How Nurses Have Historically Handled Conflicts Between Ethics and the Law

Nurses are among health care providers required to deliver quality services to patients. The services are a continuum of care across many health issues. As much as they are answerable to the law, the same law puts them on a tight spot. The law in many instances threatens to curtail their freedom to exercise their individual and patients’ rights as demanded by their professional ethics. The situation almost calls for a special ability for nurses to discern when the law of the land binds them to certain situations and when to follow professionalism to the latter. This cause of disagreement is thus the essence of this paper.

Ulrich et al. view the conflict between nursing and the law as the situation of having in mind the right thing to do but, facing a constraint to act as one should act in that situation (2007). This eventually leads to ethics related stress (Ulrich et al., 2007). Ulrich et al. agree with other authors that occupational stress has emotional, physical, and psychosocial dimensions that precipitate moral distress.

The distress is characterized by disappointment, interpersonal discord, discontentment at work, and at the worst, desertion of the profession. Nurses face numerous challenges. Some of the challenges are because of technology, others due to humans’ right to life, some are simply the limitations of possible interventions while others are outgrowths of the patient’s autonomy. Other challenges stem from issues concerning an individual’s quality of life. All these factors are hinged to nursing professional ethics.

Professional ethics create stress that is innate in the specialized role of nurses rooted in their everyday contact with patients. Bureaucratic healthcare systems easily precipitate stress due to hectic procedures to be followed. Raines describes ethics related stress as tension linked with ethical dilemmas (Ulrich et al., 2007). The dilemmas may also emanate from the organizational rules that are formulated with the law of the land in mind. An analysis done by Kälvemark et al. on a group of healthcare providers whose focus was ethical dilemmas, and moral distress showed the existence of conflicts between organizational rules and providers’ caring obligations (Ulrich et al., 2007).

Other ethical issues that can generate stress among nurses scale from the availability of resources, patient care disagreements, informed consent concerns, defending patients’ rights, issues of proficiency, surrogate decision making and end of life care (Tang et al., 2007). Withdrawing or withholding treatment due to concerns over suitable levels of staffing can also be a source of stress. These issues have a legal connotation to them. Nurses in such excruciating circumstances have their hands tied as decisions required are usually beyond their jurisdiction. They end up compromising their ethical obligations while obeying the law.

One other source of conflict between the law and the nursing profession is modern technology an example is the respirator. The machine is acclaimed to prolong life yet the contradiction surrounding it is immense. The questions that arise include when to put the patient on that machine, when to remove them and who to make such a decision. The uncertainty bred from such cases raises both legal and moral conflicts. Similarly, poignant examples can be obtained from amputation and transplantation issues, reproductive health technology, and genetics (Yeo et al., 2010). The situation calls for critical thinking that may involve overlooking certain laws. The right to life in such cases for nurses takes the center stage.

Consumer education has gained momentum in recent years. There are tremendous results as an outcome of consumer rights knowledge. The year 1973 goes down in history as the year in which the American hospital association introduces a patient’s bill of rights. The foundation of patients viewing themselves as consumers has its roots in this period, in history (Yeo et al., 2010). Many ethical issues usually at the discretion of relevant medical authorities are emerging under a new watch terminology of autonomy. Patients demand to be more involved in the decisions regarding their health, which in the present day is the ethic of informed consent.

Nursing ethics are put on the line when it comes to power issues. Whether allegiance is primarily a reserve of the physician or the patient, is questionable. Nursing being primarily associated with care is a position of subordination in the health care system. A motto for Mack nurse training school in Canada the first one of its kind portrays this clearly “I see, and I am” (Yeo et al., 2010, p.16). On the same issue one historically acclaimed nurse, Florence Nightingale pledged nursing allegiance to the physician that still causes conflict in the execution of daily nurses’ duty. However, current reforms in nursing include empowering of nurses (Yeo et al., 2010).

Nurses in many instances are obliged to live with consequences of the decisions they did not participate in making. It is so because a team of medics makes most medical decisions in which the nurse is just an innocent partaker. The reality is evident in nursing literature where themes such as integrity and conscience are paramount.

The other issue in nursing ethics is the fact that the nurse ought to be there for the patient. The nurse experiences the patient in a wholesome manner more than any other medic does as nurses relate with the patient closely. Sadly, the nurse cannot participate in important medical decisions of the patient as the law restricts them from doing so. This is a classic conflict between individual moral obligation and the law requirements.

A historical landmark ruling of a court in America in 1975 of a patient by the name Karen Anne Quinlan put bioethics in the limelight (Jecker, Jonsen & Pearlman, 2012). The Quinlan Case is a historic case that fuels a heated debate on ones right to life. There is now an endless discussion on how to define life and death, an interaction of healthcare systems, the authority of government regulations, and the responsibility of the courts on such matters.

At that moment, all the experts on her case unanimously agreed that Karen would not survive without a respirator, but how long she would live with it was still a mystery. Removing the aid given by the machine could cause further brain damage. This would render useless the help the machine had given her up to that time as it would be risking further brain damage. Karen’s parents thought it wise to switch off the machine despite the impending death on executing the decision. To this, the physician refused that led to a court battle. There is a conflict between state laws on individual right to privacy and professional ethics of the medics involved.

Information obtained by healthcare providers in therapeutic relationships is usually the vulnerable. This type of information when divulged to the wrong people, can cause extensive harm. The nurses’ code of ethics binds them to keep their patients’ information secret. In unique situations, however, the nurse might have to divulge information to other people for security reasons. A controversy ensues here. The law requires that the information likely to compromise the right to life of someone else be revealed to the relevant authorities. One such controversial case involving medics was the case of Tarasoff Versus the Regents of the University of California.

Dr. Lawrence Moore, a psychologist in Cowell Memorial Hospital at the University of California at Berkeley tried to disclose the information, but it was not considered serious hence; the severity of the matter was undermined (Yeo, 2010). This negligence eventually led to a loss of life. The gravity of the effects of the patients’ intended harm to a third party mandates the therapist to disclose classified information. In as much as confidentiality has its limitations, the level at which it suffices to interpret the information as an emergency is entirely at the nurse’s discretion. When wrong judgment is made, there can be a conflict with the law.

Governments are mandated with a sacred law of protecting their citizens’ right to life in all situations. The multidimensional tasks of governments make them have difficult decisions to make while formulating policies. Besides the role of protection, the governments must also protect the liberty and the interest of individuals. The nursing profession is just one of the many ways through which governments can ensure continued protection for life. Current trends are, however, disturbing. The sanctity of life ethic is on the verge of erosion. Oregon State has already legalized assisted killing, and many other states are trying to legislate laws permitting legal suicide (Wagner, Kane & Gismondi, 2007).

The conflict that arises hence is whether the nurse is morally right by aiding in suicide, yet the primary goal of the nursing profession is protection of life or should they ignore that and obey laws blindly. Nobody has the liberty to terminate another’s life nature has its way of doing so. People without moral consciences are as good as dead. In such extreme situations resulting to stress in the profession, nurses resort to quitting their jobs.

In medical practice, double effect is the situation where one acts with a clear conscience thereby, they are not responsible for the negative effects that may result due to such actions. Criminalizing the administration of risky pain medication hence may not go well with patients in emergencies. The controversy over criminalization of some practices centers upon the question of clarity of the law (Castellano, 2007). A criterion to determine whether a physician commits a crime in prescribing pain medication to a dying patient is necessary. In case of any mishap in the medical judgment, the physician in such a situation should be somewhat shielded from the reach of the law is necessary.

Making certain contentious judgments illegal is for protection of lives of near -death patients from the acts of their physicians. In the absence of a definitive dosage for pain reduction, the law should protect physicians intending to alleviate the pain of their patients. Some patients may accidentally die in the process.

The most contentious issue in the nursing profession is the right to life issue of individuals. It is not shocking that most nurses prefer to quit their jobs than participate in ending human life. Laws on suicide are considered divine.


Castellano, G. (2007). The criminalization of treating end of life patients with risky pain medication and the role of the extreme emergency. Fordham Law Review, 76 (1), 203-243.

Jecker, N., Jonsen, A. & Pearlman, R. (2012). Bioethics: An introduction to history, methods and practice. Canada: Jones and Bartlett Learning.

Tang, F. P., Johansson, C., Wadensten, B., Wenneberg, S., & Ahlström, G. (2007). Chinese nurses ethical concerns in a neurological ward. Nursing Ethics, 14(6), 810-824. Web.

Ulrich, C., O’Donnell, P., Taylor, C., Farrar, A., Danis, M. & Grady, C. (2007). Ethical climate, ethics stress, and the job satisfaction of nurses and social workers in the United States. Social Science and Medicine, 65(8), 1708–1719. Web.

Wagner, W., Kane, J. S., Gismondi, G. (2007). Physician-assisted killing laws, constitutional authority, and the conscience of a nation: Two worldviews. Fordham Law Review, 24(2007), 123-163.

Yeo, M., Moorhouse, A., Khan, P., & Rodney, P. (2010). Concepts and cases in nursing ethics (3rd ed.). Canada: Broadview Press.

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