Principles Guiding Ethical Decision-Making In Nursing


Nursing is a sensitive profession because lives and patients’ health are at stake. As such, these professionals must make decisions that are as informed, medically beneficial, and ethical as possible.

Ethics serves as a moral compass to guide nurses towards the profession’s code of conduct. This article examines all of the principles that define and guide ethical decision-making in nursing.

What is ethical decision-making?

Ethical decision-making is a framework that addresses the scope of ethical decisions with a thorough understanding of the consequences. When followed to the letter, these guidelines help professionals make the best judgments for all involved parties.

The concept of ethical decision-making is fundamental in the nursing profession, as nurses are held to a very high standard. Not just by society but also the patients whose lives are in their hands. Becoming a nurse takes several years, and these professionals often further their studies up to the Doctor of Nursing Practice degree. This is one of the highest academic achievements, and, for example, nurses can now opt for an online DNP at Walsh University while working.

Fortunately, ethical guidelines are well-defined for nurses, providing a template for handling difficult judgment calls.

Common points of ethical issues in nursing

Before delving into the principles guiding ethical decisions in nursing, it is necessary to understand what the core ethical issues are. First, ethical issues arise in situations that could strain clinical relationships, compromise the quality of patient care, or make the decision-maker feel guilty. In such a scenario, there’s no best decision, only the most ethical one.

Below are some common instances where ethical issues may arise for nurses.

Health disparities

This refers to the health difference that exists between people due to race/ethnicity, income level, age, gender, and other social inequities. These disparities adversely affect people who have historically been subject to social discrimination and are, therefore, morally wrong.

Nurses make the call on who gets priority treatment, but the situation becomes even more delicate when such disparities are involved. Nurses should be impartial to patients and treat everyone fairly, so ethical decision-making is required where health disparities exist.


Nurses are required to keep information regarding patients’ health confidential. However, determining the extent of this confidentiality may raise issues when they are faced with sharing such information with co-workers, patients’ relatives, law enforcement agents, and so on.

Patients’ beliefs

Sometimes a patient’s cultural or religious standpoint may oppose certain medical procedures and solutions. According to the ANA (American Nursing Association) Code of Ethics, nurses should respect patients’ unique differences, including lifestyle, value system, and religious beliefs. Therefore, things can become complicated when nurses need to make a choice that could save patients’ lives but which goes against their beliefs.

For this reason, nurses are obligated to make inquiries and understand any religious implications in order to find the best solution that respects the patient’s spirituality while reducing their suffering.

Informed consent

Health practitioners are not allowed to carry out medical procedures on patients without their consent, except in emergencies. Nurses must get full consent from the patient after explaining all the risks and facts of such medical procedures. When patients are not in the right state to consent, their caregivers or family members can issue it on their behalf.

The 6 ethical principles in nursing

As it stands, provisioning the modern ethical principles of nursing falls under the purview of the American Nurses Association. These stipulations have gone through a series of revisions and adjustments to arrive where they are today. So, as the medical research, laws, technology, and challenges surrounding health care evolve, so do these principles and provisions.

Below are the major ethical principles within the nursing profession.


Ultimately, patients can accept a suggested medical procedure or avoid it as they wish. The nurse’s job is to equip these patients with as much information as possible so they make the most medically beneficial choices.

These healthcare practitioners must explain the potential options without adding undue pressure. This also means that family members or caregivers must respect the patients’ decisions, provided they are not incapacitated or legally incompetent.

Factors that can influence the acceptance or rejection of medical treatment by a patient include:

  • Age
  • Culture
  • Religion
  • Support system
  • Prior clinical outcomes


This principle builds on that of autonomy as it stipulates that nurses must respect patients’ decisions even when they do not agree with them. Nurses are not allowed to impose their expert opinion. After providing the patients with all the options and facts, it is up to the patient to decide, and nurses must respect their decisions.

This lessens the burden of decision-making on nurses since patients are solely responsible for their own choices. Patients should also get as much time as possible to think and weigh their options before making a choice.


The core of this principle is opting for the treatment plan that will cause the least harm and lead to the most beneficial outcome. So, in situations where patients or their proxies are unable to make a clear decision, the choice should be the one that will bring the least harm to them and the community.

Unfortunately, even surgeries or procedures considered the best option might lead to unfavorable outcomes, but such cases are out of human control. The idea of non-maleficence is to not intentionally cause harm to patients.


According to this principle, nurses are required to be as kind as possible to everyone. This includes the patients, their family members, society, the community, and so on. More so, showing kindness and friendliness to patients breeds trust, which is essential in a nurse-patient relationship.

Beneficence revolves around actions guided by compassion. Whether it’s holding the hands of a grieving family member or speaking comforting words to a patient in distress, kindness goes a long way in upholding the essence of nursing and managing anxiety for healthcare workers and patients.


Patients often put their trust in the doctors and nurses caring for them, especially those who’ve shown kindness and compassion. According to this principle, such trust requires fidelity from the nurses, who must be utterly loyal to the nurse-patient relationship.

For instance, if patients do not want their family members to know about the specifics of their illness, nurses must respect this decision. The situation becomes complex if the patient becomes incapacitated and urgently needs surgery. Should nurses reveal everything to the family members before obtaining their consent for the medical procedure?

This principle simplifies this dilemma, mandating nurses stay faithful to patients’ wishes. Depending on the severity of the situation, nurses might have to consult other team members and medical professionals to make the best decision.


The principle of justice is based on the fact that medical resources and the number of health practitioners are not limitless. Therefore, there is a need for fair distribution of these resources without biased caregiving services among patients.

A perfect scenario involving this principle is triage, where many casualties are often brought in simultaneously. Here, nurses must carefully plan out the best ways to deploy resources and available personnel to promote justice for all patients. This principle is the solution to social or financial differences and other health disparities.

The Process of ethical decision making

Beyond these principles guiding ethical decision-making in nursing, the core of the process still lies in the hands of the nurse. Here are some steps that make decision-making easier:

  • Define the issue – Although nurses might not always have the luxury of time, it is crucial to properly define the issue at hand and the surrounding circumstances.
  • Collect as much information as possible – When the situation becomes a potential ethical dilemma, nurses should seek as much insight as possible. Information gathering encompasses reading research papers and published books, as well as taking recourse to the codes of ethics.
  • Evaluate the information – One of the core skills nurses must have is the ability to analyze situations properly. This skill must be deployed to fully evaluate all of the information gathered to make the best decision.
  • Identify possible solutions and choose one – Identify the different approaches to solving the dilemma and choose the best option.


Every profession has rules and guidelines that direct the way decisions are made, and nursing is no exception. Nurses are responsible for upholding the values of their profession and providing healthcare without crossing ethical lines. This is why the principles of ethical decision-making are fundamental and clearly defined for nurses.

In nursing, patients’ health is always at stake, and these professionals cannot afford to base their decisions on sentiments, emotions, or even personal knowledge. These principles stand as the framework for standardized decision-making.

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