Introduction
Ethical considerations are at the core of nursing practice, shaping interactions with patients, families, and colleagues while ensuring the delivery of compassionate and professional care. Nurses frequently encounter complex ethical issues that demand a balance between clinical responsibilities and moral obligations. This essay seeks to identify key ethical issues in nursing practice, focusing on areas such as patient autonomy, confidentiality, and resource allocation. It will critically analyse these issues through the lens of fundamental ethical principles, including autonomy, beneficence, non-maleficence, and justice. By exploring real-world scenarios and drawing on academic literature, the essay aims to highlight the challenges nurses face in upholding these principles and to evaluate their application in practice. Ultimately, it will underscore the importance of ethical decision-making in fostering trust and maintaining the integrity of the nursing profession.
Ethical Issues in Nursing Practice
Nursing is inherently tied to ethical dilemmas due to the intimate and often vulnerable nature of patient care. One prominent issue is the challenge of respecting patient autonomy. Autonomy refers to a patient’s right to make informed decisions about their own care, free from coercion (Beauchamp and Childress, 2019). However, nurses may encounter situations where a patient’s decisions conflict with medical advice or family wishes. For instance, a patient with a terminal illness might refuse life-sustaining treatment, placing nurses in a position where they must balance respect for the patient’s choice with their own professional duty to preserve life.
Another critical ethical issue is maintaining confidentiality. Nurses are entrusted with sensitive personal information, and breaches of confidentiality can erode trust and cause harm. The Nursing and Midwifery Council (NMC) Code (2018) mandates that nurses protect patient privacy, yet dilemmas arise when disclosure is necessary for safeguarding, such as reporting concerns about abuse or public safety. Deciding whether to break confidentiality in such cases often creates moral tension for practitioners.
Lastly, the allocation of limited resources presents a significant ethical challenge. In the UK’s National Health Service (NHS), nurses often work under constraints of staffing shortages and budget limitations, forcing difficult decisions about prioritising care (Royal College of Nursing, 2020). For example, allocating intensive care beds during a crisis, such as the COVID-19 pandemic, required nurses to grapple with questions of fairness and equity in treatment distribution. These issues highlight the complexities of ethical practice and the need for a robust framework to guide decision-making.
Critical Analysis of Ethical Principles
Autonomy and Its Challenges
The principle of autonomy is foundational to ethical nursing practice, as it upholds the patient’s right to self-determination (Beauchamp and Childress, 2019). Respecting autonomy involves providing patients with sufficient information to make informed choices, a process often facilitated through shared decision-making. However, challenges arise when patients lack capacity to decide, such as in cases of severe mental illness or unconsciousness. In such scenarios, nurses must rely on advance directives or proxy decision-makers, which can sometimes lead to conflicts if the patient’s previously expressed wishes are unclear or disputed by family members.
Moreover, cultural and social factors can complicate the application of autonomy. For instance, in some communities, family involvement in healthcare decisions is prioritised over individual choice, potentially clashing with Western ethical norms (Johnstone, 2019). Nurses must navigate these differences sensitively, ensuring they do not impose their own values while still advocating for the patient’s best interests. This delicate balance illustrates the limitations of autonomy as a standalone principle, often requiring integration with other ethical considerations like beneficence.
Beneficence and Non-Maleficence in Conflict
Beneficence, the duty to act in the patient’s best interest, and non-maleficence, the obligation to do no harm, are closely linked principles that guide nursing actions (Ellis, 2017). These principles are often challenged when treatments carry significant risks or when withholding care might prevent greater harm. Consider the administration of experimental drugs during a health crisis; while offering such treatment may align with beneficence by providing potential benefits, it also risks violating non-maleficence if adverse effects occur.
In practice, these principles can conflict with autonomy. A nurse might believe that a specific intervention is in the patient’s best interest, yet the patient refuses it. Here, the tension between doing good and respecting choice becomes evident. Critical reflection and ethical decision-making frameworks, such as those advocated by the NMC (2018), are essential in such cases to ensure a reasoned approach. Indeed, without such guidance, nurses risk making decisions based on personal bias rather than professional standards.
Justice and Resource Allocation
The principle of justice demands fairness in the distribution of healthcare resources and access to care (Rawls, 1971). In the context of nursing, justice is tested by systemic issues within the NHS, such as disparities in service availability across regions or unequal treatment based on socioeconomic status (Marmot, 2020). Nurses often bear witness to these inequities, which can create moral distress when they are unable to provide equal care to all patients.
During the COVID-19 pandemic, the principle of justice was particularly strained as nurses faced triage decisions in overwhelmed intensive care units. Guidelines from NICE (2020) emphasised equitable decision-making based on clinical need rather than age or status, yet the emotional toll of such decisions on healthcare workers cannot be understated. This scenario underscores the complexity of applying justice in practice, where ideal ethical standards must be reconciled with practical constraints. Furthermore, it highlights the need for systemic reforms to support nurses in upholding fairness.
Conclusion
In conclusion, ethical issues are an intrinsic part of nursing practice, manifesting through challenges related to autonomy, confidentiality, and resource allocation. A critical analysis of the principles of autonomy, beneficence, non-maleficence, and justice reveals their interdependence and the difficulties in applying them amidst real-world constraints. Autonomy, while central to patient rights, often conflicts with other duties, requiring nurses to engage in nuanced decision-making. Similarly, the dual imperatives of beneficence and non-maleficence highlight the need for balanced judgement, while justice underscores the broader systemic issues impacting equitable care. These dilemmas demonstrate that ethical principles, though vital, are not always straightforward to implement, particularly under resource limitations or cultural differences. The implications for nursing practice are clear: ongoing training in ethical reasoning, adherence to professional codes like the NMC (2018), and systemic support are essential to navigate these challenges. Ultimately, fostering an ethical practice environment not only safeguards patient welfare but also reinforces the trust and credibility of the nursing profession.
References
- Beauchamp, T.L. and Childress, J.F. (2019) Principles of Biomedical Ethics. 8th ed. Oxford University Press.
- Ellis, P. (2017) Understanding Ethics for Nursing Students. 2nd ed. Learning Matters.
- Johnstone, M.J. (2019) Bioethics: A Nursing Perspective. 7th ed. Elsevier.
- Marmot, M. (2020) Health Equity in England: The Marmot Review 10 Years On. Institute of Health Equity.
- National Institute for Health and Care Excellence (NICE) (2020) COVID-19 Rapid Guideline: Critical Care in Adults. NICE.
- Nursing and Midwifery Council (NMC) (2018) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. NMC.
- Rawls, J. (1971) A Theory of Justice. Harvard University Press.
- Royal College of Nursing (RCN) (2020) Nursing Staff Shortages Could Endanger Patients, RCN Warns. RCN.
