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Ethical Issues in Nursing

  • Ethical Issues in Nursing


    Revisiting Ethics

    Ethical situations are never easy. They typically spark deep emotions in patients, families, and the

    multidisciplinary team. They occur when an individual is forced to choose between two alternatives, neither of which is ideal. It is no wonder these situations are commonly referred to as ethical dilemmas. Deep emotions surface because there is really no way to determine whether one alterative is better than the other.


    But before we discuss ethical dilemmas any further, let’s review the difference morals and ethics because it is easy to confuse the two concepts.


    Morals Versus Ethics

    Morals are an individual’s code of acceptable behavior; they shape an individual’s values. Values are influenced by a person’s culture and experiences.


    Ethics, on the other hand, are a standardized code or guide to behaviors. Ethics consider whether

    behavior is right or wrong.


    Morals are learned through growth and development. while ethics are typically learned through an organized system. Some professional organizations have developed codes of ethics to

    help guide ethical decision-making in their specialty area. For example. as you probably recall, the

    American Nurses Association developed a Code of Ethics for Nurses; this code was designed to guide

    nursing practice.



    Bioethics examines ethical issues in health care. health science, and healthcare policy. It commonly involves decisions and behaviors surrounding life and death issues. These issues sometimes cause

    conflict between the patient’s or the family’s morals, values, and ethics, and those of healthcare team members. There may also be conflicts between members of the healthcare team and the healthcare

    facility. especially if a cost-benefit analysis is put into the equation.


    Reflect on an ethical dilemma that you encountered over the course of your nursing program. Was the

    situation emotionally charged? Were the patient’s morals, values. or ethics in conflict with the family or

    members of the multidisciplinary team? What emotions did the situation trigger in you?


    Four Ethical Principles

    As you may remember. there are four ethical principles that can help guide nurses and the entire multidisciplinary team when ethical issues arise. Let’s refresh your memory by reviewing those



    The first principle, autonomy. focuses on an individual’s right to make decisions. An individual

    can participate in treatment decisions and ultimately make the final decisions about treatment and care.

    However, to make decisions, the individual must be fully informed about treatment options. Nurses play a key role in ensuring that patients are fully informed about the risks and benefits of their treatment

    options before making decisions. They also play an important role in supporting the patient’s decisions,

    even when they do not agree with them.


    Beneficence. the second principle, involves caring for the patient not only physically. but holistically as well. It also involves maintaining the patient’s safety and protecting him from harm.


    Four Ethical Principles

    The third principle. justice, consists of treating the patient fairly. If you think back to your course on health promotion and disease prevention, it involves eliminating health disparities and making sure all

    patents receive the care they need regardless of their situation.


    Veracity, the fourth principle, entails being truthful with the patient—a key element in developing a

    trusting nurse—patient relationship. This principle is sometimes difficult to apply because some believe

    that occasionally there are instances when the truth may cause more harm than good. In that case, another principle, such as justice, may be considered before veracity.


    Ethical Decision-Making Process/Nursing Process

    When an ethical issue arises, it is important to remember that a nurse should only participate in ethical decision-making if the nurse is involved in the patient’s care. If the nurse is not involved in the patient’s care, the nurse should not participate in the ethical decision-making process for that patient.


    So, what is the first step in ethical decision-making after you identify an ethical issue? Well. you can

    begin by using the first step in the nursing process, assessment. Assess the patient’s physical condition,

    psychosocial status, and the treatment plan. Assess the patient’s wants and desires. Explore to find out

    what values are involved. What is the conflict? If the patient permits. speak with the family or significant

    others to shed more light on the situation. Keep in mind that although the family or significant others may be involved in treatment decisions, the patient is the final decision-maker, unless unable.


    Ethical Decision-Making Process/Nursing Process

    So you have assessed the situation—now what?


    Next. apply the planning step of the nursing process. Using your assessment findings, develop a plan to

    address the ethical dilemma. If willing and able, involve the patient in the planning process. Consider

    the options and goals of all of those involved.


    Before implementing the plan, make sure the patient accepts the plan and agrees with it. Advocate for the patient during implementation, even if you disagree with the patient’s decision.


    Finally, evaluate the effectiveness of the plan and revise it as needed with the patient’s involvement, if




    Case Study: Ethical Decision Making in Action

    Now’ let’s take a look at this process in action. A 58- year-old patient new4y diagnosed with colon cancer undergoes a colon resection. Her oncologist recommends follow-up treatment with chemotherapy. The patient says, “l don’t like to take drugs,” and refuses chemotherapy and other further treatment. The patient’s husband is distraught and wants the healthcare team to convince his wife that she is making a bad decision. The patient’s oncologist explains that without chemotherapy the

    patient probably will not survive.


    What is the ethical dilemma? The patient does not want to undergo chemotherapy even though it is

    most likely her only chance of survival. And you know that according to the ethical principle autonomy. the patient has the right to make decisions that impact her treatment she’s the final decision-maker. But it is difficult knowing that she most likely has no chance of survival without treatment.


    Case Study: Ethical Decision Making in Action

    You begin your assessment. Physically the patient is doing well in her surgical recovery. She is relatively young and in good physical condition despite her diagnosis. With further investigation. you uncover some psychosocial information: the patient tells you that her grandmother died of colon cancer. She mentioned that as a teen she watched her grandmother suffer and die a horrific death because of the effects of chemotherapy.


    Case Study: Ethical Decision Making in Action

    You present your assessment findings to the multidisciplinary team. using the information from your assessment, the oncologist speaks to the patient about improvements in chemotherapy since her grandmother underwent treatment. You reinforce the oncologist’s teaching so that the patient can make a fully informed decision.


    The patient stands by her decision not to undergo chemotherapy, much to the distress of her husband.


    Case Study: Ethical Decision Making in Action

    With input from the patient, you develop and implement a plan to address the ethical situation. Even though you do not agree with the decision, you support and advocate for the patient.


    This is an example of just one type of the many ethical dilemmas you are likely to face over the course of your nursing career. Remember, these situations are rarely easy, so rely on ethical principles and the nursing process to guide you through.




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