1. Autonomy vs.

Beneficence – Nurses are required to administer

prescribed medicine, but patients, at the same time, can refuse them. Patient
autonomy can go against medical directives, despite clearly defined needs.
Patients have a right to refuse all medical care. The ANA highlights that it is
important for nurses and nurse managers to understand patient backgrounds
and individual circumstances to inform the patient of the medical necessity.
“Using ethical principles to arrive at a solution should be done in an
atmosphere of caring, respect, openness, and honesty. This process should
be based on a sound ethical, decision-making model, using the best evidence-
based-practice guidelines available,” the ANA explains.

4 Common Nursing Ethics Dilemmas

1. Informed consent
Concerns that patients and their families have not been fully informed
about their treatments or clinical prognosis is a common ethical concern
of nurses, Ulrich reported.

“It can create great concern for nurses,” Ulrich said. “Patients feel more
comfortable asking the nurse to decipher what was said [by the doctor].
But it’s an ethical issue about how much they should convey.”
This is especially true about end-of-life decision making, she said. But
nurses may not be prepared to have this discussion. She suggested
building stronger interdisciplinary teams. 

2. Disclosing medical conditions

Another example of an ethical dilemma is telling the truth to a patient vs.
being deceptive, Altman said. 

“Sometimes families request that patients not be told about their medical
condition or diagnosis,” Altman added. “The nurse must consider the
patient's right to know. How does the nurse know what the family is
saying is true?”

The nurse has an obligation to the patient and the ethical principles of
nonmaleficence and fidelity—the obligation to prevent harm and the
obligation to be faithful to your colleagues, Altman said, adding, “The
nurse’s own value of truth telling must also be considered.”

3. Incompetence among peers

Another dilemma involving nursing ethics is when a nurse notes
incompetence in a fellow health care team member and struggles with
speaking up or staying silent, said Sarah Delgado, RN, MSN, ACNP, clinical
practice specialist with AACN.
“They may feel the behavior should be reported because of the threat to
patient safety but hesitate to do so because it would worsen inadequate
staffing,” Delgado said. “Some dilemmas can be framed as competing
obligations, such as protecting the patient on one hand and protecting the
 staff on the other. The principles to consider are nonmaleficence and
fidelity.

Resolving what appear to be competing obligations often requires thinking

creatively, Delgado added.

“Solutions often become apparent when we stop and consider all the
possible actions available to us,” she explained. “Beyond report or don’t
report, there may be an option to talk to the individual in question, assess
his or her awareness of the incompetence, and encourage further training,
education or practice.”

4. Broader ethical issues

According to Felicia “Liz” Stokes, JD, RN, senior policy advisor at the ANA’s
Center for Ethics and Human Rights, ANA considers the top three nursing
ethics issues as:

 Creating and maintaining an ethical work environment

 Nursing’s role in social justice, such as opposing capital punishment
 Moral distress and moral resilience.
“The Code of Ethics for Nurses with Interpretive Statements is clear that
nurses are bound in their duty to protect human health,” said Ruth McBain on
behalf of ANA. “As the guiding voice for nursing ethics in the United States,
the ANA feels that it is important to take a strong position on issues affecting
human dignity and societal health.”