Ethical Dilemma in Nursing: Balancing Autonomy and Paternalism

INTRODUCTION
Nursing ethics is a section applied ethics that relies on nursing practices. Nursing ethics
combines a variety of principles related with medical ethics including beneficence, non-
maleficence, and regards for autonomy. Nursing ethics can be differentiated by its emphasis on
relationships, human dignity and collective care towards others (Dooley and McCarthy 2012).
For any health care provider, ethical principles are crucial. Universal rules of conduct are ethical
values which provide the practical foundation for the identification of the types of actions,
intentions and motives. Ethics are fundamental to nursing (Johnstone and Facn 2019). All nurses
should respect their patients, maintain patients’ dignity and protect patients’ rights. Nurses must
create an environment of mutual trust and respect to patient’s rights and decisions. Patients’
entrust their dignity to nurses, so nurses must guard their privacy, listen to their concerns and
consider their wishes concerning the care they want to receive. Nurses usually deal with
ethical dilemmas in our normal clinical practice, and as professionals, we have the
capacity to investigate and check any ethical issues that may appear. Any judgment
should be based on an ethical principle that guards the best interest of both the patient
and the health care staff (Parahoo 2014) . This paper will describe a crucial incident
which occurred in one of my clinical practice in a nursing home. It displays the clinical
situation, recognize the ethical dilemma, and explains the principles that apply to this
circumstance.(See appendix)
The ethical principles are
• Respect for autonomy – Self-rule; freedom from the controlling of interference of
another; requires adequate understanding to make a meaningful choice (Edwards 2009).

• Beneficence – Do well. Prevent or remove evil, and promote good.
• Non-maleficence – Do not harm. Do not inflict evil or harm (Beauchamp and Childress
2004)
However, these codes and ethics should not be considered as a strict code and guidelines. Nurses
should implement and apply their judgment in situation where ethical dilemma might arise. They
have to take into consideration all of the aspect of ethical issues mentioned above and not just
follow one code of conduct strictly (Johnstone and Facn 2019).
DISCUSSION
In this case there is a conflict rising in between the patient’s autonomy and the nurses’ role.
Nurses or any health care professionals’ prime responsibility is to consider the betterment of the
health condition of any patient. However, they have also respect the patient’s autonomy as well.
The nurse could have helped Mr. X by suggesting him other better solutions compared to the one
the nurse chose or could have made the patient understand about the harmful side effects of the
condition he is in. Therefore, in the following section, the important aspects about the ethical
principles such as autonomy, beneficence, non-maleficence and paternalism that is suitable to the
scenario will be discussed critically.
AUTONOMY
Autonomy refers to capacities of self- rule and self – determination and also explains a person
competent in making significant decisions about their own lives based on their views and
preferences. It is considered as a central concern in biomedical ethics(Dooley and
McCarthy2005). To be more precise, autonomy enables people to make decisions about their

lives.As nurses, we are obliged to respect, protect and promote patients’ autonomy (Nursing and
Midwifery Board of Ireland, 2014).It is found that each person has the right to make decisionsof
their own care (National consent policy 2013, Assisted Decision making Capacity Act, 2015). In
this scenario, it can be seen that the nurse did not violated the patient’s autonomy up until his
condition got worsened. Mr. X both legs wound were worsened badly,although his independent
decision was to walk around the nursing home than resting on the bed. As a patient, he has the
totalright to take the decisions about his care. Whereas, the nurses have the duty to provide
patient care and respect the patient’s autonomy while rendering care. The nurses were only tried
to mitigate the situation in quick manner. In addition, the nurses have the duty to provide patient
care and sometimes it requires to go against the patient’s choice. In this scenario, the issue can be
solved by implementing an alternative method rather than limiting the patient in the bed and
making him aware about the adverse effects of his choice (Wilson et al. 2014).
BENEFICENCE
Beneficence is a moral principle that states that a nurse should always aim to promote good.
Doing something good refers to the actions that help in achieving betterment for the patient.
(Kinsinger, 2009. In this scenario, the concept of autonomy and the rule of non-maleficence
seems to be in complete contradiction. (Edward 2009). In the case of Mr. X, the issue that arises
for the nurse is one of balancing her obligations both to respect Mr. X’s autonomy at the same
time, to protect him from harm. In this case, the nurse can take the paternalistic decision when
the patient refused to receive the nurse’s treatment. According to Dooley and McCarthy 2005, it
is an act towards a person like fatherly way. That is, it is a commanding attitude of one over
another. The nurse should respect the patient autonomy at the same time to render essential care
to the patient. In the health care area, one of the most important commitments of nursing staff is