When choices need to be made concerning ethical issues, but the “best” course of action isn’t clear and the treatment options aren’t ideal, nurses are often faced with an ethical dilemma.
In today’s healthcare environment, ethical issues in nursing are becoming increasingly complex. The American Nurses Association developed the Code of Ethics for Nurses to establish the ethical standard for nurses and the ethical obligations and duties of everyone in the nursing profession.
Applying the nursing code of ethics in difficult patient-care situations guides you through common ethical issues nurses face every day.
Common Ethical Issues in Nursing
Ethics in nursing is fundamental to the integrity of the nursing profession and ensure better patient outcomes.
Nurses in all settings and roles are bound by the ANA’s nursing code of ethics, which deals with various areas of patient care and provides guidance in handling the top ethical issues in nursing today, such as the five discussed below.
1. Giving Artificial Hydration and Nutrition
“Artificial hydration and nutrition is the most difficult conversation to have with patients, family and staff,” says Helen Staples-Evans, DNP, RN, NE-BC and Chief Nursing Officer at Loma Linda University Children’s Hospital.
“Some issues that have caused concerns among nurses are placement of a G-tube in a nursing home patient with end-stage dementia who is no longer eating and not placing a G-tube in a stroke patient based on their Advance Directive that states he/she would never want a feeding tube placed.
“Not giving artificial feeds and hydration to a dying person is very difficult for the families and staff,” Staples-Evans continued. “Some nurses feel it is ‘starving the person to death.’ This is even worse in the pediatric setting when the parents have made the decision to discontinue life-sustaining treatments and focus on comfort. The discomfort among nurses grows the longer the child is alive and not being fed.”
2. Providing Futile Care or Agressive Interventions
Staples-Evans points out that futile care or aggressive interventions, despite seeing the patient’s progressive decline, is another ethical dilemma some nurses face.
“Nurses see patients who are in multi-organ failure suffering who continue to receive dialysis, mechanical ventilation and other aggressive interventions because the family won’t let go,” explains Staples-Evans.
Kristie Aylett, APR, Fellow PRSA, is the Public Relations/Communications Consultant for the American Association of Critical-Care Nurses. She says the number one resource accessed on the AACN website in 2018 was related to ethics: a study published in the American Journal of Critical Care about Predictors of Moral Distress in a US Sample of Critical Care Nurses.
“According to co-author Catherine Hiler, RN, DNP, CCRN-CMC, the intensive care unit is a practice environment where life-sustaining care intersects with end-of-life care. We found high levels of moral distress frequency when nurses deemed that the care being provided was futile, and the highest level of moral distress frequency occurred when the wishes of the patient’s family to continue life support were followed even though the nurse believed that doing so was not in the best interest of the patient.”
3. The Opioid Crisis
Ethical issues in nursing also emerge from the opioid crisis. Nurses must adhere to ethical guidelines surrounding the opioid epidemic as they struggle with the dilemma of the best treatment approach for their patients.
According to Staples-Evans, some of the opioid-related ethical dilemmas nurses face are “fear of giving opioids to individuals at the end of life, because the nurse doesn’t want to be the one to give the ‘last dose,’ and nurses not giving pain medications or advocating for their patients in pain because they’re concerned with addiction.”
4. Dealing with Noncompliant Patients
Ethical dilemmas for emergency room nurses sometimes stem from patients brought into the ER who clearly require acute medical care but aggressively decline medical treatment. While a patient has the right to be autonomous, as a nurse, you have an ethical obligation to advocate for needed medical treatment.
Unfortunately, you can try to administer care and dispense prescribed medications, but the patient has every right to refuse all medical treatment, even if it means they may not survive. Nursing ethics require you to inform your patients of the necessity for medical treatment, but you can’t force them to accept it.
A common barrier to noncompliance is science versus spirituality. As the Duquesne University School of Nursing explains on its blog, some religions restrict medical interventions, so patients or their family members with strong religious convictions may feel that science-based health care infringes on their religious beliefs and refuse much-needed treatment.
The ANA’s nursing code of ethics delves into this issue and states that nurses must respect their patient’s religious beliefs, but that doesn’t imply they condone those beliefs.
5. Anti-Vaccine Dilemmas
Ethical concerns about autonomy versus beneficence often become a heated debate when addressing childhood immunizations.
A parent’s autonomy gives them the right to refuse to immunize their children, but not vaccinating potentially poses a public health hazard and could cause previously eradicated diseases to reappear.
When you’re attempting to overcome the obstacles to vaccination, you must attempt to unearth why a parent is anti-vaccine, provide them with accurate information about the importance of vaccinating and discuss their hesitation.
Seek Help with Ethical Issues in Nursing
No matter what type of ethical issues you’re facing, remember there are avenues for assistance, including your nurse manager or your facility’s ethics committee.
“I tell my nurses to always ask themselves, 'What are the goals of the patient and/or family?' Our role is to help the patient and family meet those goals, not convince them otherwise,” concludes Staples-Evans.
“They must also ask themselves, 'Will the treatment I'm concerned about meet the goals of the patient and/or family?' If the answer is yes, then the treatment should be continued; if not, the treatment shouldn’t be done.”
What are some examples of ethical issues in nursing? ›
- Pro-life vs. pro-choice.
- Empirical knowledge vs. religious beliefs.
- Autonomy vs. beneficence.
- Parent refuses to vaccinate their child.
- Being honest vs. withholding information.
- Healthcare needs vs. resource allocation.
The ethical principles that nurses must adhere to are the principles of justice, beneficence, nonmaleficence, accountability, fidelity, autonomy, and veracity.What are some ethical issues with telehealth? ›
Threats to Patient Privacy
Patients may not know exactly who will be responding to and sharing their personal medical information. That information is available on different devices and computers, increasing the potential for security breaches, which may undermine patients' acceptance of telemedicine.
- Do-Not-Resuscitate Orders. ...
- Doctor and Patient Confidentiality. ...
- Malpractice and Negligence. ...
- Access to Care. ...
- Physician-Assisted Suicide.
The major 10 ethical issues, as perceived by the participants in order of their importance, were: (1) Patients' Rights, (2) Equity of resources, (3) Confidentiality of the patients, (4) Patient Safety, (5) Conflict of Interests, (6) Ethics of privatization, (7) Informed Consent, (8) Dealing with the opposite sex, (9) ...What are the 10 nursing ethical values? ›
The search yielded 10 nursing ethical values: Human dignity, privacy, justice, autonomy in decision making, precision and accuracy in caring, commitment, human relationship, sympathy, honesty, and individual and professional competency.What are the 4 ethical dilemmas? ›
In LDRS 111 you were introduced to four different ethical dilemma paradigms: truth vs loyalty, short-term vs long-term, individual vs community, and justice vs mercy.What are legal and ethical issues in telemedicine? ›
Conclusions: The ethical and legal issues related to the practice of telehealth or telemedicine services still need standard and specific rules of application in order to guarantee equitable access, quality of care, sustainable costs, professional liability, respect of patient privacy, data protection, and ...What are the three ethical and legal aspects of telemedicine? ›
There are medicolegal implications of telemedicine relating to registration, licensing, insurance, quality, privacy and confidentiality issues, as well as other risks associated with electronic health care communication.What are the 4 main ethical principles in nursing? ›
There are four main principles of ethics: autonomy, beneficence, justice, and non-maleficence. Each patient has the right to make their own decisions based on their own beliefs and values.
What is an ethical issue example? ›
Some examples of ethical dilemma include: Taking credit for others' work. Offering a client a worse product for your own profit. Utilizing inside knowledge for your own profit.What are the 9 code of ethics for nurses? ›
What Are The 7 Ethical Principles On Which The Nursing Code Of Ethics Is Based? The 7 ethical principles the Nursing Code of Ethics is based upon include beneficence, nonmaleficence, justice, accountability, autonomy, fidelity, and veracity.What are basic ethical issues? ›
Unethical accounting, harassment, health and safety, technology, privacy, social media, and discrimination are the five primary types of ethical issues in the workplace.What is the most common ethical issue? ›
Harassment and discrimination are arguably the largest ethical issues that impact business owners today. Should harassment or discrimination take place in the workplace, the result could be catastrophic for your organization both financially and reputationally.What are the 3 basic types of ethical issues? ›
There are three main types of ethical issues: Utilitarian, Deontological, and Virtue. Utilitarian ethics focus on the consequences of an action, while deontological ethics focus on the act itself. Virtue ethics focuses on the character of the person acting.What is an example of an ethical issue? ›
Some examples of ethical dilemma include: Taking credit for others' work. Offering a client a worse product for your own profit. Utilizing inside knowledge for your own profit.What is meant by ethical issues in nursing? ›
Ethical issues happen when choices need to be made, the answers may not be clear and the options are not ideal. The result could be declines in the quality of patient care; problematic clinical relationships; and moral distress, which is defined as knowing the right thing to do but not being allowed or able to do it.What are the four major ethical issues? ›
This framework approaches ethical issues in the context of four moral principles: respect for autonomy, beneficence, nonmaleficence, and justice (see table 1). This framework has been influential because the values it espouses seem to align with our moral norms.What are examples of legal and ethical issues in nursing? ›
The five major areas for legal concerns include negligence or malpractice, defamation, patient confidentiality, battery, and mandatory reporting.