Nurses face ethical dilemmas on a daily basis regardless of where they practice. No matter where nurses function in their varied roles, they are faced with ethical decisions that can impact them and their patients. There is no “right” solution to an ethical dilemma.
So what is an ethical dilemma? It is a problem without a satisfactory resolution. The significance of ethical decision-making lays in the fact that very different ethical choices regarding the same ethical dilemma can be made resulting in neither choice being a “right or wrong” decision.
Ethics involve doing “good” and causing no harm. But how one defines what is ethical can vary differently from nurse to nurse. Classes on the principles of nursing ethics give the nurse the tools to base ethical decisions upon. However, this knowledge is then shaped by the values, beliefs and experiences of the nurse. Consequently, very different choices may be made involving the same dilemma.
There are many ethical issues nurses can encounter in the workplace. These include quality versus quantity of life, pro-choice versus pro-life, freedom versus control, truth telling versus deception, distribution of resources, and empirical knowledge versus personal beliefs. Quantity may address how long a person lives or perhaps how many people will be affected by the decision. Quality pertains to how “good” a life a person may have and this varies depending on how a person defines “good”.
So how does the nurse support a patient deciding between a therapy that will prolong life but the quality of life will be compromised? The person may live longer, but will likely experience significant side effects from the therapy. What should the nurse’s position be?
- Pro-choice versus pro-life. This issue affects nurses personally. Many of the positions nurses assume in this dilemma are influenced by their own beliefs and values. How does a nurse care for a patient who has had an abortion, when the nurse considers abortion murder? Can that nurse with very opposing values support that patient’s right to choose her autonomy?
- Freedom versus control. Does a patient have the right to make choices for one’s self that may result in harm, or should the nurse prevent this choice? For example, a patient wants to stop eating, but the nurse knows the consequences will harm the patient. Does the nurse have the “right” to force the patient to eat?
- Truth telling versus deception. This is another issue that nurses may have to deal with, especially when families want to deny telling the patient the truth about the medical condition. What should a nurse do when a family insists telling the patient the prognosis will cause harm? How can a nurse know if this is true? Does the patient have the right to know?
- Another dilemma involves the distribution of resources. Who should get the limited resources? For example, nurses working with patients that are in a vegetative state; should these patients be left on life support? Look at the cost of maintaining these patients. These patients are consuming resources that could be used for patients in whom such costly interventions, if available, could save their lives. What is the role of the nurse when a family wants to continue life support for a medically futile family member?
- Empirical knowledge versus personal belief. In these dilemmas, research based knowledge in nursing practice is contrasted to beliefs gained from such things as religious beliefs. For example, what should a nurse do when a patient is admitted to the hospital that desperately needs a transfusion to live but has the belief that transfusions are unacceptable? The nurse knows this patient will die without the transfusion. How does that nurse empathize with the patient’s family who supports the family member’s choice and still be supportive of the patient’s and family’s right to this decision? Ethical dilemmas in nursing come daily in which they must make a decision. The decisions they will make will be affected by so many factors including principles learned in school and their own personal beliefs, values and experiences. Are these choices “right or wrong”?
