2.5 Ethical Practice and Decision-Making
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
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: