Whether you define ethical principles as a “moral compass” or “what you do when no one is watching” you capture the common thread of their role in decision-making affecting you personally, others around you or society in general. While Hippocrates is credited with pioneering ethical standards in medicine with the Hippocratic Oath, the formal study and application of ethical principles in healthcare have evolved significantly, incorporating diverse cultural, philosophical, and professional influences beyond ancient Greece.
The nursing profession and other healthcare disciplines align with four broad ethical principles—beneficence, nonmaleficence, autonomy, and justice—these principles are shared across the healthcare field and are not exclusive to nursing. These principles have survived the test of time as they hold patients’ best interests as their underpinning.
What are the Four Ethical Principles That Guide Nurses and Nursing Practice
1. Beneficence
Beneficence is the obligation nurses hold to act for the patient’s benefit. Nurses operationalize this ethical principle each time they carry out any of the following acts:
- Protect the patient from harm.
- Protect the patients’ rights.
- Removing conditions that could cause harm.
- Helping persons with disabilities.
- Rescuing persons from dangerous conditions.
Hence, conducting a “time-out” in the OR, implementing fall precautions for an elderly patient or identifying the need for suicide precautions are just a few examples of beneficence in nursing practice.
2. Nonmaleficence
The principle of nonmaleficence obliges nurses to avoid harming patients. It is reflected in ethical guidelines and professional standards of care rather than being solely rooted in individual morals, emphasizing actions such as preventing harm and ensuring patient safety.
- Do not kill.
- Do not cause pain or suffering.
- Do not incapacitate.
- Do not offend.
- Do not deprive others of the goods of life.
Nurses, in concert with the patient, physicians and other members of the health care team, demonstrate this principle when developing and implementing individual plans of care for patients that preserve quality of life, minimize pain and suffering and address end-of-life issues as they arise.
3. Autonomy
The principle of autonomy is rooted in the belief that humans have an unalienable right and capacity for self-determination. The principle of autonomy is demonstrated by nurses through practices such as:
- Respecting informed consent,
- Following advance directives,
- Truth-telling, maintaining confidentiality,
- Aligning with legal requirements and ethical guidelines to support patient self-determination.
Nurses frequently become entangled in the ethical dilemmas associated with autonomy when a patient’s competence (mental and physical) is in question. In these situations, nurses, along with other members of the healthcare team, must consult with the organization’s Ethics Committee to bring thoughtful and timely resolution.
The prevention of breaches of a patient’s right to confidentiality is a constant focus of nurses. Breaches of confidentiality challenge the patient’s autonomy through disclosure of information without consent. Nurses’ vigilance in maintaining patient confidentiality is pivotal to building and sustaining patient trust in providers, staff and the organization.
4. Justice
The principle of justice, emphasizing fair and equitable access to healthcare, has been highlighted during health crises such as pandemics, underscoring the ongoing role of nurses in advocating for equitable care and resource allocation. Justice in healthcare implies that all persons should have fair and equitable access to appropriate healthcare services.
Nurses experience challenges to this principle regularly whenever they and healthcare team members are faced with the need to allocate scarce resources. This includes manpower, equipment, tests, medication and transplantable organs, to name a few. In a broader sense, nurses may also experience socioeconomic challenges to justice in their communities. This is typically demonstrated by inadequate services (primary care, behavioral health, etc.) being provided to underserved communities.
Ethical Principles in Nursing: What is the Nurses’ Role When Conflicts Between Ethical Principles Arise
Although we would like to believe that guiding principles serve to minimize or eliminate conflicting situations, real-life situations frequently challenge strict interpretation and adherence to ethical principles.
The two principles that frequently conflict are beneficence and autonomy. An example of this conflict arises when a life-saving treatment (e.g., a ventilator) is initiated, and the patient expresses the desire to terminate it. The treatment was initiated out of beneficence, while the patient’s wishes demonstrated autonomy.
When ethical conflicts arise, the nurse plays a substantial role in ensuring the patient’s desires are well represented. This is achieved through:
- Obtaining copies of advanced directives if they exist.
- Communicating with family and significant others who may speak on behalf of the patient if they cannot do so themselves.
- Documentation of interactions between the nurse and the patient may help clarify the patient’s wishes.
- Participating in ethics committee meetings in person or by proxy should the need arise.
- Participating in family conferences and/or meetings with the patient wherein explanations of the benefits and risks of treatment are discussed, along with the impact on quality of life.
Situations in which ethical dilemmas are identified and resolved are typically emotionally taxing for members of the care team, families, and all others involved. It is important for nurses to keep emotions in check and strive to maintain professional objectivity throughout the process. A veil of confidentiality must be maintained as ethical dilemmas are resolved. Hence, discussing situations with persons not directly involved is forbidden.
However, nurses and other involved team members are encouraged to seek mental health support. This can be achieved through personal counseling or EAP (Employee Assistance Programs) offered by the organization.
Finally, ethical dilemmas often call upon one’s spiritual strength and background. Talking with clergy members, prayer and meditation can be useful tools as professionals assist patients and families in navigating these situations.
Conclusions for Ethics in Nursing Practice
Though the ethical principles outlined above serve as a moral compass for all healthcare disciplines, nurses play a unique role in creating nurse-patient relationships as the most consistent and closest professional to the bedside.
In their daily interactions with patients, nurses serve to protect patients from harm and preserve their rights as individuals. Nurses, as professionals and citizens, are in a position to influence fairness and equity in the delivery of health care services. The nurses’ cognizance and vigilance of these principles serve as a foundation of trust between patients, the profession, the community and the healthcare organization.
See Also
Home Loans for Healthcare Workers
How to Become a Nurse Practitioner?
Follow us