion and respect for the inherent dignity, worth, and unique characteristics of each individual.
- Provision two – The primary responsibility of nurses is to the patient, whether that patient is an individual, family, group, community, or population.
- Provision three – Nurses should advocate for and safeguard the rights, health, and safety of their patients.
- Provision four – Nurses have authority, accountability, and responsibility for nursing practice, making decisions and acting in accordance with their responsibilities.
- Fifth Provision – Nurses owe themselves the same duties as they do to others.
- Sixth Provision – Individually and collectively, nurses should build, maintain, and enhance the ethical atmosphere of their workplace and employment conditions.
- Provision seven – In all roles and contexts, nurses should promote the profession via research and intellectual inquiry, the development of professional standards, and the formulation of nursing and health policies.
- Provision eight – Nurses should engage with the public and other healthcare professionals to preserve human rights, promote health diplomacy, and assist in the reduction of health inequities.
- 9th Provision – Collectively through its professional organizations, the nursing profession must communicate nursing ideals, uphold the integrity of the profession, and integrate concepts of social justice into nursing and health policy.
What Is Ethical Dilemmas In Nursing?
Despite the ANA’s standards, nurses continue to face situations in which they must choose between two or more solutions that do not adhere to the Nurse’s Code of Ethics in its entirety. When faced with an ethical dilemmas in nursing, these professionals must choose between two or more actions, each of which will undoubtedly violate a portion of their ethics code. In addition, ethical dilemmas in nursing may produce a conflict between a nurse’s ideals that extends beyond the Nurse’s Code of Ethics.
Reasons for Ethical Dilemmas Cases in Nursing
When caring for patients, ethical issues arise in nursing. There are numerous reasons why nurses confront ethical dilemmas, with the following being among the most common:
- Patients avoid treatment despite the potentially fatal implications.
- Conflicting with their personal convictions,
- Parental consent is required for the treatment of children.
- Participation of minors in decision-making,
- Different values held by nurses and patients,
- In contradiction with other ethical norms is confidentiality.
Examples of Ethical Dilemmas in Nursing
The aforementioned causes, in conjunction with the nine rules of the Nurse’s Code of Ethics, result in a number of ethical dilemmas in nursing practice that the majority of nurses will confront at least once during their employment.
Following are some examples of frequent DNR ethical dilemmas in nursing when the treatment of patients is complicated by an increase in conflict between the patient’s rights and nursing obligations. In addition, we will cover some ethical principles of nursing designed to guide nurses’ decision-making while achieving the greatest possible patient outcome.
Pro-life vs. Pro-choice
The pro-life vs pro-choice argument in the United States is a very contentious ethical dilemma. Roe v. Wade is a major U.S. ruling. As of May 2022, the Supreme Court ruling that the Constitution of the United States preserves a woman’s right of choice about abortion is near to being overturned. Both sides have strong convictions and arguments for why one option or the other should be legally protected.
In nursing, however, a dilemma occurs when the law or a patient-related medical concern constitutes one thing, while the patient requests something else. Patient A, who is pregnant and has a history of congenital cardiac abnormalities, is a typical example of a case in which such an ethical dilemmas in nursing research could develop. The likelihood of patient A’s health worsening due to pregnancy is high. In addition, there is a possibility that the infant will suffer a cardiac issue, further complicating the birth. Patient A is, nevertheless, unwilling to undergo an abortion due to their religious convictions.
Should the nurse counsel the patient to undergo life-saving therapy when asked, or should they respect the patient’s personal preference? This is the pro-choice versus pro-life dilemma.
Empirical Knowledge vs. Religious Beliefs
It is a general understanding that religious customs should be respected. Where do you, as a nurse, draw the line when a patient’s religious views conflict with what is medically essential to preserve their health? When nurses treat Jehovah’s Witness patients, the empirical knowledge vs religious belief ethical dilemmas arise more frequently than in any other situation. Their religious views prohibit them from receiving a blood transfusion.
However, what if a patient needs a blood transfusion to survive? Again, as a nurse, should you follow your training and guarantee the patient’s safety and health, or should you honor their request? Essentially, this is the dilemma.
If the patient is conscious and aware of the repercussions of refusing the transfusion, there is typically little that can be done. Ensure that your medical explanations of their health are exhaustive and that you maintain full documentation of their refusal of treatment.
Autonomy vs. Beneficence
The autonomy vs beneficence nursing ethical dilemma examines a further scenario in which a nurse must determine whether to proceed with a necessary therapy that the patient is opposed to.
Consider the following scenario: one of your patients has been diagnosed with stage IV cancer, and doctors have determined that nothing can be done to help them. At this point, the only thing the medical staff can offer is medication to alleviate the patient’s agonizing pain while they relax at home. However, the patient refuses to take the prescription because it makes them weak and drowsy, and they wish to spend their final days with their loved ones while awake. The patient’s family members beg you, as the nurse, to administer the medication without the patient’s awareness because they can see that the patient is in excruciating pain. What ought you to do?
As terrible as it may be for the patient’s family to witness their loved one in pain, as a nurse you are required under the Code to comply with the patient’s desires so long as they are aware of their condition while making the decision.
Parent Refuses to Vaccinate their Child
Although vaccination is an effective method of disease prevention, many people in the United States and around the world are hesitant and avoid immunization completely. Permitting individuals to make decisions that could damage themselves is a minor challenge compared to working with parents who refuse to vaccinate their children.
You cannot go against the guardian’s wishes for their children as a nurse. You can only present as much information as possible to ensure that the parents are aware of the repercussions of their decision on the child. If it is not required by law that the child be vaccinated against a specific disease, all you need to do is have the parents sign a paper declaring their position. See also dilemma in psychiatric nursing.
Being Honest vs. Withholding Information
Magnificent is the capacity of honesty to establish trust between patients and healthcare personnel. We are usually instructed to be true, but what if you believe that your honesty may cause more harm than good? If patient B is not coping well with a particular health concern, this situation illustrates the ethical dilemma between being truthful and concealing information. As their nurse, you believe that a detailed explanation of the severity of their disease will increase their fear and worry, so deteriorating their mental health.
However, unless there is scientific evidence that informing patient B of the facts may have a fatal consequence, you are required to be honest and not hide any information. When faced with such a choice, your stance forces you to choose the “honesty” side, no matter how difficult it may be.
Healthcare Needs vs. Resource Allocation
Nurses are expected to provide care for each patient on an equitable basis. However, in some instances, they are forced to choose which one deserves or requires treatment more than the other. The healthcare needs versus resource allocation ethical dilemma in nursing involve a lack of resources that would provide the nurse with the means to adhere to the rule of providing equal care to all patients.
Consider yourself a nurse caring for and administering medication to twelve patients. However, you are notified that there is a scarcity of a particular prescription that all patients require. What should be done?
The best-case situation would be if the medicine could be safely substituted with another. However, you would still have to decide which individuals are in greater need of the correct medication at that moment.
Personal and Professional Boundaries
Sometimes, separating our personal and professional life is easier said than done. As a nurse, you will be well-liked for helping to improve the lives of others, and sometimes your patients or their family members will seek out your companionship.
If a patient, past patient, or even a relative of theirs follows you on social media, this is a common occurrence in the modern era where it is so simple to meet people and develop connections. The behavior appears innocuous. However, as a nurse, are you permitted to develop relationships that extend beyond the nurse-patient relationship? Typically, the answer is no.
It is acceptable to greet back a patient, inquire about their health, and respond to similar questions. Nonetheless, having a personal bond with them when they are part of your professional life is quite different. Read also ethical dilemma in nursing case study examples.
End-of-Life Decision-Making
When a patient is suffering from a dreadful condition or injury that guarantees a short period of time before death, the patient may elect to suspend some treatments and resuscitation measures. As a nurse, you must respect the patient’s decision to stop fighting for their life, no matter how difficult it may be.
The issue of making end-of-life decisions reaches its pinnacle when the patient’s heart ceases to beat consistently. As a healthcare provider, you must then choose between following your instinct and continuing with life-sustaining therapy or allowing the patient to die according to their wishes. In such instances, patients sign Do Not Resuscitate (DNR) forms, which are requests not to do CPR when necessary. The DNR is noted in the patient’s medical record, and you must adhere to it. Read also abortion ethical dilemma in nursing.
Science vs. Spirituality
The spiritual and scientific aspects of life are quite distinct yet complimentary. Similarly, research confirms that spiritual practice can have a favorable effect on medical efficacy, hence the two are complementary in the field of medicine. That is not always the case, however. When patients are overly preoccupied with their spiritual beliefs, they refuse to consider the empirical evidence you give.
As a nurse, you will face ethical dilemmas involving the spiritual versus scientific perspectives of your patients, their families, and loved ones regarding their medical condition. What should you do if patient X’s family members, who scientifically have minimal chance of surviving a procedure, refuse to acknowledge the risk due to their spiritual confidence that all will go well?
According to the Nurse’s Code of Ethics, you must respect the beliefs and religious traditions of all your patients. Therefore, you are obligated to support their decision even though you disagree with their views and feel upset when they disregard your cautions and explanations of the potential danger. See also example of ethical dilemma in nursing.
The Patient does not Have an Advanced Directive
In numerous instances, ethical dilemmas in nursing were resolved by simply accepting the patient’s desires. Nevertheless, this is not always possible. In the absence of an advanced directive, nurses may be required to act contrary to the patient’s desires.
Imagine that you are caring for a muscular dystrophy patient who is 80 years old and male. One day, he mentions that he has become tired of dealing with the condition and that he does not wish to be resuscitated when the time comes. However, he loses consciousness before signing an advanced directive, including a Do Not Resuscitate order.
Even though you are aware of the patient’s desires, in the absence of a living will, the power to decide how treatment continues typically resides with a patient’s family member. Read also ethical dilemmas in mental health nursing.
Duty and Compassion Do Not Align With Facility Safety Protocols
It should come as no surprise that most nurses are compassionate individuals who want to alleviate their patients’ suffering, given that they are motivated to nursing by a desire to aid those in need. To assist their patients, caregivers may find themselves in situations where their obligations and the facility’s safety rules prevent them from acting on their emotions.
A simple illustration of this would be if you, as a nurse, are caring for a patient with a fatal viral infection. They have no remaining family members. Consequently, you promised that you would not abandon them. A few days later, you are relocated from the sector where patient Y is located, and safety standards prohibit your return.
Knowing that you have violated a portion of your moral code by not keeping your word is challenging, but it is for the greater good. Safety protocols are designed with healthcare in mind, and you can describe the scenario to another nurse in charge of the ward where patient Y is located so they can reassure the patient that they are not alone.
Questionable Medication Orders
Nobody is perfect. Even highly qualified physicians can occasionally overlook something or make a mistake. The benefit of working at facilities with so many healthcare professionals specializing in various parts of medical care is that a single order passes through multiple persons. What the physician did not detect, a nurse may observe.
Although nurses are instructed to obey physicians’ directions, an ethical problem may develop when it is unclear if the doctor’s prescription is the best option. It could be an allergy, problems with an existing medical condition, or another factor that compels you to doubt the doctor’s medical order in the patient’s best interest.
Never be afraid to advocate for your patients and do all possible to guarantee they receive the best care possible. The physician would likely appreciate your consideration and attention to detail, which prevented a mistake. Read also the ethical dilemma in nursing informatics.
How to Deal With Ethical Dilemmas in Nursing
As you may have observed from some of the “solutions” presented in the instances of ethical dilemmas in nursing described above, the best course of action is frequently to prioritize the Nurse’s Code of Ethics over what you perceive to be the proper decision based on your emotions and feelings.
The provisions of the code that you are obligated to observe were formulated by experts who have faced similar issues and contemplated the best course of action. In situations where even the code is being questioned, remember to always respect the patient’s desires and adhere to the rules, ensuring that everything is well-documented and everyone is informed.
Consequences of Avoiding Ethical Dilemmas in Nursing
You may believe that avoiding ethical dilemmas in nursing is the best method to ensure you do not breach the nurse’s ethical code. However, this is false. If you attempt to sidestep ethical dilemmas in nursing, you will likely face disciplinary action from your supervisor or, in extreme situations, a lawsuit that can result in the loss of your license. On top of that, attempting to dodge the challenge can cause you more stress than just discussing it with your patient and healthcare team to find a solution.
Therefore, keep in mind that ethical dilemmas in nursing are a normal aspect of the job, and if you prioritize the well-being and comfort of your patients, you will find a solution.
Our Final Thoughts
Nursing and ethical dilemmas in nursing go hand in hand, so whether you are an aspiring nurse reading about challenges you may face or a certified nurse wondering whether they are the only ones facing such puzzles, you are not alone. You do not have to shoulder the entire load. Seek support and guidance to make navigating such dilemmas simpler.
Also Read: What is Evolution of Nursing
