Ethical Decisions in Nursing

The sound of sirens filled the air. Nurses and doctors rushed in and out of the hospital pushing stretchers that contained bleeding patients. As more and more patients were rushed in, nurses tried hard to contain the situation for those who had arrived. These were victims of a terrorist attack. Jane, one of the nurses was busy dressing wounds of varied degrees when one patient was brought in. It was an old lady of about eighty years. She had both her arms cut off from the shoulder. Her right leg was also missing from the knee. Her only remaining limb was the left leg which was logged with glass particles with a sharp metal sticking through her thigh. Jane’s first instinct was to let her die. This, according to her, would save her all the troubles she was going to go through at such an advanced age. But this decision could not be as easy as that. There were ethical issues to consider before making any decision. Jane’s incidence is not the first nor does it mark the last of such incidences. Nurses find themselves in difficult situations that bring the ethical decision making into test.

How does the ethical decision making process affect nursing as a profession? There are several ways by which ethical decision making affects the registered nurse profession. It should be noted that every time a situation of ethical dilemma arises, only a collective approach including the patient’s values, his family, the nurses and the whole health care team can result into an appropriate decision (Sherblom et al, 1993).

In decision making, there are several principles that provide a platform onto which decisions are to be made. These principles are:

  • Principle of autonomy
  • Principle of beneficence
  • Principle of non-maleficence, and
  • The principle of fairness/ distributive justice

The principle of autonomy determines one’s own decisions. These are decision that one feels are of his best interests. It includes the patient’s rights according to his own decisions. The patient can decide to refuse medication, he can dictate on the type of privacy he needs, it is the patient’s decision on truth telling etc. it is the responsibility of the nurse to respect these decisions by the patient. It is therefore the duty of the nurse to ensure that all the practices that he undertakes do not, by any means interfere with the decision making process of the patient. The principle of beneficence is basically the obligation of the nurse to benefit others. This principle gives the nurse the obligation to always put into consideration the welfare of others. This is meant to ensure that the nurse thus makes decisions that favor the client’s needs. He is bound by this principle to make a decision that will do good to the patient. Formerly, this principle had resulted into paternalism which is an approach that favors the decision of the nurse towards the good of the patient at the expense of the patient’s own perception of his own good. Ethics of nursing places him under the obligation to give the patient opportunities to make informed decisions about his treatment and care. This should be done even under circumstances where the patient does not seem to have the capacity to make a sound decision due to illness or other factors (Alberta Association of Registered Nurses, 2005).

The third principle that governs decision making of a nurse is the principle of non-maleficence. This is a principle that obligates the nurses to ensure that the do not inflict any harm to patients and also make sure that they protect their patients from harm. Under this principle, the nurses are supposed to ensure that they minimize as much as possible the harm that may be necessary during treatment. The nurse should also anticipate the probable harm that may occur. This harm includes physical harm and subjecting the patient in a state to feel helpless and powerless. This can be achieved by ensuring a good communication network between the patient and the nurse, it can also be achieved through maintaining standards of care that meet the professional level and competence, and finally through assessing of risks and benefits accurately and through evidence based approach (Alberta Association of Registered Nurses, 2005).

The fourth principle is the principle of distributive justice. This value has, as its basic concept, the aspect of fairness resulting from equal worth of people. This includes equality in terms of someone’s worth, needs and contribution. In health care, this principle can be interpreted in terms of every individual’s need for proper health care. A nurse should therefore ensure that every one, irrespective of their material or social position, is accessible to good life and health services. In fact, those without economic muscles should be given an upper hand. The nurse should therefore be the front runner in championing for distributive justice in terms of promoting primary health care and to engage in efforts to ensure reforms at different levels of the society which will increase each every individual’s accessibility to primary healthcare (Alberta Association of Registered Nurses, 2005).

Apart from the principles, the nursing profession has a framework that is used in ethical decision making process. These are step by step questions that a nurse has to ask himself before making a decision governed by the principles.

To make a decision for an existing ethical dilemma, the nurse is thus subjected to the ethical framework. According to the frame work, the nurse prior to making the decision has to understand the values (both spiritual and cultural) of the patient. In addition, the nurse must also understand the cultural and religious values of everyone who is significant o the patient. This includes his family members or the relevant people under whose care the patient is. After the knowledge of the patient’s values has been settled, the nurse then has to put under consideration his own values. The nurse should then ask himself whether the decision he wants to make is in accordance to his own values. After finding the answer to this, the nurse should then compare his values and the patient’s values. Do they rhyme or are there conflicting issues? If there are conflicting issues then it comes to the point of deciding whether he should impose his values to the patient (Nurses’ Board of Western Australia, 2004).

The third step in decision making framework is the analysis of the situation. At this point, the patient’s health and social status is put under consideration. This includes the available resources that could be used to influence the outcome of the situation. The family and guardians’ situation should also be considered before making the decision. The decision making frame work now dictates that after the knowledge of the patient’s values, own values and analysis of the situation, the values and standards of the profession then come into play. This includes all stipulations put across by the International Nursing Council and other boards that are concerned with the nursing profession. This includes nursing councils and the nursing boards of the specific country. The legal part of the situation also plays a role in the decision making. For example, if the situation in question is covered by any state law or commonwealth law then the law has to prevail. In this case it ceases to be a dilemma as going contrary to the law is an offence and one may find himself on the wrong side of the law (Nurses’ Board of Western Australia, 2004).

In conclusion, the decision making capacity of a nurse is entirely dictated by the ethics of the profession. It is therefore important for each nurse to learn the basic principles so as to ensure that his decisions do not contravene with the expectations of the profession. This can easily be achieved due to the provided framework and guiding principles.


Alberta Association of Registered Nurses. (2005). “Ethical decision making for registered nurses in Alberta: Guidelines and recommendations.” Web.

Nurses Board of Western Australia. (2004). “Ethical dilemmas a framework for decision making.” Web.

Sherblom, J., Sherblom, S., Shipps, T. (1993). “Justice, care and integrated concerns in ethical decision making of Nurses.” Qualitative Health Research.3, 4: pp 442-464.

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