Running head: ETHICAL DECISION MAKING 1

Ethical Decision Making

Gracie Hertel

Grand Canyon University: NSG-436

December 8, 2019
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Ethical Decision Making

As nurses, a significant part of our job includes having to manage dilemmas that occur

on a daily basis and problem-solve in order to come up with an appropriate solution for that

dilemma. One of the most problematic dilemmas in the nursing field would have to be ethical

dilemmas (Registered Nursing, 2019). At all costs, nurses try to avoid this type of dilemma.

However, they do occur, and depending on the incident, have consequences for nurses.

Therefore, it is vital for nurses to know how to ensure ethical violations and what to do in the

case that one may happen (Registered Nursing, 2019). The ethical dilemma that will be discussed

within this paper, which is one of the most common, is the withholding of pertinent information

from a patient. The purpose of this discussion is to provide a description and justification of the

ethical dilemma, explanation of how the nurse could navigate this to provide safe client care,

what decision-making skills, standards, and morals could be used to resolve the issue, and a

possible solution to the ethical dilemma.

Ethical Dilemma and Justification

A common ethical dilemma that a nurse faces is the differing of beliefs between the

family and the patient (Registered Nursing, 2019). As nurses, we not only provide care to the

patient, but to the family as well. With this in mind, there are a couple of issues a nurse could

face when providing care, one being the family asking the healthcare team to downplay or avoid

disclosing the diagnosis of the patient. This practice is known as “therapeutic privilege” (AMA

Journal of Ethics, 2012). The American Medical Association states in their Journal of Ethics, “It

creates a conflict between the physician’s obligations to promote patient’s welfare and respect

for autonomy by communicating truthfully” (AMA Journal of Ethics, 2012). Even though it is

not within the scope of practice for nurses to inform a client of their diagnosis, this statement can
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still be related to nurses because they have both a moral and ethical obligation to educate their

patients on all components of their health, including their diagnosis. With knowing the

description of the ethical dilemma, I stand with the belief that nurses have a moral and ethical

obligation to educate patients on all aspects of their care. The ethical obligation of nurses is to

respect patient autonomy and to act on beneficence, which is the promotion of doing good. With

knowing this, I believe nurses should not withhold information from their patients.

Providing Safe Client Care Despite Ethical Dilemmas

In this particular case, what the family thinks would be in the best interest for the patient,

in reality may not be the case. Withholding information regarding the patient’s diagnosis and

future education without their knowledge or consent is ethically impermissible (American

Medical Association, 2019). The type of communication that is essential in a nurse-patient

relationship is one that is open and truthful. Therefore, a nurse leader could navigate this

dilemma to provide safe client care by establishing a trusting relationship with the patient in

order to assess their readiness to learn and their coping skills (Registered Nursing, 2019).

Another way a nurse leader could navigate this dilemma is by encouraging the patient to specify

their preferences regarding the communication of medical information (AMA, 2019). It is also

important to know that even though nurses are to truthfully educate patients on all aspects of

their health, it does not mean that the information needs to be shared all at once. Most patients

need time to grieve and accept the diagnosis they receive, so one way to provide safe client care

is by providing education in intervals, rather than all at once because it could improve the

patient’s ability to comprehend the information.

Decision-making, Standards, and Morals

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One of the many jobs of a nurse is stressing human rights protection and upholding the

values and ethics of the profession. The ANA, in their position statement, states that the ICN

addresses the universal and fundamental responsibilities of nurses. They include that the ICN

states, “‘Inherent in nursing is a respect for human rights, cultural rights, the right to life and

choice, and dignity, and to be treated with respect’” (American Nurses Association, 2016).

Nurses are to be advocates for their patient’s human rights, including autonomy. One ethical

decision-making skill that the ANA recommends to use is having the nurse refuse to practice in

ways that could create a negative impact on the quality of care in order to strengthen the

environment of the hospital (ANA, 2016). This particular ethical dilemma goes against what is

considered ethical, so a nurse could politely refuse to practice that way and to suggest something

different. Another standard that could be used to resolve this dilemma is by applying the Code of

Ethics into the patient’s care. In provision 1 of the Code of Ethics, it states that patients have the

right to self-determination, which is the legal right to determine what will be done; to be given

accurate and complete information; and to have assistance with weighing the benefits and

burdens of treatment options (ANA, 2015). Nurses are to preserve, protect, and support these

rights. By applying this provision to the care of patients, it could prevent and resolve the ethical

dilemma of withholding information from a patient.

Possible Solution

With knowing this information, I came up with a possible solution to this ethical dilemma

based on my leadership style, which is servant leadership. I want to ensure that other people’s

highest-priority needs are being met in order to improve quality of care to patients and family

members (Huber, 2018). I believe it is important to put others first, so I would approach this

situation by listening to what the family of the patient has to say and respect and understand why
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they are asking me to withhold information from the patient. Afterwards, I would explain that

what I would do when I am preparing to educate the client about his/her diagnosis, which

includes assessing the patient’s readiness to learn and assessing what coping skills they have. I

would also communicate the information over time, instead of all at once. This would allow the

patient to take their time to comprehend the information and think of questions they may want to

ask. After communicating to the family what I will do, I would then explain why I cannot

withhold information from the patient, because it would be considered unethically unacceptable.

I would then allow them to ask any questions concerning the plan of care for this patient and

ensure they understand my ethical imposition.

Conclusion

One of the most common ethical dilemmas that can occur in nursing is the withholding of

information from patients. Knowing this, it is important for nurses to understand that they have

an ethical and moral obligation to educate their patients on their health condition, despite what

the families wishes may be. There are multiple ways and standards and morals for a nurse to use

to navigate around this situation in order to provide safe patient care. By providing ethically,

appropriate, and safe patient care, nurses can improve the effectiveness and outcome of client

care.
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References

American Nurses Association. (2015). Code of ethics. Retrieved from

https://www.nursingworld.org/coe-view-only

American Nurses Association. (2016). The nurse’s role in ethics and human rights: Protecting

and promoting individual worth, dignity, and human rights in practice settings. Retrieved

from https://www.nursingworld.org/~4af078/globalassets/docs/ana/ethics/ethics-and-

human-rights-protecting-and-promoting-final-formatted-20161130.pdf

American Medical Association. (2019). Withholding information from patients. Retrieved from

https://www.ama-assn.org/delivering-care/ethics/withholding-information-patients

American Medical Association Journal of Ethics. (2012). AMA code of medical ethics' opinions

on informing patients. Retrieved from https://journalofethics.ama-assn.org/article/ama-

code-medical-ethics-opinions-informing-patients/2012-07

Huber, D. (2018). Leadership and Nursing Care Management. [Pageburstls]. Retrieved from

https://pageburstls.elsevier.com/#/books/9780323389662/

Registered Nursing. (2019). How nurses can avoid the most common ethics violations. Retrieved

from https://www.registerednursing.org/how-avoid-common-ethics-violations/