Ethical decision-making is a foundational responsibility of professional nursing practice. Nurses encounter complex clinical, social, and organizational situations that require thoughtful judgment grounded in ethical principles. These principles provide a framework that guides nurses in making decisions that are fair, defensible, and centered on patient well-being while maintaining professional integrity and accountability.
The four core ethical principles most frequently applied in healthcare are autonomy, beneficence, nonmaleficence, and justice. Together, these principles support ethical nursing practice across diverse care settings and patient populations.
Autonomy: Respecting Patient Self-Determination
Autonomy refers to the patient’s right to make informed decisions about their own healthcare. In nursing practice, honoring autonomy means respecting patients as individuals with values, beliefs, and preferences that may differ from those of healthcare providers.
Nurses support autonomy by:
Providing accurate, complete, and understandable information
Ensuring patients are free from coercion or undue influence
Respecting informed consent and refusal of treatment
Advocating for patients when their decision-making capacity is questioned
Ethical challenges related to autonomy often arise when patients decline recommended treatments, have limited health literacy, or face cultural or language barriers. In such situations, nurses must balance respect for patient choice with professional obligations to promote health and safety. Supporting autonomy does not mean abandoning professional judgment; rather, it requires engaging patients in shared decision-making while honoring their rights.
Beneficence: Promoting the Patient’s Well-Being
Beneficence refers to the ethical obligation to act in ways that benefit the patient. This principle emphasizes actions that promote health, prevent harm, and contribute to positive patient outcomes.
In nursing practice, beneficence is demonstrated through:
Providing evidence-based care
Advocating for necessary resources or interventions
Supporting patient education and health promotion
Acting compassionately and responsibly
Ethical tension may arise when what is believed to be beneficial conflicts with patient preferences, institutional constraints, or limited resources. Nurses must critically evaluate interventions to ensure that actions intended to help the patient truly align with the patient’s goals and best interests.
Nonmaleficence: Avoiding Harm
Nonmaleficence is the ethical obligation to “do no harm.” While healthcare interventions often carry inherent risks, nurses are responsible for minimizing harm and preventing avoidable injury.
Application of nonmaleficence in nursing includes:
Ensuring patient safety and accurate medication administration
Recognizing and reporting errors or unsafe conditions
Practicing within scope and competence
Questioning interventions that may cause unnecessary harm
Ethical dilemmas related to nonmaleficence often occur in high-risk clinical environments, during end-of-life care, or when balancing treatment benefits against known risks. Nurses play a critical role in identifying potential harm and advocating for safer alternatives when appropriate.
Justice: Fairness and Equity in Healthcare
Justice refers to fairness in the distribution of healthcare resources and equal treatment of individuals in similar circumstances. This principle is closely tied to issues of healthcare disparities, access to care, and social determinants of health.
Nurses apply the principle of justice by:
Treating patients without discrimination
Advocating for equitable access to care
Recognizing systemic barriers that affect vulnerable populations
Supporting policies that promote fairness in healthcare delivery
Ethical concerns related to justice often extend beyond individual patient interactions, requiring nurses to consider broader social, economic, and institutional factors. Addressing justice in nursing practice involves both individual advocacy and participation in efforts to reduce health inequities at the community and policy levels.
Ethical Principles in Practice: Balancing Competing Obligations
In real-world nursing practice, ethical principles rarely exist in isolation. Nurses frequently encounter situations where principles conflict—for example, when respecting autonomy may appear to contradict beneficence or nonmaleficence. Ethical nursing practice requires thoughtful analysis, reflection, and professional judgment to balance competing obligations.
Using ethical frameworks, consulting professional codes of ethics, and engaging in interdisciplinary collaboration can support nurses in navigating these complex situations. Ethical competence develops over time through education, experience, and reflective practice.
Conclusion
Ethical principles provide a critical foundation for professional nursing practice. Autonomy, beneficence, nonmaleficence, and justice guide nurses in making decisions that are patient-centered, equitable, and professionally responsible. By applying these principles consistently, nurses contribute to ethical healthcare environments, improved patient outcomes, and the advancement of nursing as a trusted profession.
Understanding and applying ethical principles is not only an academic requirement within RN-BSN education but also an essential component of lifelong professional nursing practice.
Applying principles in real nursing contexts