Introduction
This reflection paper explores the ethical challenges encountered in the critical care setting and considers my evolving role as an advanced nurse practitioner (ANP) student in addressing these dilemmas. Critical care environments, such as intensive care units (ICUs), are high-stakes settings where life-and-death decisions are made daily, often under significant pressure. Ethical issues, including patient autonomy, end-of-life care, and resource allocation, frequently arise, demanding both clinical expertise and moral sensitivity. As an ANP student, I am learning to navigate these complexities while developing the skills to advocate for patients and contribute to multidisciplinary teams. This essay examines key ethical issues in critical care and reflects on my responsibilities and personal growth in this context, drawing on relevant literature to ground my analysis.
Ethical Issues in Critical Care
One prominent ethical issue in critical care is the tension between respecting patient autonomy and making decisions in their best interest, particularly when patients lack capacity. For instance, decisions around withholding or withdrawing life-sustaining treatment often involve balancing the patient’s previously expressed wishes with clinical judgement (Beauchamp and Childress, 2019). In the UK, the Mental Capacity Act 2005 provides a legal framework for assessing capacity and making decisions on behalf of incapable patients, yet applying this in practice can be challenging, especially when family opinions conflict with medical recommendations. As an ANP student, I have observed how emotional distress can exacerbate these conflicts, requiring nurses to mediate with empathy and clarity.
Another significant concern is the equitable allocation of scarce resources, such as ventilators or ICU beds, particularly during crises like the COVID-19 pandemic. Triage decisions often rely on utilitarian principles, prioritising outcomes for the greatest number, but this can lead to moral distress among healthcare professionals who feel they are compromising individual patient care (Truog et al., 2020). Witnessing such scenarios during my clinical placements has heightened my awareness of the emotional toll on staff, prompting me to consider how I can support ethical decision-making processes in my future role.
My Role as an ANP Student
As an ANP student, my role in addressing ethical issues is twofold: developing clinical competence and fostering ethical awareness. I am learning to engage in shared decision-making, ensuring that patients’ values and preferences are central to care plans. This involves effective communication, particularly when discussing sensitive topics like do-not-resuscitate orders. Furthermore, I am beginning to understand the importance of interprofessional collaboration in resolving ethical dilemmas. For example, working alongside consultants and ethicists during case discussions has shown me the value of diverse perspectives in achieving balanced decisions.
Reflecting on my placements, I have also recognised the need to manage my own moral distress. Indeed, encountering situations where I felt powerless—such as advocating for a patient whose treatment was deemed futile by the team—has been challenging. However, these experiences have motivated me to seek guidance through debriefing sessions and to engage with ethical frameworks to better navigate such dilemmas (Royal College of Nursing, 2021). Over time, I aim to develop resilience while maintaining compassion, ensuring that I can advocate for patients without compromising my well-being.
Conclusion
In conclusion, ethical issues in critical care, such as patient autonomy and resource allocation, present complex challenges that require careful consideration and collaboration. As an ANP student, I am at the early stages of learning how to address these dilemmas, balancing clinical responsibilities with ethical sensitivity. My experiences in placement have underscored the importance of communication, advocacy, and self-reflection in managing moral distress and contributing to patient-centred care. Looking ahead, I aim to further develop my skills in ethical decision-making, ensuring that I can support both patients and colleagues in navigating the intricate moral landscape of critical care. Ultimately, these reflections will shape my practice as I progress towards becoming a competent and compassionate advanced nurse practitioner.
References
- Beauchamp, T.L. and Childress, J.F. (2019) Principles of Biomedical Ethics. 8th ed. Oxford University Press.
- Royal College of Nursing (2021) Ethical Practice: Guidance for Nurses and Midwives. Royal College of Nursing.
- Truog, R.D., Mitchell, C. and Daley, G.Q. (2020) The Toughest Triage — Allocating Ventilators in a Pandemic. New England Journal of Medicine, 382(21), pp. 1973-1975.
