Ethical Theories and Approaches in Nursing
Key Points
- Nursing ethics draws from multiple theories rather than a single model.
- Virtue ethics focuses on character; deontology focuses on duty; utilitarianism focuses on outcomes.
- Principle-based approaches are widely used for bedside nursing decisions.
- Care-based and feminist ethics highlight dependency, relationships, power, and justice.
Pathophysiology
Complex clinical dilemmas often involve competing goals, unequal power, and uncertain outcomes. Ethical theory provides structured reasoning to reduce inconsistent decisions and improve fairness, safety, and transparency in care.
Classification
- Virtue ethics: Right action emerges from good moral character.
- Deontology: Right action follows moral law and duty regardless of outcome.
- Utilitarianism: Right action seeks greatest good and least harm for the most people.
- Principle-based approach: Uses ethical principles as direct guides for nursing action.
- Care-based approach: Emphasizes caring relationships, vulnerability, and authentic response.
- Feminist ethics: Examines power, oppression, and inequity in healthcare relationships.
Nursing Assessment
NCLEX Focus
Questions often test which ethical framework best explains a decision rationale in a specific case.
- Assess whether the dilemma is primarily duty-based, outcome-based, or relationship-based.
- Assess where autonomy, justice, and harm-prevention conflicts are strongest.
- Assess whether vulnerability or power imbalance should change the reasoning lens.
- Assess team assumptions that may reflect bias or unequal voice distribution.
- Assess whether a single framework is sufficient or blended reasoning is needed.
Nursing Interventions
- State the guiding framework explicitly during team ethical discussion.
- Use principle-based checks for bedside decisions with immediate patient impact.
- Add care-based analysis when relational trust and vulnerability are central.
- Apply feminist ethics when inequity, bias, or structural barriers shape options.
- Document ethical rationale to support continuity and accountability.
Framework Blind Spot
Using only one ethical lens can hide key risks, especially power imbalance and inequity factors.
Pharmacology
Medication ethics may require combined reasoning: duty to informed consent (deontology), harm minimization (utilitarian), and patient-centered relationship factors (care-based approach).
Clinical Judgment Application
Clinical Scenario
A team debates a high-burden intervention with low expected benefit for a frail patient who prioritizes comfort.
Recognize Cues: Outcome uncertainty and preference conflict are present. Analyze Cues: Utilitarian and autonomy considerations are both highly relevant. Prioritize Hypotheses: Principle-based and care-based reasoning together may be most balanced. Generate Solutions: Compare options through benefit-harm, duty, and relational impact lenses. Take Action: Present a patient-aligned plan with explicit ethical rationale. Evaluate Outcomes: Care remains ethically coherent and goal-concordant.
Related Concepts
- nursing-ethical-principles-and-virtues - Foundational principles and virtues used across frameworks.
- nursing-advocacy-in-professional-practice - Advocacy as an ethical action pathway.
- quality-improvement-nurse-role-and-qapi - System-level context for justice and equity concerns.
Self-Check
- What is the practical difference between deontological and utilitarian reasoning?
- When is care-based ethics especially useful in nursing decisions?
- How does feminist ethics strengthen analysis of healthcare inequity?