Ethics in Action: Considering Provision 2 in the ANA’s Nursing Code of Ethics

As a nurse, you face ethical dilemmas daily, regardless of where you work. Home health settings, clinics, and major medical centers all challenge nurses to find the best solutions for their patients. Maintaining the professional objectivity to always stand up for your patients isn’t always easy, particularly when others’ interests compete, such as family members or the patient’s insurance company.

Considering Provision 2

The American Nurses Association’s Code of Ethicsi aims to clarify some of those situations. Here, we’ll look at Provision 2: “The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.” This provision emphasizes the importance of the patient, even when that commitment is blurred by competing loyalties or other influences.
At first glance, commitment to your patient seems simple. When a broader group is involved, however, the issue can become complicated, involving not just patients, but also ethical dilemmas within their support network, as well as your own possible professional conflicts of interest, collaborations, and professional boundaries. The principle in each of these challenges centers on resolving conflicts in ways that neither compromise, nor give the appearance of compromising, patient care. This may mean determining when patients’ friends should have access to their health care information or knowing when to step away when your own friends or family members need medical care. It also means recognizing when you or your colleagues lose the ability to empathize or, conversely, become too invested in patients’ personal lives.

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

  • Conflicts of interest
    You recently attended a wonderful seminarii on pain relief hosted by a pharmaceutical company, complete with a nice lunch during the presentation. Now you’re talking with Susan Johnson about options to treat her chronic pain and you recall the seminar. If you recommend the pharmaceutical company’s new therapy, can you be certain your treatment recommendation is based upon scientific facts? If you recommend your choice of another therapy, is that recommendation based on a cautious response to your fears of possible bias? Could your patient view your use of notepads or pens handed out at the seminar as a subtle product endorsement?
  • Conflicts within family
    Richard Alvarez has expressed a clear desire to refuse extraordinary treatment but does not have a living will. Now in a coma, his adult children are divided regarding his treatment. How do you resolve this dilemma? Is the lack of a signed consent form or living will more binding than the expressed sentiments of the patient? How do you resolve conflict within the family and ensure that the patient’s needs are met?
  • Professional boundaries
    Dave Wilson, in your care for a minor procedure, is an outstanding attorney, and you need legal advice.iii He’s friendly and approachable. Is it ethical to ask his opinion of your legal problem while he is in your care or soon after he is discharged? Will your role in his care make him feel obligated to you in any way? Will his advice cause you to alter his care, either giving preferential treatment or, if he declines to help, less attention?

In the Loyola University New Orleans School of Nursing degree programs, students will encounter these scenarios and will learn effective ways to rectify issues.

For more information about the online nursing programs at Loyola University New Orleans, visit our website.