10 Examples of Ethical Dilemmas in Nursing

13 Min Read Published August 11, 2023
10 Examples of Ethical Dilemmas in Nursing

When caring for human lives, the decisions you have to make as a nurse are anything but black and white. In addition to taking vital signs and doing dressing changes, there are a realm of tough choices and ethical dilemmas that nurses have to face every day.

Picture this: a nurse finds himself torn between respecting a patient's right to refuse treatment and their deteriorating health. Moral puzzles like these leave even the most experienced nurses scratching their heads and feeling caught between a rock and a hard place. However, understanding how to handle ethical dilemmas isn't just a theoretical exercise. It's a crucial skill that nurses need to have in their toolkits. 

The nursing code of ethics acts as a guide for nurses to help in these decisions, but it can be helpful to see actual examples of ethical dilemmas in nursing and what a nurse should do with each of them. That’s exactly what this article is about. 

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10 Common Ethical Dilemmas in Nursing 

While there are many different situations in which a nurse may find themselves dealing with an ethical dilemma, here are 10 common ethical dilemmas in nursing to consider and how a nurse might deal with them:

1. Patient Autonomy vs. Beneficence

Balancing a patient's right to make decisions about their own care with the nurse's duty to promote their overall well-being.

Let's say a patient diagnosed with diabetes refuses to take insulin, despite it being essential for controlling their blood sugar levels and preventing serious complications. 

In dealing with this situation, a nurse should follow the nursing code of ethics and take the following steps:

  1. Respect Autonomy: Respect the patient's right to make decisions about their own care, even if they disagree with those decisions. 

  2. Provide Information: Ensure the patient has accurate and comprehensive information about the treatment, including its benefits, risks, and alternatives. This allows the patient to make an informed decision.

  3. Assess Understanding: Engage the patient in open and non-judgmental communication to assess their understanding of the treatment and the potential consequences of refusing it. 

  4. Collaborative Decision-Making: Engage the patient in collaborative decision-making. Involve them in discussions and explore alternatives that align with their values and preferences. This approach fosters a sense of working together and mutual respect.

  5. Seek Additional Perspectives: If the patient's decision still conflicts with the nurse's professional judgment and poses a significant risk to the patient's health, the nurse should seek guidance from the healthcare team and the nurse manager or supervisor they report to.

  6. Document the Process: Throughout the decision-making process, carefully document all discussions, assessments, and the patient's decisions. This documentation serves as evidence that the nurse has fulfilled their ethical and professional responsibilities.

>> Related: What is Autonomy in Nursing?

2. Confidentiality vs. Duty to Warn 

Struggling with maintaining patient confidentiality while also considering the potential harm to others if vital information is not shared.

Imagine a scenario where a nurse working in a mental health facility becomes aware that a patient with a history of violent behavior has confided in the nurse about their plan to cause harm to their former partner. 

The nurse finds themselves in a challenging ethical dilemma: on one hand, they have a duty to maintain the confidentiality of the patient's personal information, and on the other hand, they have an obligation to protect other people from harm.

To deal with this situation, the nurse should take the following steps:

  1. Evaluate the Severity of the Threat: Carefully assess the level of risk involved in the patient's intentions. Is there an immediate and credible threat to the safety of the potential victim? Consider factors such as the patient's history, current mental state, and access to means for carrying out the harm.

  2. Engage in a Therapeutic Relationship: Explore the underlying issues and reasons behind the patient's harmful intentions. Attempt to address any underlying issues or triggers that may contribute to their behavior and encourage them to seek alternative ways to cope.

  3. Seek Supervision and Consultation: It’s important for the nurse to consult with their supervisor or team members about the appropriate course of action to ensure the safety of the potential victim.

  4. Follow Legal and Ethical Guidelines: Be aware of local laws and regulations regarding the duty to warn or protect. If there is a legal obligation to disclose information in order to prevent harm, the nurse should adhere to those requirements while minimizing the breach of confidentiality to the extent possible.

  5. Document the Process: Document all steps taken, including the patient's disclosure, assessments, consultations, and decisions made. This documentation serves as evidence that the nurse acted ethically, responsibly, and in line with professional standards.

3. End-of-Life Care

Managing the ethical complexities around decisions about withdrawing or withholding life-sustaining treatment, considering the patient's wishes, quality of life, and family dynamics.

For example, consider the situation where a nurse is caring for an elderly patient with a terminal illness. The patient expresses the desire to die a peaceful death without aggressive interventions. However, the patient’s family opposes this and wants “everything medically possible” to be done to save the patient’s life. 

The nurse finds themselves in a complex ethical dilemma, torn between honoring the patient's wishes and respecting the concerns of the family.

Here’s how the nurse might address this situation:

  1. Communication and Education: Engage in open and compassionate communication with both the patient and the family about the patient's medical condition. Discuss the patient’s prognosis, available treatment options, and the potential benefits and downsides of continuing or discontinuing life-sustaining measures. 

  2. Respect for Autonomy: Advocate for the patient's right to self-determination and respect their wishes regarding end-of-life care.

  3. Collaboration and Mediation: Facilitate a respectful and open dialogue, promoting a collaborative decision-making process. The nurse can involve the healthcare team, including palliative care specialists and social workers, to provide support, guidance, and mediation to resolve this situation.

  4. Consider Ethical Decision-Making Frameworks: The nurse should use ethical principles in the nursing code of ethics, such as beneficence, non-maleficence, autonomy, and justice, to analyze the situation and guide their actions. By considering the patient's values, goals, and potential impact on their quality of life, the nurse can advocate for the most ethically appropriate course of action.

  5. Supportive Care: Regardless of the final decision made, the nurse should provide holistic and supportive care to the patient and their family. This includes addressing physical, emotional, and spiritual needs, ensuring optimal comfort, and facilitating open communication to foster a sense of trust and understanding.

4. Resource Allocation

Facing the difficult task of distributing limited resources fairly and ethically among patients, especially during times of scarcity or emergencies.

Consider this scenario: During a severe flu outbreak, a nurse working in a hospital emergency department faces the ethical dilemma of resource allocation. The hospital is overwhelmed with patients and the available resources, such as beds, ventilators, and medications are limited. The nurse must make decisions about which patients receive the resources, balancing the needs of the patients in their care while also considering the needs of other patients in the hospital.

The nurse should manage this situation with fairness and transparency, using the following steps:

  1. Prioritization and Triage: Follow established guidelines and protocols for triaging patients based on the severity of their condition and their likelihood of benefiting from the available resources. This ensures that decisions are made based on clinical needs rather than personal biases.

  2. Open Communication: Maintain open and transparent communication with patients and their families. Explain the challenges faced due to limited resources and the criteria being used for resource allocation. This promotes understanding and trust, even in difficult circumstances.

  3. Collaboration and Consultation: Work collaboratively with the healthcare team, including physicians and hospital administrators, to make informed decisions about resource allocation. Seeking input from multiple perspectives helps ensure fairness and accountability.

  4. Consider Ethical Decision-Making Frameworks: Use the ethical principles of fairness and justice in the nursing code of ethics to guide the nurse’s actions. By considering factors like the potential benefits, risks, and overall impact on patients and the community, the nurse can strive to allocate resources in an equitable and ethical manner.

  5. Advocacy and Support: Advocate for the well-being and rights of their patients, even when difficult decisions must be made. 

5. Informed Consent

Ensuring patients have a clear understanding of the risks, benefits, and alternatives of proposed treatments or procedures before they provide consent.

Here’s an example of how this ethical dilemma could occur: A nurse assists a physician who is rushing to obtain informed consent for a surgical procedure, despite the patient's pain and anxiety. However, the nurse quickly recognizes the patient's limited understanding of the procedure’s implications, raising ethical dilemmas regarding informed consent.

To handle this situation, the nurse should follow these steps:

  1. Ensure Adequate Information: Intervene respectfully but assertively and ask the physician to slow down and provide the patient with complete information about the procedure, risks, benefits, potential outcomes, and available alternatives. 

  2. Clarify Patient Understanding: Speak with the patient and assess their understanding of the information provided. Encourage the patient to ask questions and address any concerns they may have. 

  3. Advocate for Time and Support: If the patient appears overwhelmed or is struggling to comprehend the information, the nurse should advocate for additional time or resources, such as involving a family member or providing educational materials or an interpreter (if appropriate) to support the patient in making an informed decision. 

  4. Document the Process: Document the steps taken to address the concerns related to informed consent. Be sure to include any discussions, explanations provided, patients' questions, and their ultimate decision. Accurate documentation demonstrates the nurse's commitment to upholding ethical standards and professional accountability.

6. Cultural and Religious Beliefs

Navigating conflicts between a patient's cultural or religious values and the standard practices or protocols of healthcare.

In a multicultural society, nurses often encounter ethical dilemmas when a patient's cultural or religious beliefs clash with the standard practices or protocols of healthcare. An example is when a nurse is caring for a patient from a cultural background who strongly believes in traditional healing methods and is hesitant to accept Western medicine.

In this situation, the nurse should have a culturally sensitive discussion with the patient and demonstrate respect for diversity. Here are the steps the nurse should take:

  1. Culturally Competent Assessment: Conduct a culturally competent assessment to understand the patient's cultural and religious beliefs, values, and preferences regarding healthcare. This requires active listening, open-mindedness, and avoiding assumptions or stereotypes.

  2. Establish Trust and Rapport: Build a trusting relationship with the patient by acknowledging and respecting their cultural and religious beliefs. This can be achieved through effective communication, empathy, and demonstrating cultural humility.

  3. Collaborative Decision-Making: Engage the patient and their family in collaborative decision-making regarding their healthcare. Respectfully discuss the patient's beliefs and preferences, and explore opportunities to integrate traditional healing practices with evidence-based Western medicine. 

  4. Consultation and Education: If there are concerns about the patient's well-being or the appropriateness of certain traditional healing methods, the nurse should seek guidance from a cultural consultant, interpreter, or healthcare team. 

  5. Advocacy and Liaison: Serve as an advocate for the patient, ensuring their cultural and religious rights are respected within the healthcare system. This may involve facilitating communication between the patient and healthcare providers, ensuring the provision of culturally competent care, and addressing any cultural or religious barriers that may arise.

7. Impaired Colleague

Grappling with the ethical responsibility of reporting concerns about a colleague's impairment due to substance abuse or mental health issues.

This situation might occur when a nurse becomes aware that a nursing colleague is impaired while on duty. The impaired nurse exhibits erratic behavior and smells strongly of alcohol. The nurse who witnesses this behavior finds themselves in a challenging ethical dilemma, torn between their duty to ensure patient safety and their loyalty to their colleague.

Nevertheless, the nurse needs to prioritize patient safety and act professionally by following these steps:

  1. Immediate Concern for Patient Safety: The nurse's primary responsibility is to ensure the safety and well-being of patients. If they observe signs of impairment in their colleague that could compromise patient safety, they should take immediate action.

  2. Reporting: The nurse should report their observations and concerns to the appropriate authority within the healthcare facility, such as the nurse manager or supervisor. This report should be made objectively without personal judgments or assumptions and with a focus on patient safety.

  3. Confidentiality and Professionalism: Maintain confidentiality throughout the reporting process, being mindful not to disclose personal details of the impaired colleague unless necessary for the investigation.

  4. Collaboration and Support: Collaborate with the healthcare team and support the impaired colleague's well-being by encouraging them to seek appropriate help and support, such as employee assistance programs or counseling services. 

  5. Ethical Obligation: Nurses have an ethical obligation to protect the welfare of patients and maintain the standards of the nursing profession. This includes recognizing and addressing impairment issues among colleagues to ensure safe and quality care.

8. Professional Boundaries

Striking a balance between providing compassionate care and maintaining appropriate professional boundaries, particularly when it comes to personal relationships with patients.

In this example, let’s look at a scenario where a nurse develops a close friendship with a patient and begins sharing too many personal details about their own life unrelated to the patient’s healthcare needs.

When the nurse realizes what’s happening, they need to prioritize maintaining professional boundaries and act in the best interest of the patient by following these steps:

  1. Recognize the Boundary Issue: Use personal reflection to recognize when professional boundaries are being crossed or compromised. Acknowledging this ethical dilemma is the first step toward resolving it.

  2. Reflect on the Nurse-Patient Relationship: The nurse should remind themselves of their professional role, the duty of care, and the need to maintain objectivity and professional distance.

  3. Reestablish Boundaries: Take appropriate actions to reestablish and reinforce professional boundaries with the patient. This may involve redirecting conversations back to the patient's healthcare needs, avoiding personal disclosures, and focusing on the patient's well-being.

  4. Seek Guidance and Supervision: If the situation becomes challenging to resolve alone, the nurse should seek help from a supervisor, nurse manager, or experienced nursing team member. Consulting with experienced professionals can provide valuable insights and support in addressing this ethical dilemma.

  5. Continuous Professional Development: Engage in ongoing professional development and education regarding nursing ethics and setting professional boundaries. Staying current on ethical guidelines and participating in discussions and training on maintaining professional boundaries can help prevent future boundary issues with patients.

9. Whistleblowing

Facing the ethical dilemma of reporting concerns about wrongdoing or unethical practices within the healthcare system, despite potential professional and personal repercussions.

An example of whistleblowing would be when a nurse becomes aware that a colleague is stealing controlled substances from the medication supply. The nurse decides to report this to their supervisor because it compromises patient safety and violates professional and legal standards. However, the nurse is worried about their colleague being disciplined and possibly losing their license.

Here are the steps the nurse should follow:

  1. Gather Evidence: Collect factual evidence such as documentation discrepancies in medication records, witnessing the colleague's actions, or capturing any other supporting documentation. 

  2. Consult with Colleagues: Seek advice from trusted colleagues, supervisors, or mentors within the healthcare organization. Discuss the situation and determine the best course of action. It’s important to maintain confidentiality during these discussions to protect both the patient and the nurse making the report.

  3. Follow the Proper Chain of Command: Follow the established reporting channels within their healthcare organization. This typically involves reporting concerns to a supervisor, nurse manager, or a designated ethics or compliance hotline. Ensure that the report is made in writing and contains all relevant details and evidence.

  4. Protection and Confidentiality: Be familiar with the whistleblower protection policies and laws in their jurisdiction. The nurse should ensure that their report is treated confidentially and that appropriate steps are taken to protect them from retaliation.

  5. Documentation: Keep a detailed record of all actions taken, including the date and time of the incident, any conversations or consultations, and copies of the report submitted. This documentation helps demonstrate the nurse's commitment to reporting and acting in accordance with professional and ethical standards.

10. Ethical Use of Technology

Considering the ethical implications of using technology in healthcare, such as maintaining patient privacy and security, avoiding biases in algorithms, and ensuring equitable access to care.

An example of this ethical dilemma could occur when a nurse becomes concerned about potential biases in an algorithm and decides to report this to her supervisor. She recognizes that an algorithm where she works may disproportionately allocate resources based on patient factors such as age, race, and gender, resulting in inequitable access to care.

The nurse should advocate for equitable care by taking these steps:

  1. Investigate and Evaluate: Become familiar with the AI algorithm being used and investigate its development process. Assess whether the algorithm has been validated and tested for biases and fairness. 

  2. Raise Concerns: If the nurse identifies biases or inequities in the algorithm, they should communicate their concerns to the appropriate individuals, such as nurse leaders, healthcare administrators, or the technology implementation team. 

  3. Collaborate for Improvement: Engage in collaborative discussions with the healthcare team, including the nursing supervisor, IT specialists, and data scientists. Work with the team to develop strategies to eliminate biases and ensure equitable use of the technology for all patients.

  4. Promote Patient Advocacy: Advocate for the rights and well-being of the patients who may be affected by the technology. This involves ensuring informed consent and transparency regarding the use of AI algorithms. Patients should have the opportunity to understand and discuss the potential biases and their impact on their care.

  5. Continuous Evaluation: Advocate for ongoing evaluation and monitoring of all AI technology being used in patient care to identify and resolve biases or unintended consequences. 

Ethical dilemmas are common in nursing and can be difficult to deal with. But you don’t have to make the decisions about these issues alone. Seek out the support and input of your nursing colleagues, supervisor, or nurse manager. By doing so, you will feel more comfortable and confident about how to handle the ethical dilemma you find yourself in.

*This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease.

Leona Werezak
Leona Werezak
Nurse.org Contributor

Leona Werezak BSN, MN, RN is the Director of Business Development at NCLEX Education. She began her nursing career in a small rural hospital in northern Canada where she worked as a new staff nurse doing everything from helping deliver babies to medevacing critically ill patients. Learning much from her patients and colleagues at the bedside for 15 years, she also taught in baccalaureate nursing programs for almost 20 years as a nursing adjunct faculty member (yes! Some of those years she did both!). As a freelance writer online, she writes content for nursing schools and colleges, healthcare and medical businesses, as well as various nursing sites.

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