Major Ethical Dilemmas in Nursing

By Cathy Fant on Tue, Mar 26, 2013

nurse ethicsNurses face ethical dilemmas on a daily basis regardless of where they practice. No matter where nurses function in their varied roles, they are faced with ethical decisions that can impact them and their patients. There is no “right” solution to an ethical dilemma.

So what is an ethical dilemma? It is a problem without a satisfactory resolution. The significance of ethical decision-making lays in the fact that very different ethical choices regarding the same ethical dilemma can be made resulting in neither choice being a “right or wrong” decision. 

Ethics involve doing “good” and causing no harm. But how one defines what is ethical can vary differently from nurse to nurse. Classes on the principles of nursing ethics give the nurse the tools to base ethical decisions upon. However, this knowledge is then shaped by the values, beliefs and experiences of the nurse. Consequently, very different choices may be made involving the same dilemma. 

There are many ethical issues nurses can encounter in the workplace. These include quality versus quantity of life, pro-choice versus pro-life, freedom versus control, truth telling versus deception, distribution of resources, and empirical knowledge versus personal beliefs. Quantity may address how long a person lives or perhaps how many people will be affected by the decision. Quality pertains to how “good” a life a person may have and this varies depending on how a person defines “good”.

So how does the nurse support a patient deciding between a therapy that will prolong life but the quality of life will be compromised? The person may live longer, but will likely experience significant side effects from the therapy. What should the nurse’s position be?

  1. Pro-choice versus pro-life. This issue affects nurses personally. Many of the positions nurses assume in this dilemma are influenced by their own beliefs and values. How does a nurse care for a patient who has had an abortion, when the nurse considers abortion murder? Can that nurse with very opposing values support that patient’s right to choose her autonomy?
     
  2. Freedom versus control. Does a patient have the right to make choices for one’s self that may result in harm, or should the nurse prevent this choice? For example, a patient wants to stop eating, but the nurse knows the consequences will harm the patient. Does the nurse have the “right” to force the patient to eat?
     
  3. Truth telling versus deception. This is another issue that nurses may have to deal with, especially when families want to deny telling the patient the truth about the medical condition. What should a nurse do when a family insists telling the patient the prognosis will cause harm? How can a nurse know if this is true? Does the patient have the right to know?
     
  4. Another dilemma involves the distribution of resources. Who should get the limited resources? For example, nurses working with patients that are in a vegetative state; should these patients be left on life support? Look at the cost of maintaining these patients. These patients are consuming resources that could be used for patients in whom such costly interventions, if available, could save their lives. What is the role of the nurse when a family wants to continue life support for a medically futile family member?
     
  5. nursing ethicsEmpirical knowledge versus personal belief. In these dilemmas, research based knowledge in nursing practice is contrasted to beliefs gained from such things as religious beliefs. For example, what should a nurse do when a patient is admitted to the hospital that desperately needs a transfusion to live but has the belief that transfusions are unacceptable? The nurse knows this patient will die without the transfusion. How does that nurse empathize with the patient’s family who supports the family member’s choice and still be supportive of the patient’s and family’s right to this decision? 

Ethical dilemmas in nursing come daily in which they must make a decision. The decisions they will make will be affected by so many factors including principles learned in school and their own personal beliefs, values and experiences. Are these choices “right or wrong”?

Nurses, please leave a comment below sharing your thoughts.

Reference

Bandman, E. & Bandman, B. (2002). Nursing Ethics Through the Life Span. (4th ed.). Upper Saddle River, NJ: Prentice Hall



20 COMMENTS

Anonymous 5 months ago
when a patient is about to die, it should be the patient's decision that would be done.

Peter Billy 6 months ago
dats why we say Nursing is a Profession...

Anonymous 6 months ago
I have a question. Many patients end up staying long-term in the ICU due to surgical complications resulting from a particular surgeon's regular errors. This has been going on for many years and nothing has ever been done about it. The management are aware of it, it has been reported on an ethics line and it is very distressing for the staff who look after these patients and their families. The costs are exorbitant, the stress on the families is phenomenal and the outcome is usually quite dire (due to unmanageable sepsis etc). The staff may not suggest a second opinion, even though it is a Patient Right, yet the surgeon will demand payment from the family regardless. The staff watch the same scenario time and again and feel that they contribute to the gross wrong-doing to the patient and his family. How can this situation be turned around without causing astronomical repercussions? Obviously the longer the patient is there, the more money the institution (and the surgeon) makes. The staff stand in unison about the fact that this is hugely unethical. There should be mutual respect amongst colleagues (medical and the nursing staff). All have spent many years studying and training so there should be no cause to deride one another. Nurses make mistakes, as do surgeons, but when the same errors occur on a regular basis - something should surely be done about it. The Nursing field has very rigid disciplinary measures in place. How then, does this misdemeanour occur so frequently without intervention? I would like to know if anyone has been in a similar situation and how it was resolved. Thank you for taking the time to read this post.

Anonymous 9 months ago
Okay so I need advice im scared. I was at a new job awoke with a tooth abscess and could not call off I went to work another nurse gave me antibiotics that belonged to a patient who had been discharged an aide got in my bag and took pictures and reported me I was honest about it. I lost my job I just recieved a letter from the nurse aide registry they are placing a misappropriation charge on the nurse aide registry site but im a nurse does that mean I still wont be able to work as a nurse and I still havent heard from the actual board of nursing except a phone call interview from a FACT FINDER who reports back info to the board im moving out of state next week can I get my license there and be safe from all this or will I then have two states to fight confused and scared to death does someone have advice for me

Anonymous 4 months ago
First and foremost - you were wrong. There is no excuse for what the nurse who gave you the antibiotics did, or for you taking the antibiotics. Second - you need a lawyer - and you need to prepare to deal with your states licensing board - as they may very well want to suspend or revoke your nursing license based on your VERY poor judgment.

That said - hopefully the licensing people will give you some consideration and allow you to keep your license on a probationary basis - giving you a chance to learn from this mistake and move on to what should be a fulfilling and rewarding career.

Anonymous 9 months ago
I absolutely agree. Nursing is a hard, and often underappreciated, career. Also, when a person decides to comment about something completely irrelevant to the subject at hand, that is quite aggravating to those who are trying to comment on the article. The place you go to vent unnecessary things in an unending diatribe against those who had done you wrong, is Twitter.

anonymous anonymous 9 months ago
It's very sad that so many of these comments display incorrect use of the English language. This is a negative reflection on nurses and on the writer. Please remember - Nursing is a profession. Ugh!

Jessica Whitney 10 months ago
I think that truth telling vs deception is a difficult ethical issue, especially if the patient doesn't have issues with perceptions of reality. Personally, I would struggle with not discussing the prognosis of a status with the patient if the patient directly asks me. It would have to be under the right circumstances, for the greater good of the patient, for me to use deception comfortably. Plus, I am an awful liar to boot.

Rebecca Crane 2 months ago
There may be some cultural considerations before we could make an informed ethical decision. Some cultures believe that the patient should never know they have a life-ending illness. Usually, the patient recognizes the dire circumstances, but chooses not to speak of it to the family in order to conform to the delusion and not cause the family distress.

Anonymous 2 years ago


ihad been a practicing nurse for 22 years with an exemplary record, not even a minor complaint filed. during the early 2000's i was having trouble with a rebelious teen age son. my son made an accusation that i struck him and i was arrested, the charges were dropped. this happened during the summer of 2005. the hospital i worked at got wind of these charges and made charges against me that i had stolen drugs during this time due to slight discrepencies in the time the drugs were withdrawn from a pixis and administration was documented by handwriting. i was not notified of any of this for almost 2 years after the charges were made. during that time i had retired and had not requested that my license be renewed. the virginia board of nursing posted on the internet that i had stolen drugs, was a danger to patients and they were refusing to renew my license. i had been employed at this hospital for more than 3 years and had only recieved outstanding evaluations. even though i worked as a flex employee my supervisor jumped on the band wagon and stated that he terminated me for not reporting to work eventhough i had told him i would no longer be available. now that all of this information has been posted on the internet for anyone to view i have recieved threats from an individual that he is posting this info on other websites of my friends and family. this person is not someone that has any interest in these charges against me other than for reasons of harrassment. there is no truth in the charges. if the virginia board of nursing feels it is imperative to has to file these items, proven or unproven, might not it be wise to allow access only to those that have a professional interest in the particular nurse? in my case HIPA was also violated. something should be done about this. i would never recommend to a young women that she consider nursing as a career.



Anonymous 4 months ago
So, you've contacted which lawyer who will retrieve your employment records from your previous employer, serve the Board of Nursing with a show cause order, file appropriate charges against the hospital, pursue HIPAA violations with the state Health Department, and serve the individual harassing you with a cease and desist order?

Anonymous 10 months ago
I agree with you and think you should find out the proper way of reporting HIPPA violations, and and possibly look into a law suit against the hospital for slander, defamation of character for unfounded charges. There seems to always be someone who starts a "witch hunt" on a nurse to make them look bad for revenge or because they seem to be a good "escape goat" person to blame unexplained things on. Unfortunately, there are definite problems in Nursing like this and it's rough when you aren't vicious, cut throat like the rest of them and you look "weak" to the others

Anonymous 2 years ago
I have been a nurse for many years-long before Roe vs Wade and many of the other ethical issues. With that said, I have never worked in a facility that has requested me to perform a procedure or assist with a procedure that I personally find morally wrong. I was taught to respect the wishes of the patient, their family and not to encourage or to aid anyone requesting a opinion on moral matter. However when I was taught those values, abortion and euthanisia weren't legal murder.

Anonymous 8 months ago
Most responses here by experienced nurses reveal pretty much what it use to be like 20-30 yrs ago. My experiences have been mostly positive through out the year but now is truly about money and politics which I see and its not unusual for the nurse to be hammered with little evidence. Once you've been the victim of a lynch mob you see that side of the coin and have to remember that that kind of behavior isn't right, and Karma does come to those who lie about evidence. Remember, physicians, for the most part will say just about anything when the need is to satisfy their needs. As a nurse you can and will be served up to authorities sometimes with backwards evidence. Always save your money so you can walk, don't threaten anybody, but don't back down when you get threatened either. Patient safety remains the priority.

Anonymous 2 years ago
I have been a nurse for 35 yrs; I remember being taught that our personal views were not to interfere with what needs to get done such as a transfusion (unless it is against the patients' beliefs). When patientsw asked I gave them facts, information to read based on science and research. If asked "what would I do" I let them know my choice is irrelevent to them. ethics is clear, not a debate if you are well grounded. If you disagree in the procedures such as abortions then don't work in the abortion clinics. We are there to make them healthier not to push our personnal beliefs.

Anonymous 3 years ago
I believe that it is my job to help my patient's to the best of my ability to recover and heal. I will give my opinion if the patient asks for it but will not let my beliefs affect my patient care.

Anonymous 3 years ago
If, a patient's family member wants me to tell the pateint something besides the truth then even if, the patient's family member is the patient's legal guardian or legal decision maker I will not. I won't give the information if it is another persons decision to do so. However, if the patient is confused due to a medical condition and it will reduce the anxiety due feeling confusion for the patient then this, I would think about.

The ethics issue is huge when both decisions could cost you your license, like: Your supervisor wants you to do one thing but your nursing judgement requires you to do something else. Then you have a delimma with the nursing board if an event happens either way.

Anonymous 3 years ago
To every challenge that a nurse encounters, his/her actions will be guided by wisdom and knowledge. Each situation is very different,and the decision comes at that very moment.

Anonymous 3 years ago
Not sure how long this has been here with no comments, it is such a difficult subject. I too have been in practice for over 30 years as an RN. In my undergraduate nursing program back in the '70s, we were taught that our own personal beliefs could not take precedence over our patient/family's beliefs and wishes and that is what has always informed my practice. Thus, I cannot understand the current debate among healthcare providers about not wanting to give/participate in medications and procedures because they are opposed on moral grounds. My job as a nurse has always been to provide care and support to my patients as they make the best decision for themselves. I can give them information BASED ON RESEARCH AND FACTS but it would be far overstepping my boundaries and extremely unprofessional to impose my belief system on them. It is not for me to judge what is the best thing for them to do, only to support them through their decision once they have made it based on all the facts and their own life circumstances. This, to me, is no dilemma...it is the art of nursing.

Anonymous 7 months ago
I agree with your statement that our own personal beliefs cannot precede over over a patient's beliefs and the part they take in the direction of care. I have been taught to provide my patients with resources when they request information and to keep my opinions to myself. It is my role to support them through whatever course they decide is best for them. With advancing technology and more options open now, there will be more debate as to what is ethical. If, as nurses, we face situations that we personally find reprehensible according to our own personal code of beliefs, isn't it our sworn duty to provide resources and facts, support our patients in their decided course of action without trying to influence them, and to administer nursing care to that end?