10.6 : Ethical Issues

Nurses are essential in patient care, upholding the ethical principles of their profession and effectively navigating ethical dilemmas. Neglecting ethical issues can lead to inadequate patient care, compromised therapeutic relationships, and moral distress among healthcare workers.

Ethical Concerns in Healthcare:

• Paternalism: Nurses often encounter situations where they must act without patient consent to safeguard their well-being or prevent harm. A common example occurs in cases of elder care, especially with patients who have advanced dementia. In such scenarios, a nurse might need to make immediate decisions about the patient's daily activities, such as eating or bathing, without obtaining explicit consent due to the patient's impaired cognitive abilities. Although taken to ensure the patient's health and safety, might override their autonomy, highlighting the ongoing ethical challenge of determining the best course of action in the face of diminished capacity.
• Privacy and Confidentiality: Confidentiality and privacy are fundamental to medical ethics. Violations can undermine trust and lead to legal repercussions. For instance, discussing a patient's condition in a public space where unauthorized individuals can overhear details violates these confidentiality agreements. Similarly, the accidental disclosure of patient information through misdirected emails or faxes underscores the need for strict protocols in handling patient information electronically.
• Understaffing and Resource Allocation: The shortage of nursing staff and resources often forces nurses to prioritize care, leading to moral and ethical dilemmas about who receives immediate attention and who must wait.
• Informed Consent: Informed consent becomes challenging during medical emergencies or when patients need help understanding treatment plans. For example, an ethical dilemma arises when a patient with limited understanding refuses a life-saving procedure. Nurses must navigate between respecting the patient's autonomy and ensuring their well-being.
• Shared Decision-Making: Shared decision-making promotes patient autonomy by involving them in care decisions. Ethical issues arise when there is a lack of transparency or when a patient's circumstances are overlooked. An example is when a patient's preference for alternative treatments is disregarded due to a healthcare provider's bias.
• End-of-Life Care: Providing care to patients with severe illnesses or at the end of life often presents ethical challenges. For instance, conflicts arise when family members disagree with a Do Not Resuscitate (DNR) order, which involves withholding life-sustaining treatment upon cardiac or respiratory arrest. Nurses must balance respecting the patient's wishes with addressing family concerns.

Nurses can improve patient care and therapeutic relationships by recognizing and navigating these ethical dimensions. Integrating ethical principles into daily routines helps preserve patients' dignity, rights, and welfare while fostering trust and respect within the healthcare environment. Continuous education and moral deliberation are essential for nurses to refine their decision-making skills and provide competent and compassionate care.