Ethical and Legal Issues

Provisions 1 to 3 of the Code refer to the fundamental values of the nursing profession and the nurse’s commitment to those that they care for.

  • The nurse should provide compassionate care and respect for the client.

  • The nurse should recognize that each client is unique, has worth, and deserves to be treated with dignity.

  • The nurse should be an advocate for each client’s rights and needs.

  • The nurse should promote and protect the health and safety of each client.

Provisions 4 to 6 of the Code refer to the duty and loyalty that the nurse is expected to show to their clients and themselves.

  • The nurse should demonstrate authority, accountability, and responsibility for promoting best practices.

  • The nurse should promote health and provide the best care they can for each client.

  • The nurse should maintain competence, practice the accepted values of the nursing profession, and promote a healthy and safe practice environment.

  • The nurse should adhere to the ethical principles of the nursing profession.

Provisions 7 to 9 of the Code refer to the duty and loyalty the nurse is expected to show beyond direct client encounters and to the nursing profession as a whole.

  • The nurse should promote the profession of nursing through research and inquiry.

  • The nurse should participate in the development of standards of practice and policies governing nursing and health care.

  • The nurse should collaborate with other members of the interprofessional team to protect the rights of all individuals and decrease health disparities.

  • The nurse should promote the integrity of the nursing profession.

Autonomy

The ethical principle of autonomy refers to the nurse’s obligation to respect the client’s right to make their own decisions regarding their health care, including the right to refuse care. Unless the client’s decision is harmful to others, the nurse has an obligation to respect and advocate for the client’s wishes. This can be difficult at times if the client’s decision is not what the family wishes or if it is not the decision the nurse thinks is right.

Beneficence

The ethical principle of beneficence refers to the nurse’s obligation to minimize harm and practice in a way that benefits the client. Beneficence also means going above what is required. Nurses often practice beneficence by providing additional care or support for a client because they know it will benefit the client. Nurses also practice this ethical principle by minimizing harm, such as implementing fall precautions for a client who is at risk for falling and assigning an assistive personnel to sit with a client who is confused.

Nonmaleficence

The ethical principle of nonmaleficence refers to the nurse’s obligation to do no harm. When practicing nonmaleficence, the nurse first asks if the action will cause harm to the client: Will the care provided cause actual or potential harm to the client? If harm to the client is a risk, do the potential benefits outweigh the potential risks?

Veracity

The ethical principle of veracity refers to the nurse’s obligation to provide truthful and accurate information to the client. This truthfulness is an integral component of nursing and helps strengthen the nurse–client relationship by establishing a sense of trust. The principle of veracity is evident in times when clients are asking questions of the nurse. It is the responsibility of the nurse to respond truthfully and to provide all the information the client is requesting or will require to make informed decisions about their health care.

Fidelity

The ethical principle of fidelity refers to the nurse’s obligation to demonstrate loyalty, to keep promises, and to uphold commitments. Following through with agreements or promises made to clients is critical to build and strengthen the nurse–client relationship. Establishing patient partnerships can improve patient-centered care.

Justice

The ethical principle of justice refers to the nurse’s obligation to provide treatment, care, and resource allocation that is impartial, fair, and equitable to all clients regardless of age, sex, race, or economic status. All clients have a right to be treated fairly and provided the same standards of safety and compassionate care. Nurses have an obligation to ensure that all clients receive equitable care, even when resources are scarce.

Altruism

Altruism is the selfless concern and actions for the benefit of someone else. An example of altruism is a nurse rushing to help someone in need, sometimes ignoring risk to themselves and putting the needs of the client first. This becomes the motivation for many nurses throughout the world: Making a difference with work is important and valuable, despite the personal risk. 

Human Dignity

Human dignity implies that each individual, regardless of race, religion, gender, sexual orientation, culture, ethnicity, socioeconomic status, or any of our characteristics or personal preferences, has intrinsic value and should be respected and treated equally.

Integrity

Integrity is when a nurse demonstrates honesty, even when circumstances challenge the nurse’s character, and it can be difficult to sustain. The AACN describes integrity for nurses as upholding the professional standards of the Code, even in difficult situations. Integrity is exhibited in nursing when the nurse is honest and provides care to clients using the ethical framework that is accepted within the profession. This begins for nurses during their prelicensure training and education, then continues into their nursing career.

Autonomy

Autonomy is the right to self-determination. Autonomy refers to the nurse’s responsibility to respect the client’s right to make their own decisions regarding their health care, including the right to refuse care. Unless the client’s decision is harmful to others, the nurse has a legal obligation to respect and advocate for the client’s wishes. Autonomy can be difficult if the client’s decision is not what the family wishes or if it is not the decision the nurse thinks is right.

Social Justice

Social justice is the awareness of the basic right to health and well-being of every individual. The ANA Code of Ethics with Interpretive Statements states that it is the nurse’s obligation to support and protect the rights of clients throughout the world and fight for social justice. Social justice on a national or international scale works on behalf of every individual, regardless of their location in the world, socioeconomic status, or personal characteristics, to ensure that they have a basic right to health and happiness and to be treated equally.