Every nurse faces ethical dilemmas from time to time in the course of his or her career. These dilemmas often center on issues such as how to best provide emotional support for dying patients and their families, or how to provide culturally sensitive care. While nurses may have attempted to skirt getting involved in ethical issues in the past, today they often act as powerful advocates for the rights and needs of patients.

Nurses witness a great deal of suffering in the course of attending to their duties, and they can’t always relieve that suffering. Sometimes, the nursing interventions intended to ultimately improve a patient’s outcome temporarily worsens that patient’s experience of suffering. Nurses use a variety of strategies to cope with the ethical dilemmas they face. Many nurses today prioritize patient needs in the face of the hospital’s ethics committee, or choose to pursue a Master of Science in Health Administration with a Concentration in Health Care Ethics in order to obtain a more advanced understanding of how to approach ethical issues in health care.

Ethical Dilemmas in Nursing Care

Many of the ethical dilemmas nurses face have to do with end-of-life care. Particularly for patients nearing the end of life, nursing intervention may increase suffering without noticeably improving the patient’s prognosis. Nurses may worry about whether or not a patient’s concerns are being heard and addressed, or whether he or she is fully informed about his or her treatment options.

End-of-life issues aren’t the only ones that present ethical challenges for nursing staff. Many providers may not have training in genetics, but must still provide appropriate care and counseling to patients who bring in genetic information they obtained from online companies or other third-party sources.

Nurses may struggle to know how to provide care to patients with cultural traditions, beliefs, and rituals different from their own. They may also struggle with patients who refuse care the nurse sees as necessary, like vaccinations, or who seek procedures the nurse doesn’t approve of, like abortions.

In some cases, nurses may struggle to provide appropriate care in an organizational environment in which policy or practice forbids it. For example, Nurse.com tells the story of a Boston Children’s Hospital surgical liaison nurse who found herself caught in the jaws of an ethical dilemma when the mother of a baby who was dying on the operating table asked to be allowed into the room during her child’s last moments. Hospital policy prevented the nurse from allowing the parents to be with their child in the OR as he died, so that the nurse was unable to meet the family’s needs.

Coping with Ethical Dilemmas

In the case of the dying baby at Boston Children’s Hospital, the surgical liaison nurse was able to meet the family’s request to spend time with the baby’s body the next day. When the family later sent her a card expressing their gratitude and sorrow, the nurse was spurred to act to change a policy she saw as ethically detrimental to the needs of patients and their families.

Later, that nurse chose to act as a patient advocate, by bringing the issue to the hospital’s ethics advisory committee. The parents had the opportunity to speak with the ethics committee of their sorrow and regret at not being allowed to be with the baby when he died. Thanks to theirs and the nurse’s efforts, Boston Children’s changed their policy, so that parents of dying children are now allowed into the OR.

For the most part, coping with ethical dilemmas in nursing involves putting the needs of the patient first. But often, it may mean considering the needs of the many above the needs of the few, such as in the case of practices that refuse to treat unvaccinated children on the grounds that those children put other patients at risk of contracting dangerous contagious diseases. Nurses who have the chance to speak their minds about ethical decisions, whether to an ethical committee, other members of their team, or patients and their families, are better able to cope with the emotional difficulties of managing ethically difficult decisions. Et

hical dilemmas are part and parcel of nursing practice. There’s no escaping them. But today’s nurses are expected to handle ethical issues with grace and aplomb. That’s easier than ever, thanks to a health care environment that allows nurses to voice their ethical concerns and affect real change.