Name
University of Phoenix
NSG/426 Integrity in Practice: Ethics and Legal Considerations
Prof. Name
Date
Nurses encounter ethical issues every day, often while balancing patient preferences, professional responsibilities, legal requirements, safety concerns, limited resources, and personal values. Common ethical issues in nursing include informed consent, patient autonomy, confidentiality, end-of-life decisions, equitable access to care, resource allocation, cultural differences, and conflicts between patient wishes and clinical recommendations. Ethical decision-making gives nurses a structured way to address these situations while protecting patient dignity, promoting safety, and maintaining professional integrity.
As healthcare becomes more complex, nurses must understand both foundational ethical principles and how those principles apply to real-world clinical situations. Ethical nursing practice supports patient-centered care while helping nurses make decisions that are professionally responsible, legally appropriate, and consistent with established standards of care.
Ethics refers to moral principles that help determine what is right, fair, responsible, or appropriate. In nursing, ethics provides a framework for making decisions when there may not be an obvious or universally accepted answer.
Nurses bring their own beliefs and values to clinical practice, but professional nursing decisions must also be guided by ethical standards, evidence-based practice, organizational policies, and applicable laws. This distinction is important because a nurse’s personal beliefs should not override a competent patient’s rights or professional obligations.
Nursing ethics is particularly important when patients, families, healthcare professionals, and organizations have different perspectives about treatment or care. Ethical reasoning helps nurses examine these differences objectively and determine how to protect the patient’s interests.
Haddad and Geiger (2019) explain that ethical considerations are an integral part of nursing practice and can help healthcare professionals recognize and respond appropriately to ethical problems.
Ethics is essential because nurses frequently make decisions that directly affect patients’ health, safety, privacy, and quality of life. Ethical practice helps nurses respect patient rights while meeting professional and legal responsibilities.
Ethical nursing practice helps professionals:
Protect patient dignity, privacy, and rights.
Support informed decision-making.
Respect patient autonomy and preferences.
Promote safe and compassionate care.
Treat patients fairly and equitably.
Maintain professional trust and accountability.
Navigate conflicts between competing values or responsibilities.
Ethics also strengthens the nurse-patient relationship. When patients believe that nurses are honest, respectful, and committed to their well-being, they are more likely to participate actively in their care.
Although ethical dilemmas vary by clinical setting, several issues appear repeatedly across nursing practice.
Patient autonomy is the right of a competent individual to make informed decisions about their own healthcare. Nurses may face ethical challenges when a patient’s decision differs from what the healthcare team recommends.
For example, a patient may refuse a procedure, medication, or other recommended treatment. The nurse’s role is not simply to persuade the patient to accept treatment. Instead, the nurse should help ensure that the patient receives understandable information, has an opportunity to ask questions, and can make a voluntary and informed decision.
Protecting confidential health information is both an ethical and legal responsibility. Nurses routinely handle sensitive information contained in medical records, conversations, electronic health systems, and clinical communications.
Ethical concerns can arise when family members request information, when patient information is discussed in public areas, or when electronic information is accessed or shared inappropriately.
Nurses should disclose patient information only when permitted or required under applicable privacy laws, professional standards, and organizational policies.
End-of-life decisions can create some of the most emotionally and ethically complex situations in nursing. Nurses may care for patients who have advanced illness, have chosen comfort-focused treatment, or have documented preferences regarding life-sustaining interventions.
Ethical questions may involve advance directives, resuscitation decisions, pain and symptom management, treatment goals, surrogate decision-making, and disagreements among patients, families, and healthcare professionals.
Nurses can support ethical end-of-life care by respecting patient preferences, communicating clearly, providing compassionate care, and helping patients and families understand available options.
Healthcare organizations sometimes operate with limited staff, equipment, medications, beds, or other resources. Nurses may therefore encounter situations in which not every patient can immediately receive the same resource or level of care.
These situations raise questions about justice and fairness. Decisions should be based on relevant clinical and ethical criteria rather than discrimination or personal preference.
Patients may have cultural, religious, or personal beliefs that influence their healthcare decisions. Ethical challenges can occur when a patient’s preferences differ from the beliefs of family members or healthcare professionals.
Respect for cultural differences does not mean that nurses must agree with every belief. Rather, nurses should provide respectful, culturally responsive care while maintaining patient safety and professional standards.
Healthcare disparities can create ethical challenges when patients face barriers related to income, insurance status, geography, disability, language, or other circumstances.
Nurses often see the effects of unequal access directly. Patient advocacy may therefore involve helping individuals understand available services, connecting them with appropriate resources, and communicating concerns about barriers to care.
Ethical decision-making provides a systematic method for analyzing difficult clinical situations. Instead of relying solely on intuition or personal beliefs, nurses can examine the facts, identify competing ethical principles, consider potential consequences, and determine the most appropriate course of action.
A commonly used ethical decision-making framework involves:
Gathering the relevant facts and clinical information.
Identifying the primary ethical concern.
Determining who may be affected by the decision.
Considering the patient’s preferences, values, and goals.
Examining relevant ethical principles.
Reviewing professional standards, policies, and legal requirements.
Considering possible courses of action and their consequences.
Selecting and implementing the most ethically appropriate option.
Evaluating the outcome and reflecting on the decision.
Velasquez et al. (2015) emphasize that ethical decision-making requires careful analysis, consideration of stakeholders, evaluation of alternatives, and reflection rather than relying only on emotion or predetermined answers.
Several foundational principles help nurses evaluate ethical situations. The most commonly discussed principles include autonomy, beneficence, non-maleficence, justice, fidelity, and veracity.
| Ethical principle | Meaning in nursing practice |
|---|---|
| Autonomy | Respecting a patient’s right to make informed decisions about their care. |
| Beneficence | Taking actions intended to benefit the patient. |
| Non-maleficence | Avoiding or minimizing preventable harm. |
| Justice | Promoting fairness and equitable treatment. |
| Fidelity | Keeping professional commitments and maintaining trust. |
| Veracity | Communicating honestly and providing accurate information. |
These principles may sometimes conflict. For example, a nurse may believe that a particular treatment would benefit a patient while the patient exercises autonomy by refusing it. Ethical nursing practice requires careful consideration of both the patient’s rights and the nurse’s professional responsibilities.
Whether healthcare should be considered a fundamental right or a service primarily accessed through individual financial contribution remains an important ethical and public-policy debate.
Those who view healthcare primarily as a privilege often emphasize individual responsibility, employment, taxation, insurance structures, and the financial sustainability of healthcare systems. From this perspective, expanding universal coverage may require significant structural and financial changes.
Others argue that healthcare should be recognized as a fundamental right because access to appropriate healthcare can directly affect survival, disease prevention, quality of life, and overall population health.
This debate involves more than healthcare financing. It also raises ethical questions about justice, equality, social responsibility, and the appropriate role of government and healthcare institutions in protecting population health.
Supporters of healthcare as a right argue that access to essential healthcare should not depend primarily on a person’s income, employment, or ability to pay. They point to the relationship between healthcare access and outcomes such as disease prevention, life expectancy, and quality of life.
When people cannot obtain necessary healthcare because of financial or other barriers, conditions that could have been prevented or treated earlier may become more serious. This can contribute to avoidable health disparities.
From an ethical perspective, supporters often connect healthcare access with the principles of justice and respect for human dignity. Jones (2018), for example, argues for recognizing healthcare as a right and connects healthcare access with broader questions of equality and social responsibility.
Universal healthcare generally refers to a system in which people have access to needed health services without facing financial hardship that prevents them from obtaining care.
Supporters argue that broader healthcare coverage may:
Improve access to preventive services.
Encourage earlier diagnosis and treatment.
Reduce barriers to essential healthcare.
Address some healthcare disparities.
Support population health.
Promote greater health equity.
Hammonds et al. (2019) discuss the relationship between universal health coverage and the right to health, emphasizing the importance of health systems that advance equitable access and population well-being.
The specific effects of universal healthcare, however, depend on how a healthcare system is designed, funded, and implemented. Universal coverage does not necessarily mean that every country uses the same financing model or provides identical services.
Nurses have an important ethical role as patient advocates. Because nurses interact closely with patients and families, they are often among the first healthcare professionals to recognize barriers to treatment, communication problems, safety concerns, or conflicts between patient preferences and recommended care.
Professional nursing ethics emphasizes respect for human dignity, patient rights, advocacy, fairness, and compassionate care. Nurses should provide care without allowing a patient’s socioeconomic circumstances to determine the level of respect or compassion they receive.
In practice, nurses may advocate for patients by:
Helping patients understand their healthcare options.
Supporting informed decision-making.
Communicating patient concerns to the healthcare team.
Identifying barriers that interfere with appropriate care.
Connecting patients with available resources.
Protecting vulnerable patients from preventable harm.
Promoting equitable and evidence-based care.
Ethical nursing challenges continue to evolve as healthcare technology, treatment options, and healthcare systems change. Nurses may encounter ethical concerns involving electronic health information, artificial intelligence, genetic testing, reproductive healthcare, resource shortages, emerging treatments, and end-of-life technologies.
Technology can create additional ethical questions about privacy, informed consent, data security, accuracy, and accountability. At the same time, advances in medicine can make treatment decisions increasingly complex.
Because of these changes, ethical competence is not a one-time skill. Nurses must continue developing their knowledge of professional standards, laws, healthcare policies, and ethical reasoning throughout their careers.
When a difficult ethical situation arises, nurses should avoid making decisions based solely on personal opinion. A structured approach can help clarify the situation and identify an appropriate response.
The nurse should first establish the clinical facts and determine the patient’s preferences and decision-making capacity when relevant. Next, the nurse should identify the ethical principles involved and consider professional standards, organizational policies, and applicable laws.
When the situation remains unclear, nurses can seek assistance from appropriate resources such as a nurse manager, ethics committee, social worker, healthcare provider, or other qualified professional. Documentation and respectful communication are also important components of responsible ethical practice.
Common ethical issues include patient autonomy, informed consent, confidentiality, end-of-life care, resource allocation, cultural or religious differences, conflicts of interest, patient safety, and unequal access to healthcare.
Ethical decision-making helps nurses evaluate difficult situations systematically while protecting patient rights, promoting safety, supporting fairness, and maintaining professional and legal responsibilities.
The six commonly identified principles are autonomy, beneficence, non-maleficence, justice, fidelity, and veracity. Nurses use these principles to evaluate competing responsibilities and support ethical patient care.
The nurse should support the patient’s right to participate in decisions, ensure that the patient receives appropriate information, communicate concerns with the healthcare team, and follow applicable professional, legal, and organizational requirements.
There is no universal agreement on this question. Those who consider healthcare a right emphasize equity, human dignity, and access to essential services, while those who view it primarily as a privilege often emphasize individual responsibility, financial contribution, and healthcare-system sustainability.
Nurses advocate by protecting patient rights, promoting informed choices, communicating patient concerns, supporting equitable treatment, identifying barriers to care, and helping vulnerable patients access appropriate healthcare resources.
Ethical challenges are an integral part of professional nursing practice. Nurses must frequently balance patient autonomy, safety, professional responsibilities, legal requirements, resource limitations, and personal values.
A strong understanding of ethical principles helps nurses approach these situations objectively and compassionately. Autonomy, beneficence, non-maleficence, justice, fidelity, and veracity provide a foundation for ethical reasoning, while structured decision-making frameworks help nurses evaluate complex situations.
The debate over healthcare as a right or privilege illustrates how nursing ethics extends beyond individual patient encounters. Questions about healthcare access, health disparities, resource allocation, and social responsibility affect both individual patients and entire communities. Regardless of differing perspectives on healthcare policy, nurses have an ongoing responsibility to protect patient dignity, advocate for appropriate care, and uphold professional ethical standards.
Couronne, I. (2017, May 31). In the US, health care a privilege, not a right. Business Insider. https://www.businessinsider.com/afp-in-the-us-health-care-a-privilege-not-a-right-2017-5
Haddad, L. M., & Geiger, R. A. (2019). Nursing ethical considerations. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526054/
Hammonds, R., Ooms, G., Mulumba, M., & Maleche, A. (2019). UHC2030’s contributions to global health governance that advance the right to health care: A preliminary assessment. Health and Human Rights, 21(2), 243–252. https://www.hhrjournal.org/2019/12/uhc2030s-contributions-to-global-health-governance-that-advance-the-right-to-health-care-a-preliminary-assessment/
Jones, K. (2018, January 17). It’s time to recognize health care as a right. The Washington Post. https://www.washingtonpost.com/news/made-by-history/wp/2018/01/17/its-time-to-recognize-health-care-as-a-right/
Velasquez, M., Moberg, D. R., Meyer, M. J., Shanks, T., McLean, M., DeCosse, D., Andre, C., & Hanson, K. (2015). A framework for ethical decision making. Markkula Center for Applied Ethics, Santa Clara University. https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/a-framework-for-ethical-decision-making/
