A competent patient with terminal cancer refuses chemotherapy after being informed of the benefits and risks. The family insists treatment be given. The nurse should:

Support the patient's autonomous decision to refuse treatment. Autonomy gives competent adults the right to make their own healthcare decisions, including refusing life-prolonging treatment. The nurse's role is to ensure the patient is informed and support their autonomous choice. Family wishes cannot override a competent patient's decision.

A nurse notices that a colleague is intoxicated at work. Which ethical principle primarily guides the nurse's obligation to report this situation?

Non-maleficence. Non-maleficence (do no harm) obligates the nurse to report an impaired colleague to prevent patient harm. While this may seem to conflict with fidelity to the colleague, patient safety is the priority. An impaired nurse poses a direct risk to patients.

During a disaster with limited resources, the emergency department must prioritize patients. This decision-making involves which ethical principle?

Justice. Justice involves fair distribution of resources. During disasters, triage decisions allocate limited resources to do the greatest good for the greatest number. This may mean prioritizing patients with survivable injuries over those with minor injuries or those unlikely to survive.

2.8 Ethical Practice Principles | NCLEX-RN (Registered Nurse) | Free Exam Prep

Ethical Practice Principles

Nurses are assessed on their ability to apply ethical principles to complex dilemmas. While laws tell us what we must do, ethics guides what we should do. Ethical principles provide a framework for decision-making when clear rules don't exist.

Core Ethical Principles

Principle	Definition	Focus
Autonomy	Self-determination	Patient's right to choose
Beneficence	Do good	Acting in patient's best interest
Non-maleficence	Do no harm	Preventing harm
Justice	Fairness	Equitable treatment and resource allocation
Veracity	Truthfulness	Honest communication
Fidelity	Faithfulness	Keeping promises, loyalty

Autonomy

Autonomy is the patient's right to self-determination — the right to make decisions about their own care.

Nursing Implications:

Respect patient choices, even if you disagree
Provide information for informed decision-making
Support refusal of treatment by competent adults
Ensure cultural preferences are honored

Autonomy in Practice:

Situation	Autonomous Action
Patient refuses recommended surgery	Document refusal, ensure patient is informed
Patient wants alternative treatment	Provide information, respect choice
Family wants to override patient	Support patient's expressed wishes
Patient from culture with family-centered decisions	Assess patient's preference for involvement

Key Point: A competent adult has the absolute right to refuse treatment, even if refusal will result in death.

Beneficence

Beneficence is the duty to do good and act in the best interest of the patient.

Nursing Implications:

Advocate for patient's well-being
Provide competent, evidence-based care
Consider all aspects of patient welfare
Balance benefits against risks

Beneficence in Practice:

Action	Example
Advocating for pain management	Requesting adequate analgesia for suffering patient
Preventing complications	Implementing fall prevention measures
Promoting health	Providing patient education
Supporting coping	Offering emotional support during crisis

Non-maleficence

Non-maleficence means "do no harm" — the duty to prevent harm to patients.

Nursing Implications:

Verify medications (rights of medication administration)
Recognize and report errors
Identify and correct unsafe conditions
Maintain competency to prevent harm from lack of skill

Non-maleficence in Practice:

Potential Harm	Prevention
Medication error	Verify right patient, drug, dose, route, time
Falls	Assess risk, implement prevention measures
Infections	Follow standard precautions, sterile technique
Skin breakdown	Reposition q2h, assess skin integrity

Principle of Double Effect: Sometimes an action intended to help may also cause harm. This is ethically acceptable when:

The action itself is good or neutral
The intent is for good effect, not harm
The good effect is not achieved through the harm
There is proportionate reason for allowing harm

Example: Giving morphine for pain relief (good) even though it may hasten death (harm)

Justice

Justice is the fair distribution of resources and equitable treatment of all patients.

Nursing Implications:

Treat all patients with equal respect
Allocate resources fairly
Advocate for underserved populations
Recognize and address bias

Justice in Practice:

Situation	Just Action
Multiple patients need nurse's attention	Triage based on clinical need, not preference
Scarce resource (e.g., ventilator)	Allocate based on clinical criteria, not social worth
Patient from different culture	Provide culturally competent care
Uninsured patient	Provide same standard of care as insured patient

Distributive Justice Considerations:

How should scarce resources be allocated?
Should everyone receive the same care, or care based on need?
How do we balance individual needs vs. societal needs?

Veracity

Veracity is the obligation to tell the truth.

Nursing Implications:

Provide honest information about care and condition
Do not deceive patients or families
Correct misinformation
Acknowledge errors honestly

Veracity in Practice:

Situation	Truthful Action
Patient asks about diagnosis	Provide information within scope; defer to provider for detailed disclosure
Medication error occurred	Disclose to patient and provider
Patient has false hope	Gently clarify realistic expectations
Family asks to withhold information	Assess patient's wishes for information

Truthful Communication Includes:

Not withholding relevant information
Correcting false beliefs when appropriate
Documenting accurately
Reporting errors honestly

Fidelity

Fidelity is faithfulness to commitments, keeping promises, and loyalty.

Nursing Implications:

Follow through on commitments to patients
Maintain confidentiality
Be reliable and dependable
Honor the nurse-patient relationship

Ethical Dilemmas

An ethical dilemma occurs when two or more ethical principles conflict.

Common Nursing Dilemmas:

Conflict	Principles in Tension
Patient refuses life-saving treatment	Autonomy vs. Beneficence
Scarce resources, multiple patients	Justice vs. Beneficence
Truth may harm patient	Veracity vs. Non-maleficence
Family wants information withheld	Fidelity to patient vs. Fidelity to family

Ethics Committee Consultation

When ethical dilemmas cannot be resolved at the bedside, consult the ethics committee:

Complex end-of-life decisions
Treatment futility questions
Conflicts between patient and family wishes
Resource allocation decisions

On the NCLEX

Expect questions about:

Applying ethical principles to clinical scenarios
Recognizing conflicts between principles
Respecting patient autonomy, especially refusal of treatment
Fair treatment regardless of patient characteristics

Exam Tip: When autonomy (patient's choice) conflicts with beneficence (what seems best), autonomy generally wins for competent adults. The patient's informed choice must be respected.

NCLEX-RN

1Introduction

2Chapter 2: Management of Care

3Chapter 3: Safety and Infection Prevention and Control

4Chapter 4: Health Promotion and Maintenance

5Chapter 5: Psychosocial Integrity

6Chapter 6: Basic Care and Comfort

7Chapter 7: Pharmacological and Parenteral Therapies

8Chapter 8: Reduction of Risk Potential

9Chapter 9: Physiological Adaptation

Key Takeaways

Ethical Practice Principles

Core Ethical Principles

Autonomy

Beneficence

Non-maleficence

Justice

Veracity

Fidelity

Ethical Dilemmas

Ethics Committee Consultation

On the NCLEX