Overview
Ethical Reasoning at the Bedside
An ethical problem is more than a disagreement between a client and the healthcare team.
An ethical problem is more than a disagreement between a client and the healthcare team. It occurs when important duties or values pull in different directions: a client refuses a treatment that could prevent death, a family member requests information the client has not authorized, or a colleague’s practice may place clients at risk. The first task is to separate facts from assumptions. What does the client want? What information has the client received? Can the client make this particular decision? What harm is foreseeable if care proceeds, is delayed, or is refused? Which legal, regulatory, and organizational rules apply? A sound response protects the client’s rights without ignoring preventable harm. Clarify the concern, identify the client’s values and goals, check consent and decision-making capacity, consider the least restrictive safe option, escalate when needed, and document the reasoning. Ethical practice is not choosing whichever principle feels most persuasive; it is making the most defensible decision for this client in this situation. Consider a client with decision-making capacity who refuses a recommended blood product. Beneficence supports treatment that could be life-saving,...