Ethics in Action: Considering Provision 3 in the Nursing Code of Ethics

Nurses today face a gauntlet of ethical dilemmas that are as complex as they are vexing. Advocating for your patient, for example, seems straightforward, but the right course of action isn’t always clear-cut. The American Nurses Association (ANA) Code of Ethics helps you navigate ethically challenging environments by pointing out areas of potential conflict and providing guidance to help you make your best decisions.

Consider Provision #3

Provision #3 in the ANA Code of Ethics states, “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.” The operative word is this provision is “protect.”

This core concept applies not only to those who need nursing, but to all those who need a nurse’s help in protecting their health and privacy as well as their information. This may mean advocating for patients who don’t understand their options, protecting their privacy and confidences and intervening when coworkers (or yourself) are impaired or exhausted.

Vexing Scenarios:
When evaluating what protecting patients means in your daily practice, consider these ethical dilemmas:

      • Privacy
        Mr. Jackson has dealt with health issues his entire life. Recently he found out his brother is in need of a kidney transplant and time is running out. Desperate to save his brother, Mr. Jackson offers his kidney. The family is ecstatic! In Mr. Jackson’s immediate reaction to volunteer, he doesn’t understand the risks to his own health. As his nurse, do you continue to discuss with him the possible consequences of his decision to himself and his brother? If he doesn’t understand the implications, should you express your concerns to his family or protect the privacy of your discussion? If the chance of success is minimal, should you discourage him from organ donation? If he isn’t a match, should you mention other options, like directed transplants? Should you treat the information as private and confidential, or as a factor that should invalidate an organ donation?
      • Confidentiality
        While you were preparing 91-year old Mrs. Gillock for surgery, she confessed that she really doesn’t want this procedure. Her family pressured her into it, hoping it would extend her life. Are you obligated to protect her confidence and proceed with the surgery, or to inform the surgical team the surgery was coerced and therefore violates her right to consent? Should the presumed health benefit factor into your assessment? What is your obligation to her family?
      • Impairment
        A major disaster requires all hands on deck, but you just worked a 16-hour shift and relaxed afterward with a glass of wine. Do you return to work? What if you skipped the wine but are exhausted? Do you, right now, have the stamina and judgement to perform your duties and to advocate effectively for patients, knowing that other caregivers also are tense and tired? What if you’re starting your own family and the nature of the accident puts your own unborn child at risk?
      • Informed Consent
        Mr. Vincent was transferred to your hospital from the state penitentiary for treatment for stage 3 lung cancer. He may benefit from participating in a clinical trial. The physician explained the details of the trial and the therapy, but Mr. Vincent has been in prison for 20 years and hasn’t graduated high school. He seems defeated. Does he understand he has the right to refuse to participate in the trial? Is he fully cognizant of the potential risks and benefits or either decision? Does he know he will receive standard of care, regardless his decision?

How you handle these situations depends, in part, on training. Nurses studying nursing at Loyola University New Orleans explore the legal and practical issues of such ethical challenges, readying them for practice in their communities.

If you are interested in earning an online nursing degree from Loyola University New Orleans, contact the admissions office.