Understanding Ethical Dilemmas in Nursing: A Nurse’s Guide to Decision-Making

Blog title image for Ethical Dilemmas in Nursing

No matter how much you enjoy being a nurse saving the lives of thousands of people but there is time when you face a situation where you have to make a difficult decision. The decision of choosing between the options that conflict with your personal and professional ethics. No matter what choice you make it will have its consequences. This is called ethical dilemmas in nursing. In this blog we will discuss the code of ethics in nursing, the principles and standards that will help you in making difficult decisions.

What is the code of Ethics in Nursing?

The code of ethics in healthcare is set of principles or standards that nurses or healthcare professionals must follow to make tough decisions. The code of ethics is important because it helps nurses and other healthcare professionals to make morally sound decisions to provide best patient care.

To learn more about code ethics read our blog “Common Nursing Code of Ethics Challenges That Nurses Frequently Face.”

What are Ethical dilemmas in nursing?

Ethical dilemmas in nursing arise when nurses are facing conflicting choices regarding patient care. Making ethical decisions is an important skill for nurses and healthcare providers. Here we will discuss examples of ethical dilemmas in nursing and how to deal with these ethical dilemmas in healthcare.

Examples of ethical dilemmas in nursing

Learning how to handle ethical dilemmas is really important for the nurses and healthcare providers. Common ethical dilemmas in nursing and how to manage these ethical dilemmas are as follows:

Patient Autonomy vs Beneficence

  • Autonomy: Patient autonomy means the right of patients to make their owns decisions about their life, for example refusing treatment or leaving the hospital without treatment.
  • Beneficence: Beneficence in nursing means the duty of providing care that is best for their patients.

How is it an Ethical Nursing dilemma?

Sometimes nurses find themselves in a situation where they are caught in between patient’s autonomy (Right of making their own health choices) and beneficence (Duty to provide the best possible care). Let us discuss an example and the solution of how to deal with this nursing dilemma.

Example:

A patient is suffering from heart disease and the doctor thinks that the best thing to do is to have open heart surgery. This can give him the chance of survival. According to the cardiologist, without surgery the patient might live only for 6 months. Even though the patient knows the risks and benefits of the surgery, he still refuses to go with it. The family members force the healthcare providers to go on with the surgery but the patient refuses to do so. This is an example of an ethical nursing dilemma, where the nurses are caught between patient’s autonomy and beneficence.

What to do?

  • Nurses should fully inform the patient about the surgery and how it can be beneficial and what the risks are. But they should also respect the patient’s autonomy.
  • Nurses should acknowledge the fears and concerns related to the surgery and provide emotional support.
  • With the help of healthcare providers, nurses should communicate with the patient’s family to make sure that the patient is making an informed decision.
  • The nurses should always advocate for their patients, even if the healthcare team thinks that the surgery is the best thing to go for.
  • Offering alternative care options to the patient.

 

Common ethical dilemmas explained in the image

 

Confidentiality and Patient Privacy

  • Patient Confidentiality: To protect the healthcare information shared between patient and the health care provider. For example, sharing information to the unauthorized person.
  • Patient Privacy: The right of patients to control who can have access to the patient’s personal healthcare information so that they are free from what the outside world thinks about them who are not involved in care.

How is it an Ethical Nursing dilemma?

The patient confidentiality and patient privacy is another example of ethical dilemma in nursing where nurses cannot share healthcare information with the other person, but it might also cause a problem for the other person. Let us discuss an example and strategy on how to solve this problem.

Example:

If a patient is diagnosed with HIV and asks the nurse not to tell his partner about the disease. The nurse is facing an ethical dilemma because the nurse knows that the partner is at risk of infection.

What to do?

  • Patient counseling and encouraging the patient to talk to their partner.
  • Nurses can consult with the ethics committee to get guidance on what to do.
  • Legal reporting considerations.
  • Seeking help and advice from public health officials.

Allocation of medical resources during shortages

Another example of ethical nursing dilemma is allocation of resources during shortages. For example, during crisis hospitals might face shortage of resources where they face dilemma of who can get the care. This can depend on factors like age, medical necessity and more.

Example:

There is an emergency situation where 8 patients need ventilators to survive but there are only 5 ventilators. Three patients are of age with healthcare problems and 3 patients are adults who have a better chance of survival and 2 of the patients are middle aged suffering from other medical conditions too. This is a nursing dilemma for the nurses where they must decide who gets the ventilators.

What to do?

  • Follow triage protocols where they have to see which patients are critical and have the best chance of survival.
  • If triage protocol is not working in the situation, they can seek guidance from the ethics committee.
  • Open communication and transparency with patient families to maintain trust even in difficult situations.
  • Seek guidance from regulatory bodies if the decision is hard to make.

 

Strategies to solve ethical dilemmas shown in picture

 

End of life decisions

This is another nursing ethical dilemma example that the nurses might face. It is the decision where conflict arises between the patient, their families and healthcare providers.

Example:

Here is an ethical dilemma scenario where an 80-year-old patient is ill with heart problems and is on a ventilator. The patients request the nurses and healthcare providers that if the health of patient deteriorates they should not perform the life saving procedure such ad DNR ( Do Not Resuscitate). Now the patient has a heart attack and cannot communicate but the family members are forcing the healthcare professionals to perform DNR. Here the nurses are facing an ethical dilemma where they have to respect their patient’s request but also, they know that performing DNR might save the life of the patient.

Solution:

  • Most important thing for the nurses to do during this situation is to respect the patient request and wishes despite what family members say because DNR is a legal document that nurses must follow.
  • Communicate with the family and provide emotional support.
  • Seeking help and guidance form ethics and legal consultation if the family is pressuring and decision is hard to make.

What are moral dilemmas in healthcare?

  • Informed consent.
  • The right to refuse treatment is harmful for patients.
  • Resource allocation.
  • Conflicts with care givers.
  • Incompetence among peers.
  • Accepting gifts from patients.
  • Contrasting values between nurses and patients.

What action by a nurse best promotes the ethical principle of justice?

The principle of justice means that the nurses provide equal distribution of resources and care to the patient regardless of their background, ethnicity, race etc.

What are the most common ethical dilemmas in nursing?

Some of the most common ethical dilemmas that the nurses might face are:

  • Patient’s autonomy vs beneficence.
  • End of life decisions.
  • Resource allocation during crises.
  • Mandatory reporting vs patients trust.
  • Cultural competence.
  • Telling the truth and protecting patient’s emotions.

Strategies to solve ethical dilemmas

Here is the list of strategies that nurses must follow to solve ethical dilemmas:

  • Identify ethical dilemma
  • Gather important and related information
  • Consult ethical guidelines and policies
  • Engage in open communication
  • Involve patient and family
  • Apply key ethical principles
  • Explore different courses of action
  • Seeking guidance and help from the ethics committee
  • Reflect on your personal values
  • Document and keep record of your decisions
  • Follow up

Conclusion

Nurses face ethical dilemmas in their profession where they make tough decisions and navigate through challenging situations. In this blog we have provided the example of different ethical dilemmas in nursing and what is the best practice to solve these ethical dilemmas. We have discussed common ethical dilemmas in nursing such as patient autonomy and beneficence, maintaining confidentiality, allocation of resources during pandemic and much more. Nurses, while making these decisions, must adhere to the code of ethics in nursing.

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