Major Ethical Dilemmas in Nursing

What is an Ethical Dilemma?

An ethical dilemma is defined as a complex situation in which there is a mental conflict between choosing two different courses of action. The conflict is ethical in nature and involves having to compromise either your personal or professional ethics in favor of one course of action.

Generally speaking, the following elements need to be present in order for an ethical dilemma to exist:

• A decision has to be made about which course of action is ‘best’
• There must be different courses of action to choose from in the decision
• Irrespective of which course of action is taken, an ethical principle is compromised. In other words, there will be no ‘right’ or ‘perfect’ solution

Ethics in Nursing

Today’s healthcare settings are complex. Nurses, while carrying out their jobs, must adhere to strict codes and principles in order to ensure the highest quality of care. There are numerous regulatory mechanisms that are designed to ensure that the highest standards of ethics are met in healthcare settings.

Included among these is the International Council of Nurses’ ICN Code of Ethics. This states that nurses, in addition to carrying out their main responsibilities of promoting health, mitigating suffering, and preventing illness in patients, must also display “a respect for human rights, including cultural rights, the right to life and choice, to dignity, and to be treated with respect”.  

The code also states that while nurses are primarily responsible to those individuals who require nursing care, they must also render services to families and communities.

This makes it clear that nurses have a wide range of responsibilities to a wide range of individuals. Ethical dilemmas crop up very frequently in this line of work. Some of the most common dilemmas faced by nurses include:

• Patient Freedom vs. Nurse Control – What happens when a patient decides to make a personal choice about their treatment which is in direct conflict with established medical practices?
• Honesty vs. Selective Information – In some cases, families choose to withhold information about a patient’s medical condition to avoid causing them emotional distress. How does a nurse decide what information to give the patient?
• Dilemmas surrounding Minors – This is a particularly tricky area because not only do nurses have to consider the best interests of the minor patient, but they also have to respect the wishes and beliefs of the child’s parents.
• Patients’ Personal Beliefs – Sometimes, the personal or religious beliefs of a patient may clash with science-based empirical knowledge. A patient’s right to make their own choices/decisions must be carefully balanced against a nurse’s responsibility to provide them with the best care.
• Reproductive-rights – Nurses must deal with the ‘pro-life’ and ‘pro-choice’ head on, on a daily basis. A patient’s choice may even clash with their own personal moral views on the matter.

Real Experiences from the Field

To get an idea of what some of the major ethical dilemmas are in nursing, some of the experiences of real life nurses have been listed below. Here’s what they had to say.

Amelia Roberts - BSN RN

In nursing these are just some of the types of Ethical Dilemmas Nurses face

• Patients whose religious view limit treatment options
• Patients whose religious view restricts ALL medical treatment options
• Patients whose lifestyle choices are leading to their death
• Post-transplant patients who would rather not pursue treatment for various reasons and opt for
  care vs. a cure
• Pediatric Care brings the child's choice in to the picture. At what age, do we have to respect the child's choice? When are they of an age where their opinion counts?

Brooke Wallace, Founder of registerednursing.org
‘Ethical dilemmas in nursing occur when the RN experiences a conflict with personal values or beliefs and with some aspect of patient care. The struggle is to perform the job and provide the best possible patient care no matter what the RN is feeling. But, ethical dilemmas in nursing aren't all the same.

The environment and specialty a RN works in can determine specific ethical dilemmas. For instance, a RN working in the PICU may be asked to care for a child who has been a victim of child abuse and be asked to also be kind and impartial to the parents at their child's bedside who are suspected, but not convicted, with the crime.

Or perhaps the RN working in hospice may feel some satisfaction on a personal level in providing comfort care to a terminally ill patient who is actively dying because he/she believes it is the right thing to do, but feels conflicted by seeing the patient's family so distraught and the loss they will feel forever.

As RNs, we have a duty and a responsibility to our patients to always guide them in finding the right plan of care for them, based on their belief system alone. Keeping ourselves and our own beliefs out of the situation is important in helping patients receive amazing and individualized care.’
 

At the end of the day, there are many ethical dilemmas that present themselves in nursing. In complex healthcare settings, nurses have a responsibility to ensure their patients get the best care while grappling with sensitive ethical issues. This ethical tight-rope is walked by nursing professionals on a daily basis; how they handle these ethical dilemmas will vary.