Ethics in Nursing
Ethics are moral principles that guide nursing practice. Nurses face ethical dilemmas regularly and must be able to identify ethical issues, consider different perspectives, and make reasoned decisions.
The Four Core Ethical Principles
- Autonomy — Respecting the patient's right to make their own decisions
- Beneficence — Acting in the patient's best interests, doing good
- Non-maleficence — Avoiding harm to the patient
- Justice — Treating patients fairly and equitably
Autonomy and Consent
Respecting autonomy means respecting a patient's right to make decisions about their own care, even if you disagree with their choice. For consent to be valid, it must be given voluntarily by a person with capacity who has been fully informed.
Patients have the right to refuse treatment, even life-saving treatment, provided they have capacity. The only exception is under the Mental Health Act 1983 for patients with mental disorders.
Beneficence vs Non-maleficence
Nurses must balance doing good (beneficence) with avoiding harm (non-maleficence). Some treatments may cause side effects or discomfort but provide overall benefit. The principle of proportionality means the benefits must outweigh the harms.
Justice and Fairness
Justice means treating all patients fairly and without discrimination. The Equality Act 2010 protects against discrimination based on age, disability, gender reassignment, marriage/civil partnership, pregnancy/maternity, race, religion/belief, sex, and sexual orientation.
Ethical Dilemmas
Common ethical dilemmas in nursing include:
- Withholding or withdrawing treatment
- End of life decisions and advance directives
- Confidentiality vs protecting others
- Allocating scarce resources
- Conscientious objection
- Whistleblowing
The Four Quadrant Approach
When facing an ethical dilemma, consider:
- Medical indications — What are the medical facts?
- Patient preferences — What does the patient want?
- Quality of life — How will this affect the patient's life?
- Contextual features — What are the social, cultural, legal, and financial factors?