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7Nursing Ethics Essay


In the health care realm, upholding fixed principles is difficult. This is because there numerous variables in clinical cases’ context and also due to the fact that within health care, there are numerous principles applicable in several circumstances. Health care ethics consists of moral principles that apply values and judgements to the health care practice. The universally accepted health care principles are; respect for autonomy, nonmaleficence, beneficence and principle of justice. Ethical theory establishes the essential aspects of morality and then explains how they are related with each other. Ethical theories offer a systematic approach to moral reasoning within nursing practice (Lakhan, 2009). This paper will be analysing the healthcare ethics and ethical theories in a case where a nurse disregarded the patient’s expressed wishes not to receive pressure-area care.

The principle of respect for autonomy involves taking into consideration the views of the patient regarding his/her treatment. Respecting the autonomy of the patient means acknowledging the right of an individual to hold opinions, to choose, to cat on their own individual values and beliefs, for example the right to refuse treatment. In this case, the patient might not be entirely autonomous and also not lawfully competent to decline treatment (pressure-area care); nevertheless, this doesn’t imply that ethically the patient’s views are not supposed to be taken into consideration and respected as much as possible. The patient has expressed her views distinctly; the patient does not want to receive pressure-area care (Tauber, 2005). Basically, an autonomous decision doesn’t have to be ‘proper’ resolution from an objective point of view otherwise the person’s values as well as needs would not be respected. In a prima facie sense, the autonomy of the patient should always be respected. The respect should not be merely a matter of attitude, but an action aimed at acknowledging and even promoting the patient’s autonomous actions. An autonomous decision is an informed one; this means that the patient should be provided with adequate information in a way she can understand. The nurse may strongly want to give pressure-area care to the patient believing this to be a “medical benefit” to the patient. However, when appropriately and compassionately informed, the patient is free to choose if to accept pressure-area care or not (Lakhan, 2009).

The key objective of health care is to cure and alleviate suffering and not to promote personal autonomy and therefore while making the decision the nurse should be cognizant of the susceptibility of the patient. Consequently, the nurse had a prima facie duty of respecting the autonomous decision of the patient and also a prima facie duty of avoiding harm and to offer medical benefit (Peter, & Joan, 2004). The right of the patient to self-decision can be efficiently applied only if the patient has adequate information to enable him or her to make an intelligent choice. On the other hand, the nurse has an ethical duty of assisting the patient to choose the therapeutic option consistent with excellent medical practice. Autonomy can be restricted in case the nurse believes that the patient would be harmed by the patient’s decision. For that reason, the nurse was justified in turning the patient because he gave greater priority to the duty and not respect for the patient’s autonomy since respecting the patient’s autonomy would have worsened the patient’s condition (Meslin,, 2009).

The principle of beneficence requires the healthcare practitioners to act in the benefit of the patient; they should promote good and prevent harm. If the patient makes a decision that the nurse does not think will be beneficial to the patient, the nurse may choose to ignore the patient’s wishes. In this case, both the long-term and the short-term effects of overruling the patient’s wish should be considered. In short-term the patient will be embarrassed, uncomfortable and also the patient will experience a little pain and this may cause the patient to mistrust the nurses in the future and to be unwilling to seek medical assistance. In the long-term, there is a benefit to the patient’s autonomy being overruled in this case (Lakhan, 2009). Without treatment, the patient can suffer long-term health problems (sores and pressure ulcer) that would need greater medical intervention than the treatment need at the moment (pressure-area care). The benefits of acting beneficently should be weighed against the disadvantages of refusing to respect the patient’s autonomy and since in this case the benefits outweigh the disadvantages, the nurse was justified in turning the patient. The nurse has the responsibility of making sure that the patient gets safe, effective and ethical care (Verena, 2003).

Additionally, the principle of nonmaleficence requires the healthcare practitioners not to deliberately create an unnecessary harm to the patient and not to injure the patient, either by acts of commission or omission (Judith, 2000). Principally, it is considered as negligence in case a health practitioner inflicts a careless or irrational risk of harm on the patient. Offering an appropriate standard of care that eliminates or reduces the risk of harm is held by moral convictions as well as by the societal laws. The nurse can be morally and lawfully blameworthy in case she/he does not meet the principles of due care. The principle of nonmaleficence asserts the necessity for medical competence (Armstrong, 2007). The legal standards in establishing negligence are as follows: The professional should have a duty to the affected party, should violate that duty, the affected party has to be harmed and the harm should result from the violation of duty (Jill, et al, 2005).

When caring for the patients, there are some circumstances whereby some kind of harms seems unavoidable, and therefore healthcare practitioners are normally morally bound to select the lesser of the two evils, even though it is possible to establish the lesser evil by the situations (Verena, 2003). Do no harm to the patient. In this case, the patient would be harmed by the nurse forcibly turning her in order to give her pressure-area care; the patient was probably embarrassed, uncomfortable and the process could have experienced some pain. In contrast, if the patient is not turned, she might end up developing pressure ulcer. In this regard, the nurse was supposed to take the course of action that would result to the least harm. Apparently, turning the patient and making the patient to be uncomfortable, embarrassed and also resulting to a little pain for the patient is better than refusing to turn the patient which would consequently lead to greater harm. Therefore, the nurse was justified in turning the patient since he chose the lesser of the two resulting harms (Armstrong, 2007).

Utilitarianism ethical theory proposes that the right moral response has a relation with the outcome of the action. The significance of an action is established by the degree to which it produces happiness or welfare and hence no act is wrong or right since only the action of the outcome is important. All the likely outcomes of all the actions should be considered and the action likely to be the most beneficial (producing highest level of happiness) and producing the minimum unhappiness is the best (Steven, 2009).

In this case, utilitarianism theory would probably consider the turning of the patient justified. This is because among the two choices, providing the pressure-area care and not providing the pressure-area care, the former is the action likely to produce the highest level of happiness since it promotes the patient’s wellbeing more effectively. Additionally, turning the patient is likely to have minimal risks which include, embarrassment, little pain and discomfort as compared to “not giving the pressure-area care” which is likely to bring minimal unhappiness since the patient could develop pressure ulcer, which is worse. Therefore, turning of the patient is justified because it produces the greatest welfare (Steven, 2009).

Virtue ethics is about a person of outstanding character doing the correct thing. The important thing in this theory is that an individual cultivates good character habits for him/her to be a person who can always do what is good and right. Here, the nurse chose to do what was good and right since giving the patient pressure-area care was the right thing to do. Virtue ethics theory hence justifies the nurse’s action (Steven, 2009).


The nurse is justified in turning the patient. This is because nurses have a “prima facie” duty of benefiting the patient as well as avoiding harming the patient. Nevertheless, in a tangible situation, for instance in this case study, the nurse is supposed to balance the demands of healthcare ethical principles by establishing which has more weight in the given case. Normally, prima facie duties are always obligatory except when they conflict with more stringent responsibilities (Martin, & Curtis, 2010). The moral duty of an individual is establishing by considering and balancing all competing prima facie duties within any given case. Therefore, in deciding to turn the patient despite the patient having expressed otherwise, the nurse gave precedence to the prima facie duty of avoiding harm and providing medical benefit. Finally, according to the utilitarianism theory, the nurse’s action is justified because it is the moral action likely to produce the utmost good for the greatest number.


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