Bioethics Comprehensive Course Manual
1
ETHICAL DECISION MAKING
Geraldine S. Canete, MAN, RN
Health care delivery system has undergone notable changes during the last few decades that includes
Increased client participation, shorter hospital stays and restructuring services (outpatient clinics, short-
stay units, long-term care and in home-care).
The dynamic changes contributed to the development of new clinical environment and expanded practice.
At present, nurses frequently encounter difficult situations involving decisions about the best course of
action. Furthermore, nurses are obligated to provide not only expanding nursing care but also ethical and
legal client care that demonstrates respect for others. Consequently, nurses confront not only the
expanding role and ever-changing clinical environment but also various ethical or moral problems and
concerns.
What are these moral or ethical problems that nurses are facing?
Jameton (1984) described 3 different types of moral problems:
Moral uncertainty
The nurse identifies a moral problem but is unsure of the morally correct action.
Moral distress:
Moral distress is the physical or emotional anguish that is experienced when we are prevented from
following the course of action that we believe is right. We may be prevented from doing what we think is
right by facility policy or procedure, influence from the patient and/or family, direction from a supervisor,
or limited time. When the nurses are unable to follow their moral beliefs because of institutional or other
restriction. The distress occurs when the nurse violates a personal moral value and fails to fulfill perceived
responsibility.
Moral distress also happen when two or more mutually exclusive moral claims clearly apply and both seem
to have equal weight. Moral distress represent practical, rather than ethical dilemmas.
Moral outrage
The nurse knows the morally correct action and feels a responsibility to the patient, but institutional or
other restraints make it nearly impossible to follow through with appropriate action. Occurs when someone
else in the health care setting performs an act the nurse believes to be immoral. Nurses do not participate
in the act. Nurses not responsible for wrong but perceive that they are powerless to prevent.
Examples of Ethical Concerns in Nursing
Patient Freedom Versus Nurse Control
• Nurses are highly educated and therefore aware of the best clinical course of action when one
exists. But what happens when a patient rejects medical advice and makes a decision that may
result in less optimal outcomes?
• From deciding whether or not a labor and delivery patient would benefit from pain medication,
to encouraging a patient to eat when they are refusing food, nurses walk a fine line everyday.
