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Providing high-quality care and avoiding patient harm are the basis of ethical nursing practice. Nurses want to do the right thing, but often the most ethical action is not always clear. As healthcare continues to become more complex, the potential for ethical dilemmas in healthcare settings increases. In some cases, protecting one ethical principle may cause another to be violated. Therefore, it is necessary to identify the areas in which the greatest ethical risks exist. Having an understanding of ethical risk in the healthcare arena is important, and equally important is the ability of the nurse to know, in a given situation, which ethical principle is potentially at stake.

This chapter briefly describes some of the most ethically challenging issues in the healthcare industry today.


As described in Chapter 2, autonomy is the right of a patient or surrogate to make his or her own decisions. Autonomy can be jeopardized in certain healthcare situations, specifically when respecting that right will cause harm, either to the patients themselves or to another person or persons. Risk to autonomy may also arise when a patient suddenly loses the ability to make decisions and the patient's family is unaware of what his or her wishes were. Situations like those described in this section are common in today's healthcare environment.


Those in the mental health field face unique challenges with ethical risk. Patients with mental illness are guaranteed the same civil rights as any other citizen. The ethical principle of autonomy has the highest potential of violation, specifically if a person is deemed not to have decision-making capacity or is declared incompetent by a court of law—for example, the patient who attempts suicide and is brought into the hospital. Once stabilized, the patient then finds himself unable to leave voluntarily. The process for a patient who has attempted suicide is to place him with a "sitter" who ensures his safety and prevents self-harm. The "sitter" is an employee of the hospital who watches over the patient and never leaves him by himself. A psychiatric evaluation is required to determine the patient's safety. Based on that evaluation, the patient may be committed to a facility to undergo treatment for intentional self-harm. In this case, the patient's autonomy is not able to be recognized. However, the patient has the right to respectful interactions, privacy, and a safe environment.


A 23-year-old female with a history of anorexia presents to the hospital after a syncopal episode. It is determined that she has been fasting in an attempt to end her life. Once she is conscious, the psychiatrist determines she needs to be admitted to an inpatient treatment center where her eating disorder can be addressed safely. The patient declines treatment, refusing to eat or drink. The ...

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