Ethical Dilemmas in Nursing

November 23, 2022
Janelle Thomas MSN, RN
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Nursing is a profession tightly connected to ethics. By taking on a role that involves caring for people dealing with sickness or injury, any nurse doing their job in good faith will be helping people.

Nurses can regularly run into dilemmas about what is the most right and ethical course of action. Each situation is unique and there are often no clear-cut answers, but the following guide can help you better understand some common examples of ethical dilemmas in nursing and how best to handle them.

Understanding Nursing Ethics and Ethical Dilemmas

Ethics are any set of moral principles that guide a person’s behavior or how they perform an activity such as a job. Nursing ethics are part of the broader idea of medical ethics, which helps medical professionals understand right and wrong as it applies to clinical medicine. Nursing ethics are specifically laid out by the American Nurses Association in their Code of Ethics for Nurses document, which contains nine provisions, including compassion and respect for patients, patient advocacy, and duty to self, among other directives.

As in any profession, ethical dilemmas can arise when a situation presents a choice between breaking or compromising one ethical value over another. Jobs are complex, and while the right thing to do may be obvious in some situations, in others, not so much. Being able to recognize these dilemmas when they arise can make it a little more clear to navigate — and hopefully, make the best possible choice.

4 Examples of Common Ethical Dilemmas in Nursing

Ethical dilemmas can occur anywhere a nurse practices, from the hospital to the clinic to the home. The following ethical dilemmas represent some of the most common clashes that nurses encounter in any setting.

1. Helping a Patient Whose Beliefs Clash with Medical Advice

Whether due to personal beliefs or stubbornness, many patients can be reluctant or even refuse a recommended medical treatment that a nurse has been ordered to administer. For example, a patient may refuse pain medication out of fear of becoming addicted or because they don’t want to be drowsy. This presents a dilemma to a nurse who must choose between a patient’s comfort and their own desires.

What to Do: Ultimately, as long as a patient is making an informed and conscious decision and it does not threaten their life or anyone else’s health, nurses are usually ethically bound to respect a patient’s wishes to refuse medication or treatment. When in doubt, always seek the guidance of a supervisor, manager, or physician.

2. Withholding Information to Save a Patient from Distress

If a nurse learns about a diagnosis or other piece of health information that they know would cause worry and anxiety, it may be tempting to withhold that information to save them from stress. For example, if a patient doesn’t understand the full extent of a particular condition they have been diagnosed with, but you are worried that giving them more information would just make them more upset and inhibit treatment.

What to Do: Nurses are ethically obligated to educate patients to help them make informed treatment decisions. Withholding important information can do them more harm in the long run and potentially cause further distress down the road. Always remember your therapeutic nursing skills and use empathy and compassion when speaking to anxious patients.

3. Having to Choose Between Patients

Dealing with limited resources is a reality that every nurse encounters, and some may have to make tough choices because of it. It is not uncommon to run into a situation where it seems like giving one patient the care he or she needs will require depriving another patient of equally essential care.

What to Do: This is one ethical dilemma that requires careful and respectful judgment on the part of the nurse, as well as collaboration with physicians, managers, and other team members. If presented with a situation like this, nurses should try to make a good faith decision based on the patient’s needs and current health. In the most difficult cases, care can come down to first come first serve if other factors are equal.

4. Dealing with Professional and Personal Boundaries

Nurses are supposed to keep a wall between their professional and personal lives, and personal relationships and emotions should not dictate care or decision making. Despite this, there may be situations where a nurse coincidentally encounters a patient they know personally, or encounter a current patient in a social situation or on social media. An ethical dilemma could arise if a deep personal relationship develops or exists with a patient you are currently helping in any capacity.

What to Do: It is important to gently establish boundaries with a patient who is looking to extend the nurse-patient relationship into a personal relationship. If the patient persists beyond a point you see as an ethical relationship, report this to your supervisor or manager and request having the patient reassigned to another nurse if possible.

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