Ethical and Bioethical Issues in Nursing Paper: Theories, ANA Code of Ethics, Principles and Situation Assessment Procedure

Ethical and Bioethical Issues in Nursing Paper: Utilitarianism, Deontology, ANA Code (2025), Principles and Situation Assessment Procedure

Write an APA paper that identifies ethical theories and principles as a basis for practice, discusses moral theory and identifies a common ethical dilemma in your area of nursing. Use these headings:

1. Title/introduction with a purpose statement.
2. Ethical Theory: Utilitarianism and Deontology, defined and applied with clinical examples, plus a comprehensive discussion of the ANA Code of Ethics and its components.
3. Ethical Principles: Autonomy, Beneficence and Nonmaleficence, Veracity, with challenges and a current clinical example of each.
4. Ethical Decision-Making Model: Situation Assessment Procedure (Cherry and Jacob, Chapter 9), applying every step to your chosen issue.
5. Reflection: what you learned, your strategy to improve and the impact on your practice.
6. Conclusion: restate the topic, address opposing viewpoints and call for action or future research.

Use exactly five current references (within five years), including Cherry and Jacob and a peer-reviewed reference for each section, all with APA identifiers.

Original example for study purposes (about 1,560 words). Uses exactly five references from 2021–2025. Clinical examples are samples; replace them with your own. Match the decision-model steps to the wording in your Cherry and Jacob, Chapter 9.

Ethical and Bioethical Issues in Nursing: Honoring Truth and Autonomy When Families Request Nondisclosure

Every nurse eventually faces situations in which doing the right thing is not obvious, such as when patients, families and providers disagree about what information should be shared or what care should be given. Ethics provides a framework for reasoning through these situations rather than relying on instinct or habit. The purpose of this paper is to examine the ethical theories of utilitarianism and deontology, the American Nurses Association (ANA) Code of Ethics for Nurses, the principles of autonomy, beneficence, nonmaleficence and veracity and the situation assessment procedure described by Cherry and Jacob (2023), applying them to a common dilemma in medical-surgical and oncology nursing: a family’s request that a patient not be told about a serious diagnosis.

Ethical Theory: Utilitarianism and Deontology

Utilitarianism is a consequence-based theory holding that the right action produces the greatest good for the greatest number. A nurse applying utilitarian reasoning focuses on outcomes. For example, during a staffing shortage, a charge nurse may assign the most experienced nurse to the sickest patients, accepting slightly longer waits for stable patients because the overall benefit to the unit is greater. Utilitarian thinking also underlies triage and resource allocation policies. Its weakness is that it can justify harming or ignoring an individual if doing so benefits the majority.

Deontology is a duty-based theory holding that some actions are right or wrong in themselves, regardless of consequences. A deontological nurse follows obligations such as telling the truth, keeping promises and respecting persons. For example, a nurse who discovers a medication error reports it even if the patient was not harmed and reporting is uncomfortable, because honesty is a duty. Deontology protects individual rights but can be rigid when duties conflict, such as the duty to tell the truth and the duty to prevent harm (Cherry & Jacob, 2023).

The ANA Code of Ethics for Nurses. The ANA Code of Ethics for Nurses is the profession’s nonnegotiable ethical standard and explains nurses’ duties to patients, themselves, colleagues and society. In January 2025, the ANA released a revised Code with ten provisions, adding a tenth provision on nursing’s role in advancing global health and the well-being of people and the environment (American Nurses Association [ANA], 2025). The revision also addresses structural racism and health disparities, workplace safety, emerging technologies and the idea that nurses’ self-care is inseparable from patient care (ANA, 2025). Broadly, the provisions describe the nurse’s commitment to respecting the dignity and worth of every person; a primary commitment to the patient, whether an individual, family, group or community; advocacy for patients’ rights, health and safety; authority, accountability and responsibility for nursing practice; duties to oneself, including integrity and well-being; creating ethical and safe work environments; advancing the profession through scholarship and inquiry; collaboration to protect human rights and reduce health disparities; promoting social justice through the profession; and, in the new provision, global and environmental health. Together, these provisions guide practice by telling nurses what they owe patients when interests conflict: the patient remains the primary commitment, and the nurse must act as an advocate.

Ethical Principles: Autonomy, Beneficence and Nonmaleficence, Veracity

Autonomy is respect for a person’s right to make informed decisions about their own care. Its challenges include patients with impaired capacity, family pressure and cultural norms that emphasize family decision-making (Varkey, 2021). [Clinical example; replace with your own.] On my medical-surgical unit, a patient with heart failure declined a recommended central line after the risks were explained. The team documented her informed refusal and adjusted the plan, honoring her autonomy.

Beneficence is the duty to act for the patient’s good, and nonmaleficence is the duty to avoid causing harm. Challenges arise because nearly every intervention carries both benefits and risks, and treatments that extend life can increase suffering. Arends et al. (2022) found that nurses experienced moral distress, felt powerless and were often excluded from decisions when administering life-prolonging treatment to patients with short life expectancies. [Clinical example.] I saw a nurse advocate for a palliative care consult for a patient receiving repeated painful procedures with little expected benefit, balancing beneficence and nonmaleficence.

Veracity is the duty to tell the truth. Challenges include delivering bad news, family requests to withhold information and cultural differences in disclosure. Khaki et al. (2024) found that families often tried to keep diagnoses from patients and that providers sometimes withheld information, leaving patients confused about their condition, while emphasizing that patients have a right to timely information. [Clinical example.] On my unit, a nurse answered a patient’s direct question about his biopsy results honestly by explaining that the physician would review the results with him that afternoon and then ensuring that the conversation occurred.

Ethical Decision-Making Model: Situation Assessment Procedure

The situation assessment procedure presented by Cherry and Jacob (2023) guides nurses through a dilemma in sequential steps. [Match each step’s wording to the model in Chapter 9.] I apply it to the following situation: Mr. L., 74, was admitted with weight loss and found to have metastatic pancreatic cancer. His adult children ask the team not to tell him, saying the news will “take away his hope.” Mr. L. is alert and has capacity and asks his nurse, “What did the scan show?”

1. Review the situation: health problems, decision needed, ethical components and key individuals. The health problem is a serious, likely terminal diagnosis. The decision is whether and how to disclose. The ethical components are autonomy and veracity versus the family’s view of beneficence. The key individuals are Mr. L., his children, the oncologist, the nurse and the palliative care team.
2. Gather additional information. Assess Mr. L.’s capacity, his cultural and religious background and, most importantly, his own preferences about information. Ask him how much he wants to know and whether he wants his family involved in decisions.
3. Identify the ethical issues. Respect for the patient’s right to know and to make decisions versus the family’s wish to protect him from distress; truth-telling versus perceived harm.
4. Define personal and professional moral positions. Personally, I value honesty and believe patients deserve the truth delivered with compassion. Professionally, the ANA Code identifies the patient as the nurse’s primary commitment and calls for advocacy (ANA, 2025).
5. Identify the moral positions of key individuals. The family values protecting their father’s hope and may hold cultural beliefs favoring family-mediated disclosure. The oncologist values informed consent before treatment decisions.
6. Identify value conflicts. The family’s beneficence-based protectiveness conflicts with the patient’s autonomy and the team’s duty of veracity.
7. Determine who should make the decision. Mr. L., a competent adult, decides how much information he wants and who should receive it; the physician leads disclosure of the diagnosis, and the nurse supports and advocates.
8. Identify the range of actions and anticipated outcomes. (a) Withhold information: preserves family harmony short-term but violates autonomy, undermines trust and blocks advance care planning. (b) Disclose abruptly: respects veracity but may cause unnecessary distress. (c) Hold a family meeting, ask Mr. L. about his preferences and disclose with compassion at his pace: respects autonomy and veracity while honoring the family’s concern.
9. Decide on a course of action and carry it out. Choose option (c). The nurse informs the oncologist of Mr. L.’s question, the team meets with the family to explain the patient’s rights and their shared goal of supporting him, and the physician discloses the diagnosis with the nurse and palliative care present, using his stated preferences.
10. Evaluate the results. Assess Mr. L.’s understanding and emotional response, the family’s coping and whether care decisions now reflect his values, and debrief with staff to reduce moral distress.

Reflection

Studying ethics showed me that most dilemmas do not involve choosing between good and bad, but between competing goods, such as honesty and comfort. I learned that ethical frameworks give nurses language to explain their concerns clearly and a process for working through disagreement, rather than avoiding it. My strategy to improve is to (1) practice communication skills for difficult conversations, such as structured approaches to breaking bad news; (2) request ethics consultations and participate in unit ethics rounds; and (3) review the revised ANA Code annually and reflect on cases with my preceptor. This learning will affect my future practice by making me a more confident advocate: when I see a patient’s rights at risk, I will speak up early, bring the team together and document clearly. Recognizing moral distress in myself and colleagues will also help me protect my integrity and well-being, as the Code now emphasizes.

Conclusion

Family requests for nondisclosure are a common and emotionally charged dilemma in nursing. Ethical theories, principles, the ANA Code and a structured decision-making model help nurses respond in ways that honor both truth and compassion. Some argue that withholding information protects vulnerable patients from despair and respects family-centered cultures, and those concerns deserve respect. However, competent patients have the right to decide how much they want to know, and deception undermines trust and prevents patients from making choices about their remaining time. The best approach is not blunt disclosure but asking patients what they want to know and involving families with the patient’s permission. Nurses should advocate for clear institutional policies on disclosure, routine involvement of palliative care and nurses’ inclusion in decision-making, and future research should examine culturally responsive disclosure practices that preserve both autonomy and family relationships.

References

American Nurses Association. (2025). Code of ethics for nurses. American Nurses Association. https://codeofethics.ana.org

Arends, S. A. M., Steenbergen, M., Thodé, M., Francke, A. L., & Jongerden, I. P. (2022). Moral distress among nurses involved in life-prolonging treatments in patients with a short life expectancy: A qualitative interview study. Patient Education and Counseling, 105(7), 2531–2536. https://doi.org/10.1016/j.pec.2022.01.017

Cherry, B., & Jacob, S. R. (2023). Contemporary nursing: Issues, trends, & management (9th ed.). Elsevier.

Khaki, S., Hosseini, M. A., Mohammadi-Shahboulaghi, F., Can, G., & Fallahi-Khoshknab, M. (2024). Challenges of truth-telling to patients and their families: A qualitative study. International Journal of Cancer Management, 17(1), Article e146075. https://doi.org/10.5812/ijcm-146075

Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119

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