What ethical principles should an Acute Care Nurse Practitioner (ACNP) consider when deciding whether to recommend a long-term medication regimen that controls disease symptoms but may cause troublesome side effects?

Autonomy is the Primary Ethical Principle

When recommending a long-term medication regimen that controls disease symptoms but causes troublesome side effects, the AG-ACNP must prioritize the ethical principle of autonomy, which requires informed patient decision-making after full disclosure of both benefits and harms. 1, 2

Why Autonomy Takes Precedence in This Scenario

The decision fundamentally involves patient choice between competing outcomes—symptom control versus side effect burden—rather than a straightforward determination of medical benefit. 1 This scenario explicitly requires:

• Full disclosure of treatment goals and expectations 3
• Clear explanation of potential side effects and their impact on quality of life 3
• Patient participation in weighing benefits against burdens 3

The principle of autonomy mandates that patients receive comprehensive information about both the therapeutic benefits and the troublesome side effects, then make their own informed choice based on their personal values and preferences. 1, 2

How Other Principles Inform But Don't Override Autonomy

Beneficence and Nonmaleficence Create the Framework

While beneficence (doing good by controlling disease symptoms) and nonmaleficence (avoiding harm from side effects) are both relevant, they conflict in this scenario rather than provide clear direction. 4 The medication simultaneously fulfills beneficence (symptom control) and violates nonmaleficence (causes troublesome side effects). 4

Nonmaleficence filters treatment options by ensuring the medication serves the patient's best medical interests, but when a treatment offers genuine symptom control alongside genuine side effects, the patient must decide which outcome matters more to them personally. 4, 5

The Clinical Context Demands Patient-Centered Decision-Making

For long-term medication regimens specifically, guidelines emphasize that:

• Treatment decisions must incorporate patient preferences, goals of care, and quality of life priorities 3
• The balance between benefit and burden varies by individual patient values 3
• Patients are often poorly informed about adverse effects compared to benefits, making full disclosure ethically mandatory 3

Practical Application: The Autonomy-Centered Approach

When recommending this regimen, the ACNP should:

1. Provide complete information about symptom control benefits with specific expected outcomes 3
2. Describe the nature, frequency, and severity of anticipated side effects 3
3. Explain the time horizon to benefit versus time to harm 3
4. Discuss alternative treatment options including non-pharmacological approaches 3
5. Document the patient's understanding and their reasoning for accepting or declining treatment 3

Common Pitfall to Avoid

Do not make this decision based solely on clinical judgment about whether benefits outweigh harms. 3 While beneficence and nonmaleficence inform what options to present, autonomy requires that the patient—not the clinician—determines whether symptom control justifies the side effect burden based on their personal quality of life priorities. 1, 2

Why Fidelity and Justice Are Secondary Here

• Fidelity (faithfulness to commitments) relates to maintaining the therapeutic relationship but doesn't address the core ethical tension in this decision 1
• Justice (fair distribution of resources) would be relevant if resource allocation were the issue, but this scenario focuses on individual treatment choice 1, 2

The ethical principle at stake is autonomy because the decision requires the patient to choose between competing personal values—symptom relief versus side effect tolerance—after receiving complete information from the clinician. 1, 2, 5