WHEN DOES AN ETHICAL DILEMMA EXIST?

An ethical dilemma is a conflict between alternatives, where choosing any of them will lead to a
compromise of some ethical principle and lead to an ethical violation. A crucial feature of an ethical
dilemma is that the person faced with it should do both the conflicting acts, based on a strong ethical
compass, but cannot; he may only choose one.

Ethical dilemmas may exist when there is conflict between the rights or values of the people
involved in the situation. They may occur when those involved believe that different principles ought to
motivate their behavior or when they believe that considerations of the consequences of their actions
should drive their decision making.

Ethical dilemmas exist when there is a choice to be made between two options, neither of which
resolves the situation in an ethically acceptable fashion. It is called ethical dilemmas because this assume
that the chooser will abide by societal norms, such as codes of laws or religious teachings.

ETHICAL DILEMMA EXAMPLES:

1. Your classmate always takes credit for your and others’ work. Now, you have the chance to take
credit for her work. Would you do it?
2. At a restaurant, you see your friend’s boyfriend engaged in some serious flirting with another
woman. Do you tell your friend and ruin her relationship or do you pretend you never saw that?

4 COMMON NURSING ETHICS DILEMMAS

1. Informed consent
• Concerns that patients and their families have not been fully informed about their
treatments or clinical prognosis is a common ethical concern of nurses, Ulrich reported.
2. Disclosing medical conditions
• Another example of an ethical dilemma is telling the truth to a patient vs. being deceptive.
o “Sometimes families request that patients not be told about their medical condition
or diagnosis,”
o “The nurse must consider the patient's right to know. How does the nurse know
what the family is saying is true?”
• The nurse has an obligation to the patient and the ethical principles of nonmaleficence and
fidelity—the obligation to prevent harm and the obligation to be faithful to your colleagues,
Altman said, adding, “The nurse’s own value of truth telling must also be considered.”
3. Incompetence among peers
• Another dilemma involving nursing ethics is when a nurse notes incompetence in a fellow
health care team member and struggles with speaking up or staying silent.
o “They may feel the behavior should be reported because of the threat to patient
safety but hesitate to do so because it would worsen inadequate staffing,”
o “Some dilemmas can be framed as competing obligations, such as protecting the
patient on one hand and protecting the staff on the other.” The principles to
consider are nonmaleficence and fidelity.
o “Solutions often become apparent when we stop and consider all the possible
actions available to us,”
o “Beyond report or don’t report, there may be an option to talk to the individual in
question, assess his or her awareness of the incompetence, and encourage further
training, education or practice.”
 4. Broader ethical issues
• ANA considers the top three nursing ethics issues as:
o Creating and maintaining an ethical work environment
o Nursing’s role in social justice, such as opposing capital punishment
o Moral distress and moral resilience.

WHAT INFORMATION DOES A NURSE NEED TO MAKE AN INFORMED DECISION?

Every day we are faced with problems that at some time, we need to a moment to think it over. Nurses
have probably always known that their decisions have important implications for patient outcomes. Being
cast in the role of active decision makers in the health care by policy makers and other members of the
healthcare team is a big task at hand.

To make informed practice decisions, nurses need access to aggregate data about their patients and the
impact of their care, and they need to know how to interpret that data. This includes the plan of care,
physiological parameters, assessments, interventions and progress evaluations. With this, nurses are
expected to use the best available evidence in their judgments and decisions.

WHAT ETHICAL FRAMEWORKS MIGHT A NURSE USE TO UNDERSTAND A DILEMMA?

The ethical framework is a set of principles and values that provide a solid foundation for safe and
ethical practice. These are the ethical frameworks:
• International and National Code of Ethics for Nurses
• Declaration of Helsinski
• Nuremberg Code
• Markkula Center Framework for Ethical Decision Making
• National Research Act
• ANA’s Ethical Guidelines for Nursing Research
• Federal, State, Facility Bill of Rights
• Respect for Person, Beneficence and Justice
• Nursing Caring Theory by Swanson
• Deontological Code
• Declaration of Human Rights
• Autonomy and Advocacy Model
• Compassion and Advocacy Model
• ER Environmental Model
• Greipp’s Model of Ethical
• Decision Making
• Trust Approach to Nursing Ethics
• SBAR (Situation, Background, Assessment, Recommendation)
• Dignity Enhancing Framework

Each person has their own set of personal ethics and morals. Ethics within healthcare are important
because workers must recognize healthcare dilemmas, make good judgments and decisions based on
their values while keeping within the laws that govern them.
HOW CAN A NURSE BEST CARRY OUT THE DECISION?

A nurse can best carry out the decision if he/she understood and implemented in practice the four basic
principles which are Autonomy, Benevolence, Nonmaleficence and Distributive Justice. Nurses can also
carry out the decision by requiring good quality judgment including critical thinking, and extensive shared
decision making.

WHY DO REASONABLE PEOPLE DISAGREE ABOUT A RESOLUTION OF A DILEMMA?

Reasonable people disagree about a resolution of a dilemma because of prioritization or accommodate

and reconcile between different principles, values and or moral beliefs. They perceived differently on
different perspective, and principles and values conflict with one another.

Sometimes, decision making in these cases may be challenging, and even distressing. However, the
difficulty of resolving ethical dilemmas is not a reason to give up trying to understand the right thing to
do. As troubling as these decisions might be, they also present an opportunity to contemplate the best
thing to do under the circumstances.

Reasonable people disagree about a resolution of a dilemma because some issues are often perceived
differently by those who are involved.

WHAT CAN A NURSE DO TO ENCHANCE GROUP DECISION MAKING AND RESOLUTION OF A DILEMMA?

Nurses may do enhance group decision making and resolution of dilemma by making good judgments and
decisions based on the values with the keeping within the laws that governs them. Also, to practice
competently with integrity, professionalism, competence, and social responsibility.

Many hospitals, medical centers and other healthcare facilities have multidisciplinary ethics committees
that meet as a group and resolve ethical dilemmas and conflicts. Nurses should avail themselves to
ethicists and ethical committees within their facility when such ethical resources and mechanisms are
present in order to resolve ethical concerns and ethical dilemmas.

WHAT SHOULD THE NURSE DO IF SHE OR HE DISAGREES WITH A DECISION?

A nurse does not have to accept an assignment that conflicts with her personal ethical standards. In
particular, issues such as abortion, DNR orders, and the withdrawal of nutrition may pit a nurse’s
conscience against the demands of her job. Although a nurse does not have to perform ethically
repugnant tasks, there is a correct, sometimes legally necessary, way to refuse such assignments.

A nurse is legally responsible for the care of the patient and cannot, under any circumstances, endanger
the patient or abandon him. Although courts sometimes uphold the right of a health care provider to not
deliver morally objectionable care, no court will condone the abandonment of a patient, even for valid
ethical reasons. Therefore, if a change in a patient’s status or condition requires that you perform a task
that you cannot perform in good conscience, you are nonetheless responsible for him until adequate
arrangements can be made for his continued care. If changed conditions make it impossible for you to
continue to ethically provide care for a patient, it is important that you immediately communicate this
fact to a supervisor so that alternative arrangements can be instituted as soon as possible. Similarly, in
emergency situations, a nurse has a moral and legal obligation to provide care that overrides her moral
objections to the care.

With the recognition of nursing as an independent profession in its own right, nurses are not only
expected to question a physician’s order when the order is potentially against the patient’s interest, in
most cases, we are required to advocate for the patient’s interests. A nurse who follows an order that is
inappropriate for her patient faces legal liability because as an independent professional, the standard of
care requires that she realize that an inappropriate order is endangering her patient.