Western Governors University
Nursing Ethics and Values (0310)
Initial Submission: July 5th 2012
Revised Submission: July 12, 2012
2nd Revised Submission: July 19th 2012
of Ethical Decisions Facing Nurses
What is ethical? The question of ethics is a highly debated
subject in nearly every facet of humanity.
However, in the field of medicine, ethics is often a pivotal issue that
balances life and death. Nurses
especially face difficult situations on a daily basis that require use of
ethical decision-making ability. To
allow for a panoramic view of ethical decisions facing nurses it is necessary
to explore various components that make up the whole. Consequently, the analysis will commence with
a discussion concerning the relevance of ethical theory to the nursing
profession. Following this will be a
comparison of the concepts of confidentiality and reasonable limits,
specifically reasoning on when confidentiality should be maintained or broken. Next, is an exploration of conflict that may
occur when ethical principalities collide and how this can be resolved. Cultural influences on value systems will
follow and offer two nursing interventions that could be of aid in the case
presentation. Lastly, an application of
an ethical decision-making model is given to the case scenario.
Modern times necessitate a
nurse’s need to grasp a proper understanding of the ethical responsibilities to
patients under their care. By its very nature,
nursing proves to be a virtuous profession.
Though material gain can motivate care given to others in need, most
nurses are not inundated with wealth in exchange for their labor. Conversely, many nurses are not materially
poor. This fact presents the question of
whether modern care is provided for ethical reasons; thus, a need for ethical
theory in the nursing profession (Davis &
Aroskar, 1991). Additionally, various
scenarios present themselves that call for nurses to make decisions that are
ethical in nature (Knoblauch, Childre & Strasser,
1997). In the case presentation,
an ethical situation occurs which forces a nurse to make an ethical decision
that will affect the patient and her family.
What is the “right” decision to make and upon what is the decision
based? The answer to such questions
depends on the ethical theory chosen.
There are an array of ethical
theories that are used by nurses and healthcare institutions. Each theory has positive and negative
qualities that are exposed in certain circumstances. Nevertheless, an ethical theory must “be
clear, internally consistent and coherent, complete and comprehensive, simple,
and generally supportive or ordinary judgment (Sherman,
2007).” If any of these elements are
lacking the theory becomes confusing and unsubstantial. Conversely, when all of the elements are
present the theory is not only substantial but also serves as a foundation in
which important decisions can be solidly based.
This is why an ethical theory is essential to nursing; namely, so that medical
decisions can be made which are born from sound reasonings founded on an
established mode of thought.
of such a theory is Utilitarism. This
theory, founded by Aristole, holds that whatever brings the greatest amount of good
for the majority is most important. Those
holding to this theory promote that what is most useful is what is right. A nurse using this theory may make a decision
that benefits the majority of patients while negatively impacting the minority.
Confidentiality and Reasonable
All healthcare facilities and workers
are bound to the laws respecting and guarding patient confidentiality. In principle patients “should be certain
that, whatever their issues are, they won’t be shared with anybody else unnecessarily (O’Dowd, 2011).” Especially with advances in technology should
nurses remain diligent to consent to laws, policies, and standards to maintain
privacy with electronic health records.
This openness between the patient and healthcare provider allows for the
best diagnosis and care to be given (Allmark,
Although confidentiality is a
fundamental right of all patients, situations do occur where patient
confidentiality interferes with the common good. In such instances a reasonable limit can be
ascertained which one can discern whether the right of confidentiality is being
used for a good purpose. Additionally,
it can be determined if ones confidentiality puts the lives of other in
jeopardy. Occurrences such as life
threatening emergencies, government regulations, public health issues, legal
and judicial proceedings, and worker’s compensation rules allow for medical
information to be disclosed (U.S. Department of Health & Human Services,
2003). These circumstances and those
similar to these present ethical bases for reasonable limits to patient
confidentiality. When ethical dilemmas
to patient confidentiality present themselves to nurses, they must weigh
decision carefully and understand the responsibility they have to break such
confidences when necessary.
Ethical Conflict Resolutions
Conflicts of ethics will arise in
nursing. As show in our case
presentation, decisions will be placed upon nurses that will have far-reaching
affects. Therefore, resolving ethical
conflicts is sometimes an essential part of patient care (Fry, 1994). In the case
study, Mrs. Z has chosen to keep medical information about her positive biopsy
to her family. Additionally, in order to
keep the information she is refusing medical treatment. The immediate dilemma suggested by this case
study is the nurse’s responsibility to help Mrs. Z, while simultaneously respecting
her confidentiality. Two conflicting
ethical principles occur between nonmaleficence and beneficence (see Table 1).
In this case, the nurse will
circumvent beneficence is if she decides to alert Mrs. Z’s husband of her
the utilitarian viewpoint, the good of the majority is worth the disaster of
the minority. Application of this theory
would support that the good of the majority, represented by Mrs. Z’s family,
would be consented to. In addition, the
medical care given would most likely help all parties involved including Mrs.
Z. A nurse taking this position would
have the possibility of prolonging Mrs. Z’s life and saving her family from
grief. The nurse presented with such an
ethical dilemma would certainly be justified in concluding that a reasonable
limit to Mrs. Z’s confidentiality has been reached.
In order to
rectify multiple conflicts between varying ethical principles nurses need to
consider the holistic values of each theory.
After considering the values, they must be weighed against the good that
it will produce for the patient and the patient’s family. Nurses must remember that their main goal is
to give the best possible care to the patient.
Therefore, when finding the solution between conflicting values nurses
keep in mind that have the responsibility to use elements of all ethical values
to reach the common good for the patient’s well-being.
Culture’s Influence on Values
Culture often directly affects the
values that are adopted by the patient. The
values held by Mr. Z conflicts with confidentiality since the husband is
accustomed to being the primary decision maker.
However, this culture is not a determining factor to Mrs. Z who has
opted to make her own decisions regarding her medical health while in the
One nursing intervention that can be
implemented is counseling (Varcoe, et al., 2004). The nurse caring for Mrs. Z can counsel and
educate Mrs. Z about the seriousness and consequences of her decision to refuse
medical treatment. She may also relate
how Mrs. Z’s decision can negatively affect her family.
Another option is using a patient
advocacy team. The nurse could alert
Mrs. Z to take advice from a team of individuals that can give her advice about
her medical and family situation (American
Medical Association, 2007). The
group including the nurse may be able to present Mrs. Z with numerous
perspectives that may help her to accept the appropriate medical
treatment. Both interventions would
allow the nurse to maintain confidentiality with Mrs. Z.
Fry formulated a “four-step process
that examines the story and context of the ethical problem; the significance of
the values pertinent to the problem; the meaning of the conflict to individuals
involved; and possible solutions to the problem (p. 23).” In step one, the nurse would review the
situation and solidly fixed in mind the ethical concerns involved. Next, all background information regarding
Mrs. Z and the reasons for her decisions must be gathered. As a third step, the nurse will analyze how
this specific occurrence affects Mrs. Z and her immediate family. Lastly, a comprehensive review of resolutions
that will enable Mrs. Z to receive the best healthcare possible will
occur. Such systematic approaches to
ethical dilemmas aid nurses to reduce and relieve tense situations that hinder
medical care (Thiroux, 1977).
P. (1992). “The ethical enterprise of nursing.” Journal of Advanced Nursing,
Medical Association. (2007). Informed consent. AMA Legal Issues. Retrieved June
3, 2007, from http://www.ama-assn.org/ama/pub/category/print/4608.html
A. & Aroskar, M. (1991). Ethical dilemmas and nursing practice (3rd ed.).
Norwalk, Conn.: Appleton & Lange.
S. (1994). “Ethics in nursing practice: A Guide to ethical decision making.”
Geneva: International Council of Nurses.
D., Childre, F., & Strasser, P. (1997). Legal and Ethical Issues. In M.K.
Salazar (Ed), AAOHN core curriculum for occupational and environmental health
nursing, (pp. 71-93). Philadelphia; W.B. Saunders.
A. (2011, August). HCAs and patient confidentiality. Retrieved from
Nursing Times.net Web site:
J. (2007). American Society for Bioethics and Humanities. Retrieved June
19, 2012, from American Society for Bioethics and Humanities Web site:
J. (1977). Ethics: Theory and practice. Philadelphia: Macmillan.
Department of Health and Human Services. (2003). Summary of the HIPAA Privacy
Rules & Frequently Asked Questions & Answers. Retrieved from http://www.hhs/gov/ocr/hipaa.
C., Doane, G., Pauly, B., Rodney, P., Storch, J. L., Mahoney, K., . . .
Starzomski, R. (2004). Ethical practice in nursing: working the in-betweens. Journal
of Advanced Nursing, 45(3), 316–325. doi:DOI: