Ethical Decision-Making in Nursing


Nursing practice is very challenging. At times, nurses’ personal values contradict the decisions they make in order to help their patients. An understanding of the set rules is mandatory for every nurse to ensure objectivity in their decisions. This paper recognizes the importance of ethical theory to nursing. It also highlights the principle of confidentiality and uses moral point of view ethical theory to address a decision on an ethical dilemma case resulting from cultural values on one side and confidentiality on the other.

Justify the importance of ethical theory to nursing

Through ethical theories, nurses are able to develop their own professional values and reason ethically, especially when faced with ethical dilemmas (Almark, pp. 620). For instance, a patient may prefer to keep his diagnosis a secret as seen in the case study provided. Ethical theories thus guide nurses in making decisions by setting limits for confidentiality. Besides, ethical theories provide the main framework upon which nursing code of ethics operate (ANA, provisions 1, 2 and 3). For instance, ethical theories influence the nursing code by viewing caring as used in nursing in a holistic manner that includes nurses’ ethical and moral values.

Moreover, ethical theories make nursing practice a unique and holistic endeavour (Beauchamp and Childress, pp. 278). For instance, ethical theories ensure that treatment of a patient in crisis also includes assessment of the family’s post trauma physiological status to ensure that whatever the intervention used will lessen their stress (Rowe, pp. 441). Beneficence, autonomy, justice and non-malfeasance combined with advocacy and care foundations all contribute to the uniqueness of nursing profession (Fry and Johnston, pp. 76).

Relate the principle of confidentiality to the concept of reasonable limits

The principle of confidentiality concerns information sharing. According to the principle of confidentiality, nurses and medical practitioners should strive to ensure safety and privacy of patients’ health information (ANA, provision 3). According to ANA, 2001, it is the duty of the nurse to advocate for, promote and protect the patient’s health safety and rights (ANA, provision 3). However, adhering to the principle of confidentiality may result into ethical dilemma as will be discussed later in this essay.

In order to ensure that patient’s well-being is not compromised by confidentiality principle, some reasonable limits has to be put in place upon which confidentiality can be violated. The concept of reasonable limits states that there has to be a limit upon which the principle of confidentiality can be breached to protect the well-being of the patient and others (Rowe, pp. 438). It is ethically right to breach confidentiality to allow for sharing of information among health care practitioners for the sake of patients’ well-being, but strictly on a need-to-know basis (Rowe, pp. 238). However, patient’s well-being, safety and dignity should top the list of priorities. With that in mind, HIPPA (Clause on Protected Health Information) provides the following limits as the rationale for breaking confidentiality:

  • When a patient has gunshot wound injury
  • When breaching confidentiality contributes to prevention or detection of a serious crime
  • When a serious harm has occurred or is likely to occur to the patient
  • When handling underage (minor) patients and the nurse believes, sharing information with the parents would be in the best interest, but the patient insists on secrecy
  • When the patient has symptoms of abuse, but refuses to consent

Identify how to resolve conflict between two or more ethical principles

Implementation of all ethical principles results into conflict. Mostly, the conflict results from the need to adhere to the laws and ethical codes of conduct contradicted with care for patients and their families on the other. The best way to solve ethical conflicts is through taking a holistic approach by considering all the ethical principles and coming up with a decision that promotes value of life, prevents harm and is morally justified even if it violates some principles.

Breaching the principle of confidentiality, however, contradicts the principle of respect for autonomy. However, Susan Fry’s Moral Point of View theory provides for breaking the principle of confidentiality if the patient’s decisions are likely to cause harm to others (Fry and Johnston, pp. 99; Beauchamp and Childress, pp. 277-278).

Discuss the influence of culture on values

Cultural values are belief systems or ideals that a society or an individual alleges commitment to (Ludwick and Silvia, 2000, par. 3). For instance, cultural values in the United States emphasizes individualism and self-reliance (par. 3). However, most societies in the world consider society’s rights to be more important than individual’s rights, a value reflected in their health care (par. 4). The difference in cultural values sometimes results into ethical conflict in nursing practice. For instance, the principle of autonomy promotes individual’s right to make decisions, but at the same time demands respect for the sovereignty of others.

Consequently, it is unethical to ignore the decisions made by others based on their cultural values. Professional nurses should be aware of the cultural implications of the decisions they make as well as those made by patients (Leininger, pp. 4).

The case study

This case study provides a perfect example of ethical dilemma involving the principle of confidentiality and cultural values. The Zs family lives as a group with Mr. Z as the head and holds a cultural value where the family has more rights in making decisions. Using this value, the family has the right to know about Mrs. Zs condition and collectively make a decision concerning her treatment. On the other hand, Dr. F and the nurse come from a society that believes in respect for individual’s autonomy. Dr. F and the nurse will thus find it difficult to go against their values and breach the principle of confidentiality.

However, the following interventions can resolve Mrs. Z’s case.

First, the nurse should try to take Mrs. Z through a series of counselling to explore her window of opportunities. Patients diagnosed with cancer often suffer denial. Mrs. Zs decision to keep her diagnosis a secret and refuse treatment may be irrational due to her state of denial. It is only through counselling that the nurse can make Mrs. Z accept her situation and give consent for her family to know about it.

Alternatively, the nurse and Dr. F can weigh confidentiality with regard to Mrs. Z’s autonomy against caring for her family at large. The underlying question here should be, “Is Mrs. Z’s autonomy more important than the harm her condition is likely to cause her family?” Care in this case should be looked at from a moral point of view that includes the patient and the family as stated in Susan Fry’s Moral Point of View Theory (Fry and Johnston, pp. 99). It is thus morally right for the nurse to disclose Mrs. Z’s diagnosis if no other means exist. The nurse can breach confidentiality in this case by arguing that Mrs. Z situation is likely to cause harm to her family thus requires intervention.

Ethical decision-making Model

Thiroux’s decision-making model is best fit in this case. The model emphasizes the respect for patient’s confidentiality without compromising the family’s right to information that affects them directly (Thiroux, pp. 10). Thiroux proposes six elements as a guide to decision making.

Value of life

Nursing theories seek to protect and preserve human life. Mrs. Z’s condition is most likely to affect the value and quality of her life. Moreover, her decision not to proceed with treatment will affect the lives of her family as well. Should the nurse adhere to confidentiality at the expense of the lives of Mrs. Z’s family, especially the two young children who would lose their mother if no treatment takes place? Guided by this element, it is ethically right for the nurse to disclose Mrs. Z diagnosis as provided for in ANA 2001 (provisions, 1, 2 and 3).

Goodness or Rightness

Nursing ethics dictate that a nurse endeavours to do what is right especially where harm is suspected if no action is taken (Ludwick and Silvia, 1999, par. 9). In this case, it is likely that there will be harm if the nurse does not intervene and disclose Mrs. Z’s diagnosis.

Justice and fairness

This element dictates some level of justice and fairness when making decisions. Mrs. Z comes from a society that holds high values for the family. When making decisions concerning her case, the nurse should consider this and come up with a decision that will not only be fair for the family, but also one that does not demean the level of trust she has earned from Mrs. Z


The nurse in this case is faced with a dilemma on whether to break the trust Mrs. Z has in her by disclosing her diagnosis or break the family’s trust in her ability to take care of Mrs. Z by adhering to the principle of confidentiality. It will be right for the nurse in this case to be honest to Mrs. Z by advising her on the importance of disclosing the information about her health to her husband and the consequences of ignoring treatment. The nurse can also be honest and disclose Mrs. Z diagnosis to her husband, but must make Mrs. Z understand that it is for the good of all.

Individual freedom

There are reasonable limits to autonomy especially when there is a likelihood of harm on others. In this case, it is morally right for the nurse to violate autonomy and disclose Mrs. Z condition since respecting it will cause harm to Mrs. Z family.

Cultural Considerations

Cultural values play a great role in nursing decision making. In this case, the nurse has to consider the cultural values of Mrs. Z and come up with an intervention that is culturally accepted by Z’s family.


Ethical theories are very important in nursing. Without them, solving conflicts resulting from ethical dilemmas can be challenging. It is ethically right for the nurse to breach confidentiality and autonomy principle, but come up with a decision that will be the best for both Mrs. Z and her family as provided for in Thiroux decision-making model and Moral point of view theory.

Works Cited

Almark, P. Can the study of ethics enhance nursing practice. Journal of advanced nursing Vol. 51 Issue 6 (2005): 618-624. Great Britain: Blackwell Publishing Ltd. Print.

ANA. Code of ethics for Nurses with Interpretive Statements. USA: American Nurses Association, 2010. Web.

Beauchamp, Tom L., and Childress, James F. Principles of biomedical ethics. 4th edition. New York: Oxford University Press. 1994. Print.

Fry, Sara T. and Johnston, Megan-Jane. Ethics in Nursing Practice: a guide to ethical decision making. 2nd edition. USA: Blackwell Publishing Company. 2002. Print.

HIPPA. Health Insurance Portability and Accountability Act of 1996. United States: Governments Press. 1996. Print.

Leininger, Madeleine. Culture care diversity and universality: A theory of nursing. New York: National League for Nursing Press. 1991. Print.

Ludwick, R., Silva, Mary C., (2000) “Ethics: Nursing Around the World: Cultural Values and Ethical Conflicts” Online Journal of Issues in Nursing Vol. 5 No. 3. Web.

Ludwick, Ruth and Silva, Mary C. Interstate Nursing Practice and Regulation: Ethical Issues for the 21st Century. Online Journal of Issues in Nursing Vol. 4 No. 2, 1999. Web.

Rowe, John. Information disclosure to family caregivers: Applying Thiroux’s framework. Nursing Ethics Vol. 17, No. 4 (2010): 435-444. Print.

Thiroux, Jacques. Ethics: Theory and Practice. 6th edition. Westport: Prentice Hall, 1998. Print.

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