While a career in nursing is immensely fulfilling, it’s not without its share of challenges. Regardless of their area of practice or accreditation, nurses face a multitude of ethical dilemmas every day. Let’s take a closer look at what ethics mean for today’s healthcare professionals, along with some of the common ethical issues faced by nurses in today’s complex healthcare settings.
A Closer Look at Ethics in Nursing
While there’s no clear-cut right or wrong answer to the often life and death ethical issues encountered by nurses, there is a set of principles upon which ethical decision making is based. Regulatory mechanisms are aimed at ensuring the highest standards of ethics. For example, the International Council of Nurses’ ICN Code of Ethics asserts that, in addition to the core responsibilities of promoting health, preventing illness and easing suffering, “a respect for human rights, including cultural rights, the right to life and choice, to dignity, and to be treated with respect,” is also an inherent part of the job.
While the code further dictates that “the nurse’s primary professional responsibility is to people requiring nursing care,” it also specifies that nurses not only render services to individuals, but also to families and communities. This is a tall order when you factor in the many diversities represented in society today.
Common Ethical Dilemmas in Nursing
So what are some of the most common ethical dilemmas nurses encounter on the job? They include the following:
- Patient Freedom Versus Nurse Control
Nurses are highly educated and therefore aware of the best clinical course of action when one exists. But what happens when a patient rejects medical advice and makes a decision that may result in less optimal outcomes? From deciding whether or not a labor and delivery patient would benefit from pain medication, to encouraging a patient to eat when they are refusing food, nurses walk a fine line every day.
While nurses do not sign the Hippocratic Oath, they are still bound by the promise to devote themselves to the welfare of the patients committed to the care, as well as to live up to the standards of the profession.
- Reproductive Rights
The pro-choice vs. pro-life argument is an intensely personal one based on an individual's core set of values and beliefs. If you are pro-life, can you support a patient’s right to an abortion? If you are pro-choice, can you respect a patient’s choice to continue a pregnancy even if it threatens her own life?
With more than 208 million pregnancies occurring worldwide every year, nurses can expect to be confronted with this ethical dilemma on any given shift.
- Honesty vs. Information
Families will often choose to withhold truthful information to “protect” a patient from emotional distress. For nurses, this poses another common ethical dilemma: does a patient have the right to know everything about their condition, even if sharing the information will cause harm? Is honesty always best? What if sparing a patient this information can promote happier, less stressful final days?
Deciding what information will be shared – along with how and when to share it – can be a difficult part of a nurse’s responsibilities.
- The Minor Dilemma
Working with children presents a unique set of ethical challenges. Not only must nurses consider the best interests of the patient, but they must balance this against the wishes, beliefs and values of a family. While patients, families and physicians may be aligned in the ideal world, in the real world ethical issues do arise. While parents are tasked with difficult decisions too, the nurse’s ultimate responsibility is to the patient.
Ethical issues related to privacy can also arise with minors. While they do have some basic rights to privacy, the law requires disclosure of certain information to parents. In many cases, this is information that minors do not want disclosed. In this instance, nurses benefit from an understanding of law, as well as hospital policy.
- The Battle of Beliefs
What is science-based, empirical knowledge to a nurse might be completely subjective to a patient with a particular set of religious or personal beliefs. Certain religions forbid medical procedures which can mean the difference between life and death. For example, in some cultures and religions, blood transfusions – even lifesaving ones – are unacceptable. A nurse’s attempts to explain the benefits of the procedure weighed against the risks of opting out can overstep the line. Is it the nurse’s job to support the patient’s right to the decision, or is it their responsibility to do everything in their power to urge them toward a preventable action?
As science continues its onward march, questions related to ethics and human rights are only expected to grow, pertaining to everything from stem cell research to genetic testing.
- Resource Management
If a patient is in a medically futile, vegetative state, the cost of maintenance is high. At what point do you draw the line and redirect these resources to patients for whom they could be truly life-saving? How do you balance what may be perceived as a financial decision against what is an entirely personal decision to a grieving family? After all, when it comes to clinging to hope for the survival of a loved one, no resource is poorly spent.
Nurses are charged with maintaining a “big picture” perspective while simultaneously dealing with intensely personal situations on a day to day basis.
Guidance Along the Way
While these ethical dilemmas are an inherent part of the nursing profession, nurses aren’t without access to help. The American Nursing Association (ANA) offers ethics and human rights position statements on everything from DNRs to capital punishment to aid nurses in addressing specific ethical challenges. Furthermore, hospitals have their own ethics committees where nurses can voice their concerns and gain access to helpful resources.
Ultimately, nurses are a highly valued part of the healthcare system because they care. In fact, year after year they receive the highest ratings from the American public in terms of honesty and ethical standards – besting medical doctors, pharmacists, police officers and members of the clergy. This trust not only comes with great responsibility, but remains the bedrock upon which the American healthcare system is built.
Interested in learning how to vet ethical issues in nursing from top nursing professionals? Contact the Loyola University School of Nursing to learn more about programs and courses offered.