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Conflict in Ethical Principles 1 Ethical Principles Pro Side Beneficence Non-maleficence Justice Veracity Con Side Autonomy: Beneficence Non-maleficence: Justice: Fidelity: Veracity: 2 ANA Code of Ethics Provisions (3) Pro Side Provision 1 * Provision 2 * Provision 3 * Provision 4 * Provision 5 * Provision 7 * Con Side Provision 1: Provision 2: Provision 3: Provision 4: Provision 5: Provision 6: Provision 7: Provision 8: Provision 9: 3 *American Nurses Association, Code of Ethics for Nurses with Interpretive Statements, Washington, D.C.: American Nurses Publishing, 2015

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Conflict in Ethical Principles: The Intersection of Beneficence, Autonomy, and the ANA Code of Ethics

Introduction

The practice of nursing is deeply rooted in ethical principles that guide the decision-making processes regarding patient care. Among these principles, beneficence, non-maleficence, autonomy, justice, fidelity, and veracity play crucial roles. However, ethical dilemmas often arise due to potential conflicts between these principles. In this essay, I will explore the pro and con sides of beneficence and autonomy, describe the provisions of the American Nurses Association (ANA) Code of Ethics that inform these principles, and discuss potential ethical conflicts within nursing practice.

Ethical Principles in Nursing

Beneficence and Non-maleficence

Beneficence is the ethical principle that promotes actions that benefit others, encouraging nurses to act in the best interests of their patients. It requires healthcare professionals to provide care that enhances patients' outcomes and quality of life. Non-maleficence, on the other hand, focuses on the obligation to ‘do no harm.’ Together, these principles aim to ensure that nurses contribute positively to patient welfare while avoiding actions that could harm the patient (Beauchamp & Childress, 2019).
In support of beneficence, advocates argue that healthcare professionals must prioritize the welfare of their patients. For instance, effective pain management or providing life-saving treatments embodies this principle. Many ethical frameworks emphasize that healthcare services aim to promote healing and alleviate suffering (McDonagh & Mant, 2020).
Conversely, non-maleficence often provides a contrasting argument. Nurses might hesitate to act on beneficence if their actions are likely to cause harm or distress, such as when a treatment causes severe side effects. This dual obligation creates tension in clinical judgments, particularly with interventions that may have both beneficial and harmful consequences (Fitzgerald et al., 2019).

Autonomy

Autonomy refers to a patient's right to make informed decisions about their healthcare. This ethical principle recognizes the individual's capacity to govern themselves and the respect that should be afforded to their values, beliefs, and choices (Beauchamp & Childress, 2019). Autonomy can sometimes conflict with beneficence, particularly when patients refuse treatments caregivers believe would be beneficial.
The con side of autonomy argues that while patient choice is important, a nurse's responsibility to 'do good' may supersede a patient's refusal of treatment—especially in life-threatening situations. For instance, if a patient insists on refusing a necessary surgery that could save their life, the nurse faces an ethical dilemma. They may feel compelled to advocate for the surgery under beneficence, while simultaneously respecting the patient's autonomy (Hurst et al., 2020).

ANA Code of Ethics: Provisions Pertaining to Ethical Principles

The ANA Code of Ethics offers guidance aligned with ethical principles, particularly beneficence and autonomy.
- Provision 1 states that nurses should practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person. This supports both beneficence and autonomy by valuing the individuality of the patient while encouraging supportive care (American Nurses Association, 2015).
- Provision 2 emphasizes the role of the nurse in advocating for the rights, health, and safety of the patient, implicitly endorsing both beneficence and non-maleficence.
- Provision 5 highlights the importance of addressing ethical issues as they arise, reinforcing the need for nurses to navigate the conflicts that can emerge between beneficence and autonomy.
- Provision 7 acknowledges the role of the nurse in advancing health and welfare at a community and societal level through advocacy, further intertwining beneficence with broader ethical responsibilities (American Nurses Association, 2015).
However, potential conflicts arise when nurses must consider the implications of these provisions surrounding patient autonomy:
- Provision 3 emphasizes the need for nurses to promote an ethical practice environment. However, this can be challenging when patients exercise their autonomy in ways that counteract the nurse's objective to do good.
- Provision 6 underscores the importance of communicating effectively and transparently, which may be complicated when patients make decisions contrary to a nurse’s recommendations.

Navigating Ethical Conflicts in Practice

These ethical principles can create challenges for nursing professionals as they navigate patient care. For example, in cases where patients refuse life-saving interventions, nurses must carefully consider how best to respect the patient’s autonomy while fulfilling their obligation to provide beneficial care.

Strategies for Resolution

To effectively resolve conflicts between beneficence and autonomy, nurses can adopt several strategies:
1. Open Communication - Engaging in dialogue with patients about their values and beliefs fosters mutual understanding and respect. By listening to patients and providing informed choices, nurses can promote autonomy while also guiding patients towards beneficial decisions (Wheeler & Kravitz, 2019).
2. Shared Decision-Making - Implementing a shared decision-making model empowers patients and encourages their involvement in healthcare choices. This collaborative approach respects patient autonomy while aligning care decisions with beneficence (Charles et al., 2020).
3. Ethics Consultation - In complex cases, seeking an ethics consultation can provide healthcare professionals with additional perspectives for addressing conflicts between ethical principles. Ethics committees can assist in exploring the implications alongside legal and institutional policies (Harrison et al., 2018).
4. Education and Training - Continual education on ethical principles can equip nurses to navigate dilemmas effectively, enhancing their ability to balance beneficence and autonomy in practice (Fitzgerald, 2019).

Conclusion

The interplay between beneficence, autonomy, and the provisions of the ANA Code of Ethics illustrates the complexities of ethical decision-making in nursing. While beneficence advocates for actions that benefit patients, respect for patient autonomy emphasizes the right of individuals to make informed choices about their healthcare. Navigating these tensions requires ongoing dialogue, ethical deliberation, and a commitment to promoting patient well-being within the framework established by the ANA Code of Ethics. It is essential for nursing professionals to remain cognizant of these ethical principles and their implications to ensure both quality care and respect for patient autonomy.

References

1. American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statements. Washington, D.C.: American Nurses Publishing.
2. Beauchamp, T. L., & Childress, J. F. (2019). Principles of Biomedical Ethics. Oxford University Press.
3. Charles, C., Gafni, A., & Whelan, T. (2020). Shared decision-making in the medical encounter: What does it mean? Social Science & Medicine, 60(6), 1301-1312.
4. Fitzgerald, G. K. (2019). Understanding ethical principles in nursing practice. Nursing Ethics, 26(1), 1-3.
5. Fitzgerald, G. K., Williams, K., & Zaychik, L. (2019). Balancing beneficence and autonomy in healthcare: A nursing perspective. Nursing Ethics, 26(2), 249-256.
6. Harrison, R., et al. (2018). Ethics consultation in health care: A guide to establishing a consultation service. The Journal of Clinical Ethics, 29(3), 223-232.
7. Hurst, S. A., et al. (2020). Why do we neglect the moral dimensions of care? Nursing Philosophy, 21(4), e12310.
8. McDonagh, M., & Mant, J. (2020). Ethical principles and their application in nursing practice: An overview. International Nursing Review, 67(1), 50-57.
9. Wheeler, D., & Kravitz, R. L. (2019). Patient preferences in shared decision-making: A review and synthesis of the literature. The Journal of Clinical Ethics, 30(1), 79-96.
10. Beauchamp, T. L., & Childress, J. F. (2013). Principles of Biomedical Ethics, 7th ed. Oxford University Press.