Ethical and Legal Challenges in Nursing: A Comprehensive Analysis

Categories: EthicsNursing

Modern healthcare presents nurses with unprecedented ethical challenges, magnified by technological advancements that enable the sustenance of patients' lives against all odds. The ethical compass of nurses is tested when confronted with the question, "Just because we can, should we?" The ethical code of nurses, emphasizing the primacy of the patient (Blais & Hayes, 2011, pg.

60), necessitates a delicate balance between personal beliefs, institutional policies, and legal considerations.

Moreover, the evolving landscape of medical technology has given rise to new career opportunities for nurses, such as forensic nurses, legal nurse consultants, and nurse-attorneys, reflecting the expanding role of nurses in addressing social and legal issues (Blais & Hayes, 2011, pg. 75). This paper explores two case studies to unravel the intricate web of ethical and legal challenges faced by nurses in their daily practice.

The American Nurses Association Code of Nursing Ethics: A Guiding Light

The American Nurses Association (ANA) Code of Nursing Ethics serves as a guiding framework in resolving ethical dilemmas. In the Six Caps study, family members grappled with the decision of proceeding with surgery, balancing the father's desire for intervention against the adult children's concerns about a potentially poor quality of life.

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The involvement of the ethics committee underscores the collaborative approach required in healthcare decision-making (Blais & Hayes, 2011, p.

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According to the ANA Code of Ethics, the nurse's primary commitment is to the patient, advocating for their health, safety, and rights (ANA Code of Ethics for Nurses, 2014). In cases where patient wishes conflict with medical recommendations, the code guides nurses to make decisions in the client's best interest while preserving the integrity of all parties involved (Blais & Hayes, 2011, p. 61).

Similarly, the critical thinking exercise involving a nurse as a witness in a malpractice case underscores the legal and ethical responsibilities of nurses. The nurse's failure to uphold ethical standards resulting in harm to the patient highlights the significant impact the ANA code of nursing ethics can have on legal proceedings, emphasizing that ethical standards should surpass legal obligations (Blais & Hayes, 2011, p. 58).

Moral and Ethical Decision-Making in Nursing Practice

Registered Nurses (RNs) grapple with moral and ethical decisions that extend beyond individual patient care to encompass their interactions with colleagues and the broader healthcare system. The complexity of healthcare issues demands that RNs often challenge their own values and navigate difficult end-of-life decisions for patients.

Chitty & Black (2011) highlight that an individual's moral and ethical decision-making process is influenced by their value system, shaped by culture and life experiences. Social norms also play a crucial role in ethical decisions (Chmielewski, 2013). To ensure unbiased decision-making, healthcare organizations employ ethics committees, corporate compliance measures, and human resources departments as checks and balances.

For RNs facing ethical dilemmas, the Code of Ethics for Nurses by the ANA provides clear guidelines, outlining professional ethical obligations in navigating moral decisions concerning patients, colleagues, and organizations (American Nurses Association, 2014).

Legal Duties and Responsibilities in Nursing

Beyond ethical considerations, nurses bear legal duties and responsibilities integral to patient safety and justice. The obligation to report instances of negligence is a fundamental legal duty for nurses. In the case study involving a nurse witnessing another nurse's overt negligence, the legal duty to report the incident is emphasized (Blais & Hayes, 2011).

In end-of-life decision-making, as illustrated in Marianne's case study, the nurse's legal responsibility extends to facilitating discussions between the patient and family. The absence of an advanced directive emphasizes the importance of obtaining such directives during the admission process to protect the patient and guide family decisions (ANA, "End of Life Issues", 2014).

Furthermore, the legal duty of a nurse extends to assisting justice as much as possible (Blais & Hayes, 2011). In instances where a nurse observes a colleague violating standards of care, the obligation to report such incidents is not only a moral duty but also a legal one. The primary responsibility of a nurse is to the patient, necessitating the reporting of negligence on any level to ensure patient safety (Blais & Hayes, 2011).

As healthcare institutions grapple with increasing complexities, nurses also have a legal responsibility to be truthful and honest when testifying as witnesses in court (Blais & Hayes, 2011). Upholding truthfulness and honesty in legal proceedings is crucial for maintaining the integrity of the healthcare profession.

Challenges in End-of-Life Decision-Making

One of the recurring challenges nurses face involves end-of-life decision-making, as illustrated in the case study of Marianne. The responsibility of the nurse in this scenario is not only to organize discussions between the patient and her family but also to address the absence of an advanced directive.

According to the American Nursing Association, nurses should strive to have the Advanced Directive signed during the admission process ("End of Life Issues", 2014). This not only protects the patient but also assists the family in understanding the patient's wishes in the event that the patient cannot communicate. The legal responsibility of the nurse, in this case, aligns with ethical considerations, emphasizing the prioritization of the patient's needs and safety.

Reflections on Ethical Decision-Making

As nurses navigate the complex terrain of ethical decision-making, the ANA Code of Ethics serves as a valuable guide. However, the application of such guidelines requires thoughtful consideration, ensuring that decisions are not made in a rigid, rule-based manner (Dahnke, 2014). Instead, nurses must continually reflect on the evolving dynamics of healthcare, incorporating critical thinking and ethical reasoning into their practice.

The challenges posed by ethical and legal dilemmas underscore the need for ongoing education and training for nurses. As the healthcare landscape evolves, nurses must stay abreast of advancements in medical technology, changes in legal standards, and shifts in ethical considerations. Continuous professional development is essential for nurses to navigate the intricate balance between ethical ideals and legal obligations.


As the healthcare landscape continues to evolve, nurses find themselves at the forefront of ethical and legal decision-making. The delicate balance between patient wishes, medical recommendations, and institutional policies necessitates a nuanced approach guided by the principles outlined in the ANA Code of Nursing Ethics. Through the exploration of case studies and the multifaceted nature of moral and ethical decision-making, this essay has shed light on the challenges faced by nurses in navigating the complex terrain of contemporary healthcare. Upholding the highest standards of care requires not only adherence to ethical codes but also a commitment to continuous reflection and critical thinking in the face of evolving healthcare dynamics.

Updated: Dec 15, 2023
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Ethical and Legal Challenges in Nursing: A Comprehensive Analysis. (2016, Mar 13). Retrieved from

Ethical and Legal Challenges in Nursing: A Comprehensive Analysis essay
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