Ethical dilemmas and moral conflicts

What are ethical issues, problems, moral conflicts and dilemmas in health care? Are there any differences between the concepts?

Ethical issues in health care can be defined as types of behaviour or phenomena that have the potential to become a problem, for example, if a nurse begins to avoid the patient’s next-of-kin who is so demanding or anguished about the patient’s situation.

Most health care professionals are familiar with obvious ethical issues such as abortion or euthanasia. However, issues which occur in everyday work may be ignored, such as pain management procedures, rights of vulnerable people, conflicts within a team, and interaction with demanding relatives. Sometimes we forget that for the most part ethical issues are small, practical by nature and relevant to the everyday lives of the patients and their next-of-kin.

Although many people think that they know what ethics is in relation to health care, they may confuse the term with etiquette, which is a different concept. Hawley et al. (2007) argue that professional etiquette means following orders, codes of practice, organisation policy and legislation. Therefore, etiquette can advise us how to behave in certain circumstances and situations, and it guides health professionals in good manners.

Ethical problems or moral dilemmas differ from questions about etiquette significantly. Ethical problems always involve well-being of another person, usually the patient’s.

How do health professionals react to ethical dilemmas in health care practice? De Casterle et al. (2008) conducted a meta-analysis of nurses’ responses to ethical dilemmas in their work. They examined nine studies on nurses’ ethical reasoning and implementation of their ethical judgment in response to ethical dilemmas in nursing practice.

The results showed that nurses tend to reason in a conformist way in daily ethical dilemmas, being guided by conventional workplace rules and norms, rather than using creative and critical reflection. The research group also found that nurses have difficulties implementing ethical decisions in more challenging contexts. Nurses’ conformist pattern of ethical response in daily ethical dilemmas seems to be a universal phenomenon.

Although the results of the study are based on one meta-analysis, the message is clear. Nurses, as well as other health care professionals, should be stimulated through education and a professional environment to reflect critically on their work. It is essential to reflect on ethical issues instead of only following the rules.