What is the importance of maintaining bioethical practice in nursing?

Bioethics in Nursing: The Foundation of Professional Practice

Maintaining bioethical practice in nursing is essential because it provides the fundamental framework for protecting patient dignity, ensuring safe care delivery, and upholding professional accountability through the four core principles: autonomy, beneficence, non-maleficence, and justice. 1

The Four Pillars of Nursing Bioethics

The internationally recognized bioethical principles form an interdependent framework that must be applied in every clinical decision:

Autonomy: Respecting Patient Self-Determination

• Competent patients have the absolute right to refuse treatment after adequate information, even when refusal leads to death. 1
• Autonomy requires providing full information that the patient comprehends, without coercion or undue pressure. 1
• Critical caveat: Autonomy does not grant patients the right to demand medically inappropriate treatments—the physician retains final decision-making responsibility when treatments lack medical indication. 1
• For patients unable to consent (due to mental disability, disease, or legal status), authorized representatives must implement the patient's presumed will. 1
• Even legally incompetent patients retain the right to express wishes, and their objections to interventions must be considered. 1

Beneficence and Non-Maleficence: Balancing Benefits and Harms

• When risks and burdens of therapy outweigh benefits for a specific patient, the intervention should not be pursued. 1
• These principles form the core of nursing care, directly impacting patient well-being, mortality reduction, satisfaction, and preservation of human dignity. 2
• Nurses must engage in ethical decision-making that transforms healthcare practices, as they constitute the largest human capital in the health system. 2

Justice: Ensuring Fair Resource Allocation

• Justice principles must be applied alongside autonomy and beneficence in all medical decision-making. 1
• Qualified providers delivering necessary assessments and treatments for patient conditions must receive appropriate reimbursement. 1

Why Bioethical Practice Cannot Be Compromised

Professional Accountability

• Being a professional nurse inherently implies ethical behavior and knowledge of what it means to be ethical. 3
• Ethics forms the foundation of committed service to humankind—without it, nursing loses its professional identity. 3
• Nurses serve as advocates for vulnerable patients; failure to behave ethically results in exploitation of poor and uneducated patients. 3

Patient Protection and Empowerment

• Ethics-based nursing practice transforms healthcare delivery and empowers patients, particularly in vulnerable populations. 3, 2
• Adherence to ethical principles increases patient well-being, reduces mortality, enhances satisfaction, and maintains human dignity. 2
• Nurses regularly confront moral questions where patient decisions conflict with their own views—ethical frameworks provide the necessary structure for navigating these dilemmas. 4

Institutional Culture Requirements

• High-quality care is only possible where overall institutional care quality is high and leadership commits to maintaining quality of life. 1
• The nursing home culture must foster trusting relationships, build community, support resident contributions, and respect choice in daily activities. 1
• Adequate staffing is essential—it facilitates permanent staff assignments, enables nursing assistants to participate in interdisciplinary care planning, and allows closer observation of patient preferences. 1

Critical Implementation Considerations

Prerequisites for Ethical Medical Interventions

Every medical intervention (including artificial nutrition, hydration, and other treatments) requires three mandatory elements:

1. A clear medical indication
2. A defined, achievable therapeutic goal
3. The informed consent of the competent patient or authorized representative 1

Communication and Documentation

• Careful, prudent wording is essential when discussing treatment decisions with patients and families. 1
• Avoid biased language (e.g., suggesting patients "may die of hunger or thirst") that manipulates decision-making. 1
• The patient's ability to consent should be reviewed and documented in writing for every therapeutic decision, including details of explanations provided. 1
• In doubtful cases, psychiatric or neurological consultation helps determine decision-making capacity. 1

Barriers to Ethical Practice

• Heavy workloads and staffing shortages limit nurses' ability to implement comprehensive ethical assessments. 5
• Lack of understanding about ethical principles affects 48% of nurses. 5
• Workplace environments prioritizing task completion over holistic care impede ethical implementation. 5
• The gap between theoretical education and practical application creates significant challenges. 5

Overcoming Implementation Barriers

Develop educational programs focused specifically on practical applications of ethical principles in various clinical settings. 5

• Create documentation templates incorporating the four ethical principles to facilitate ethics-based care planning. 5
• Implement barrier assessments before introducing ethics-based practice changes. 5
• Use participatory approaches involving nurses in adapting ethical frameworks to their specific practice environments. 5
• Establish organizational policies that explicitly support ethics-based nursing practice. 5

Global Health Context

• In multicultural societies, awareness of different values and beliefs is essential—cultural and religious issues significantly impact ethical decision-making. 1
• Ethical concerns in global health extend beyond traditional bioethical principles to include context, limited resources, cultural barriers, collaborative relationships, and capacity building. 1