What is an Ethical Dilemma in Nursing Practice?

An ethical dilemma in nursing practice arises when the nurse cannot proceed with a course of action that upholds all ethical principles or values. The original Nightingale Pledge recognizes the ethical principle of do no harm .

There are many ethical issues in nursing that suggest two or more equally compelling courses of action that appear to be morally right. The nurse trying to make an ethical decision may recognize that one specific course of action will uphold some ethical principles but not all of them.

What are the principles of ethics?

Ethical principles are the foundation of moral theory. Many health care professionals are familiar with these principles as they form the foundation for ethical codes used to guide professional practice.

Autonomy

At the cornerstone of nursing practice in Canada is the idea of patient autonomy and the rights of individuals to decide on the best course of action for themselves. The legal doctrine of informed consent is based on respect for this principle of patient autonomy. In order to practice ethically nurses must respect the patient's individual values and uphold the right of patients to choose or refuse treatment.

Non-Malfeasance

The principle of non-malfeasance is contained within the Hippocratic Oath recited by doctors as well as the Nightingale Pledge often recited by graduating nurses. Florence Nightingale herself articulated this principle when she wrote:

"It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm."

Malfeasance refers to a break in the public trust. Non-malfeasance (sometimes spelled as non-maleficence) suggests that ethical behaviour is an action that does no harm to the person in care.

The moral obligation to do no harm is recognized within both medical and nursing practice.

Beneficence

This principle is about doing more that just not harming another person. This principle suggests that ethical behaviour must "do good". In fact this principle in its true meaning suggests an obligation to benefit others.

Fidelity

This principle is about keeping promises and establishing loyalty and is at the foundation of the nurse patient relationship.

Justice

The principle of justice suggests that ethical behaviour is conduct that treats people equitably. Nurses are morally obligated to provide safe, competent, and ethical care to all patients.

What is an ethical dilemma?

Most of the time nurses can uphold each ethical principle in their daily nursing practice. At times however, two or more principles may conflict and the nurse must engage in ethical decision making to determine which principle is the priority to uphold at that time.

A good example of an ethical dilemma in nursing practice is when a patient refuses care or treatments. The nurse may not be able to follow the principles of autonomy and beneficence at the same time because respecting patient autonomy means the nurse is not able to fulfill the obligation to "do good" for the patient.

In this instance as long as the patient is conscious and competent the principle of patient autonomy would take priority.

It is always considered a higher priority for an individual to have the right to self determination than for the nurse to fulfill the duty to care.

Questions on the Canadian Registered Nurse Exam that test the ability to understand an ethical dilemma are testing the competencies in the Professional Practice category.

Go back to Nursing Ethics and Nursing Practice in Canada

Here is a list of all the the pages on this website (including this one) that contain more specific information about ethics in nursing.

Nursing Ethics in Canada - an introduction to the regulations that require ethical nursing practice in Canada.

What is the Nursing Code of Ethics for nursing practice in Canada?

The What's and Why's of an Ethical Code for Nursing Practice

Ethical Theories - a brief explanation of the three classifications of ethical theories used most often by nurses

What is an Ethical Dilemma in Nursing Practice? - a description of the ethical principles used in moral reasoning in nursing practice.

Ethical Decision Making in Nursing Practice - the Influence of Personal and Professional Values

Ethical Issues in Nursing Practice in Canada - What are Some of the Current Ethical Issues in Nursing?

The requirement for Ethics in Nursing Curriculum in Canada

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