Key Takeaways
- Ethical principles guide nursing actions when laws and policies don't provide clear direction
- Autonomy respects the patient's right to make their own decisions, including refusing treatment
- Beneficence (doing good) and non-maleficence (avoiding harm) guide clinical care decisions
- Justice requires fair treatment of all patients regardless of personal characteristics
- When ethical dilemmas arise, the LPN should consult with the RN supervisor or ethics committee
Ethical Practice and Decision-Making
Ethics provides guidance when laws and policies don't give clear answers. Understanding ethical principles helps LPN/LVNs navigate complex situations and make decisions that protect patients.
Core Ethical Principles
| Principle | Definition | Application |
|---|---|---|
| Autonomy | Right to self-determination | Respect patient choices, even if you disagree |
| Beneficence | Duty to do good | Act in the patient's best interest |
| Non-maleficence | Duty to avoid harm | Prevent errors, don't cause injury |
| Justice | Fairness and equity | Treat all patients equally |
| Veracity | Truthfulness | Be honest in all communications |
| Fidelity | Faithfulness | Keep promises, be reliable |
Autonomy in Practice
Autonomy means respecting the patient's right to make decisions about their own care.
Examples of supporting autonomy:
- Providing information so patients can make informed choices
- Respecting a patient's decision to refuse treatment
- Supporting patients who make choices different from what you would choose
- Ensuring patients understand their options
Critical Point: Competent adults have the absolute right to refuse any treatment, even if refusal may result in death.
| Situation | Autonomous Response |
|---|---|
| Patient refuses recommended surgery | Ensure they understand consequences, respect decision |
| Patient wants to leave AMA | Notify RN, document understanding of risks |
| Patient chooses alternative treatment | Respect choice, continue supportive care |
| Family disagrees with patient's choice | Support the patient's expressed wishes |
Beneficence and Non-maleficence
Beneficence means actively doing good for patients:
- Providing competent, timely care
- Advocating for patient needs
- Promoting health and well-being
Non-maleficence means avoiding harm:
- Checking medications before administration
- Following safety protocols
- Reporting errors and near-misses
- Maintaining competency
Balancing benefit and harm:
| Intervention | Benefit | Potential Harm | Balance |
|---|---|---|---|
| Pain medication | Relief of suffering | Sedation, addiction risk | Adequate pain control with monitoring |
| Blood transfusion | Replace blood loss | Transfusion reaction | Screen carefully, monitor closely |
| Restraints | Prevent falls/harm | Loss of dignity, injury | Use alternatives first, least restrictive |
Justice in Healthcare
Justice requires fair treatment of all patients:
| Do | Don't |
|---|---|
| Prioritize based on clinical need | Prioritize based on personal preference |
| Provide same care regardless of background | Treat patients differently based on race, religion, etc. |
| Allocate resources fairly | Give better care to "easier" patients |
| Advocate for equitable treatment | Ignore disparities in care |
Veracity (Truthfulness)
Truthful communication includes:
- Honest answers to patient questions (within scope)
- Accurate documentation
- Reporting errors honestly
- Correcting misinformation
When patients ask difficult questions:
- Answer truthfully within your scope
- Refer to RN or provider for information beyond your scope
- Don't provide false reassurance
- Support emotional response to difficult information
Ethical Dilemmas
An ethical dilemma occurs when two or more principles conflict.
| Common Dilemma | Conflicting Principles |
|---|---|
| Patient refuses life-saving treatment | Autonomy vs. Beneficence |
| Truth may cause emotional harm | Veracity vs. Non-maleficence |
| Limited resources, multiple patients | Justice vs. Beneficence |
| Family wants information withheld | Fidelity to patient vs. Family wishes |
Navigating Ethical Dilemmas
As an LPN/LVN:
- Recognize the dilemma - Identify the conflicting principles
- Gather information - Understand the situation fully
- Consult with others - Talk to the RN supervisor
- Consider options - What are the possible courses of action?
- Respect patient wishes - Autonomy often takes precedence
- Escalate when needed - Ethics committee for complex issues
Ethics Committee
Many facilities have an ethics committee that can help with:
- Complex end-of-life decisions
- Conflicts between patient and family wishes
- Resource allocation decisions
- Treatment futility questions
The LPN/LVN can:
- Request an ethics consultation through the supervisor
- Participate in ethics discussions about assigned patients
- Contribute observations and concerns
Professional Boundaries
Maintaining professional boundaries:
| Appropriate | Boundary Violation |
|---|---|
| Therapeutic relationship | Personal relationship |
| Professional self-disclosure | Sharing personal problems |
| Equal care for all patients | Favoritism |
| Maintaining confidentiality | Sharing patient stories outside work |
| Accepting thanks graciously | Accepting gifts of significant value |
On the NCLEX-PN
Expect questions about:
- Applying ethical principles to scenarios
- Supporting patient autonomy
- Recognizing ethical dilemmas
- When to escalate to supervisor or ethics committee
A competent patient with heart failure decides to stop all medications against medical advice. The LPN should:
An LPN notices that a coworker frequently ignores hand hygiene protocols. Which ethical principle is most relevant to reporting this behavior?
A patient asks the LPN not to tell her family about her cancer diagnosis. The family later asks the LPN about the diagnosis. The LPN should: