Professional ethics, law & patient rights: consent, negligence & advocacy

Professional nursing is grounded in a small set of ethical PRINCIPLES that recur through the codes of ethics (such as the ANA and ICN codes). Most ethics stems can be solved by naming which principle is at stake and choosing the option that honours it. Learn the principles as a working toolkit, not as vocabulary.

The four classical bioethical principles:

• •AUTONOMY — the patient's right to SELF-DETERMINATION: to make their own informed decisions about their care, including the right to REFUSE treatment, based on their own values. The nurse supports autonomy by giving information, ensuring understanding, respecting the choice and advocating for it — even when the team disagrees. Informed consent and the right to refuse both flow from autonomy.
• •BENEFICENCE — the duty to do GOOD and act in the patient's best interest: promote well-being, relieve suffering, take positive action that benefits the patient. Beneficence must be balanced against autonomy — doing what YOU think is best cannot override a competent patient's own decision.
• •NON-MALEFICENCE — the duty to do NO HARM ('first, do no harm'): avoid causing injury, prevent foreseeable harm, weigh risk against benefit, and protect the vulnerable. Much of patient safety — preventing errors, falls, infections and unsafe practice — is non-maleficence in action.
• •JUSTICE — FAIRNESS and equal treatment: distribute care and resources impartially and treat every patient equitably regardless of age, wealth, ethnicity, diagnosis, lifestyle or personal feelings. Refusing to let bias affect care, and fair allocation of scarce resources, are justice questions.

Further principles the exam tests:

• •FIDELITY — faithfulness: keeping promises and commitments to the patient, being loyal and reliable, following through, and maintaining the trust of the nurse–patient relationship.
• •VERACITY — TRUTHFULNESS: being honest with patients, giving accurate and complete information, and not deceiving them. Veracity underpins informed consent and honest disclosure of errors.
• •ACCOUNTABILITY / RESPONSIBILITY — answering for your own actions and omissions, practising within your scope and competence, and owning the outcomes of your professional decisions.
• •ADVOCACY — acting on the patient's behalf: protecting their rights, voicing their wishes, and speaking up when their safety or dignity is threatened. Advocacy is the thread that ties the principles to action.

How principles clash — the heart of an ethical dilemma: dilemmas arise when principles COMPETE (e.g. autonomy vs beneficence when a patient refuses a life-saving treatment; justice vs beneficence when resources are scarce). The exam's answer is rarely to abandon a principle but to find the option that best respects the patient's autonomy and rights while minimising harm — usually informing, involving the patient, advocating, and documenting, rather than overriding them.

Anchor: name the principle at stake — autonomy (their choice), beneficence (do good), non-maleficence (do no harm), justice (be fair), fidelity/veracity (be faithful and honest) — and choose the option that honours it, defaulting to respecting the competent patient's own informed decision.