Every nurse has a moment that lingers—a choice that wasn’t black or white, but somewhere in the grey. These are the moments where ethics stop being a lecture topic and start shaping patient lives.
In this guide, you will find 10 nursing ethical dilemma examples drawn from true-to-practice situations, plus clear steps on how to navigate them. You’ll explore common conflicts like autonomy vs. beneficence, confidentiality breaches, end-of-life decisions, and scarce resource allocation. Along the way, you’ll learn proven resolution tools, from decision-making models to mentorship and ethics committee support. You’ll also see how the ANA Code of Ethics can guide you in making decisions that protect patient dignity, uphold your integrity, and strengthen your professional voice.
And you’re doing it on top of work and family life. That’s exactly why we exist — to give you back your evenings, your weekends, and your peace of mind. We’ll take care of the writing. You take care of you.
What Are Ethical Dilemmas in Nursing?
Ethical dilemmas in nursing arise when two or more moral principles conflict, making the “right” decision difficult to determine. Unlike legal issues—which are based on statutes, regulations, and court decisions—ethical dilemmas often involve ambiguous, deeply personal, or culturally sensitive questions. Legal issues may tell us what must be done. Ethics asks what should be done.
For example, a legal mandate might require mandatory reporting of abuse, but an ethical conflict may occur when a patient pleads for confidentiality. Nurses often find themselves navigating this space—where the law provides structure, but ethics demands compassion, critical thinking, and self-reflection.
Why Learning From Nursing Ethical Dilemma Examples Matters
The reason is twofold: learning and preparation.
In academic settings, analyzing ethical dilemmas helps nursing students develop clinical reasoning, emotional resilience, and professional language for reflection. These assignments train students to think beyond tasks—to weigh the human, cultural, and systemic impacts of their decisions.
For job seekers, ethical dilemmas often come up in interviews. Employers want to know how you handle moral ambiguity. Can you stay grounded under pressure? Do you understand patient rights? Can you advocate without overstepping? Preparing ethical scenario examples can turn a tough interview into a confident conversation.
Beyond academics and interviews, discussing ethical challenges helps nurses build emotional stamina. Research published in Nursing Ethics shows that regular exposure to ethical training improves nurses’ moral confidence and reduces burnout (Ulrich et al., 2010). Nurses who process dilemmas reflectively are better equipped to navigate future ones without moral distress.
In short, learning from real nursing ethical dilemma examples not only sharpens your clinical voice—it strengthens your ability to lead, communicate, and protect patients with both heart and principle.
Types of Ethical Issues in Nursing Practice
Ethical dilemmas rarely arrive neatly labeled. But most can be grouped into a few recurring themes. Let’s explore how they show up in clinical settings—with real-life examples to bring them to life.
Autonomy vs. Beneficence
Here, nurses are torn between respecting a patient’s right to refuse treatment (autonomy) and the desire to act in the patient’s best interest (beneficence).
Take, for example, a patient in diabetic ketoacidosis who refuses insulin. Legally, they may have the right to refuse. But ethically, a nurse may question whether that decision is truly informed or a result of cognitive impairment. Do you intervene? Do you escalate?
A well-known case involves a Jehovah’s Witness patient refusing a life-saving blood transfusion due to religious beliefs. In many states, this choice must be honored—even if the nurse personally feels a duty to preserve life. This creates an emotionally charged ethical conflict, especially when family members plead for intervention.
Confidentiality vs. Duty to Warn
Nurses are entrusted with private health information—but what happens when keeping that secret could harm the patient or others?
Consider a patient who confides suicidal thoughts but begs the nurse not to tell anyone. The Health Insurance Portability and Accountability Act (HIPAA) protects privacy, yet legal exceptions exist when there is “imminent danger.” Nurses must weigh the trust of the patient against their legal and ethical responsibility to act.
Precedent cases, such as Tarasoff v. Regents of the University of California, have shaped this duty, especially in psychiatric and community health settings. Nurses must recognize these moments and act with both care and legal awareness.
End-of-Life Care Dilemmas
Decisions at the end of life are rarely simple. Nurses often face situations involving ventilator withdrawal, DNR (Do Not Resuscitate) orders, or disagreement between a patient’s advance directives and a family’s emotional wishes.
For instance, a patient may clearly state in writing they don’t want aggressive measures. Yet when the time comes, their family insists “do everything.” Nurses are caught between documentation, ethics, and the raw reality of grief.
Ethical concerns also emerge around withholding versus withdrawing care. One feels passive; the other feels like a decision. But ethically and legally, they are considered equivalent—yet emotionally, they land very differently on providers.
Resource Allocation
In the aftermath of COVID-19, many nurses encountered ethical distress around resource triage. Who gets the last ICU bed? How do you prioritize care when staff are stretched thin?
In rural hospitals with limited ventilators, equity becomes more than a buzzword—it becomes a life-and-death question. Nurses often see the systemic disparities firsthand. Ethical practice demands we acknowledge these limitations while advocating fiercely for fair care.
10 Nursing Ethical Dilemma Examples With Clinical Scenarios
1. Minor Refuses Life-Saving Care
A 16-year-old patient with leukemia refuses further chemotherapy, citing severe side effects, emotional trauma, and a desire to try alternative therapies. Their parents, desperate for survival, want to continue the medical plan without delay. The oncology team is split—some believe in honoring the teen’s growing autonomy, while others insist the parents’ consent is enough. The nurse is placed at the center, witnessing both the teen’s anguish and the family’s desperation. Should the nurse advocate for the teen’s voice, or prioritize parental authority and medical best interest?
Solution:
In such cases, the nurse should assess the teen’s decision-making capacity and ensure they fully understand the potential outcomes of refusing treatment. If deemed competent, their autonomy must be respected while facilitating open discussions between the patient, parents, and care team. An ethics consult can help mediate and explore alternative or supportive care options that balance autonomy with beneficence.
2. Parent Declines Vaccination
A mother brings in her infant for a wellness check but refuses all scheduled vaccinations, citing personal and religious beliefs. The nurse knows the area has recently seen a rise in pertussis cases and fears the child—and others—may be at risk. The clinic has a policy to educate but not to force. The ethical dilemma lies in protecting public health versus honoring individual freedom. How far can the nurse go in advocating without crossing ethical or legal boundaries?
Solution:
The nurse should provide evidence-based education on vaccine safety and disease prevention, addressing misconceptions respectfully. While honoring the parent’s rights, the nurse can document the refusal, advise on outbreak risks, and recommend alternative protective measures. If public health laws apply, the nurse should follow reporting protocols.
3. DNR Conflicts Between Patient and Family
An elderly patient with metastatic cancer has a valid Do Not Resuscitate (DNR) order on file, confirmed during prior visits. Now hospitalized and unconscious, their adult children insist on “doing everything possible” after a sudden cardiac arrest. The nurse must act quickly. Should the code be called against the patient’s documented wishes, or should the nurse uphold the DNR and risk a heated legal or emotional fallout?
Solution:
The nurse must uphold the patient’s documented wishes, supported by legal and ethical guidelines, while communicating compassionately with the family. Clear explanation of the DNR’s purpose and the patient’s prior decisions can help reduce emotional conflict. Involve palliative care or an ethics team for support.
4. Terminal Patient Requests Assisted Suicide in a Non-Legal State
A hospice patient in extreme pain asks the nurse if there’s any way to help “end things sooner.” They express exhaustion, loss of dignity, and a desire to control the dying process. However, the nurse practices in a state where physician-assisted death is not legally permitted. Even discussing options might cross ethical or legal lines. The dilemma: Can the nurse offer compassionate conversation without implying endorsement—or does silence risk abandoning the patient emotionally?
Solution:
The nurse should respond with empathy, exploring the patient’s fears, symptoms, and concerns. While not endorsing illegal actions, the nurse can advocate for enhanced palliative care, pain management, and psychosocial support. Consultation with the healthcare team ensures the patient’s dignity and comfort are prioritized within legal boundaries.
5. Reporting an Impaired Colleague
During a night shift, a nurse notices her colleague, who is responsible for medication administration, slurring speech and appearing disoriented. The colleague insists she’s just tired, but the signs suggest possible substance use. Reporting her might protect patients—but could destroy a friendship and a career. Saying nothing might put lives at risk. The nurse must choose between loyalty to a peer and the duty to uphold patient safety. What should come first?
Solution:
The nurse should prioritize patient safety by following facility policy for reporting suspected impairment to a supervisor or manager. Documentation of observed behaviors—not assumptions—is essential. While this may strain personal relationships, the nurse’s duty to protect patients must take precedence.
6. Falsified Documentation Pressure
A newly licensed nurse is asked by a senior staff member to “just sign off” on a dressing change that wasn’t completed due to time constraints. “It happens all the time,” the senior says, “and it keeps the chart clean.” The nurse is torn—refusing might provoke backlash or even retaliation, but going along would be knowingly falsifying a record. In a high-pressure unit, how does a nurse maintain ethical integrity without alienating team members?
Solution:
In this scenario, the principle of veracity (truth-telling) and professional accountability take precedence. Accurate documentation is both a legal and ethical requirement in nursing, as false charting can jeopardize patient safety and expose the nurse to disciplinary action or loss of licensure. The nurse should politely but firmly decline to falsify records, explaining the potential legal and clinical consequences. Following the chain of command—such as reporting the issue to a charge nurse, nurse manager, or compliance officer—provides a protective framework. Seeking mentorship from a trusted colleague or preceptor can also help the new nurse navigate the situation without unnecessary conflict, while reinforcing a culture of integrity in the unit.
7. Bullying or Horizontal Violence in the Unit
A charge nurse consistently belittles junior nurses during handoff, rolling eyes, interrupting, and criticizing in front of patients. One new graduate reports feeling physically sick before every shift. The team knows it happens—but no one wants to confront her due to her influence. When workplace incivility compromises team morale and patient safety, should a nurse report it to management or try to cope silently? What if leadership fails to act?
Solution:
This scenario involves the principles of nonmaleficence (do no harm) and professional respect. Bullying in healthcare undermines teamwork, damages morale, and can directly impact patient safety. The nurse should document specific incidents, including dates, behaviors, and any patient care impact, and then report through formal channels such as the unit manager or HR. If leadership fails to act, escalation to higher administration or a professional board may be necessary. Seeking peer or union support can provide protection against retaliation. Encouraging a culture of civility benefits not only staff well-being but also quality of care.
8. Family Overrides Patient’s Wishes
A patient with early-stage Alzheimer’s clearly communicates her desire not to undergo dialysis if her kidney function worsens. However, when her labs decline, her adult son insists the treatment proceed, claiming she’s “not in her right mind” and “would want to live.” The nurse recalls the earlier conversation and documented consent. Yet, family members are now pressuring the care team to override the plan. In honoring the patient’s autonomy, is the nurse going against the family’s protective instincts—or standing up for dignity?
Solution:
The ethical principle at the forefront here is autonomy. When a patient’s preferences are clearly documented and expressed, those wishes should guide care—even if family members disagree. The nurse should advocate for honoring the patient’s decision, referencing prior documentation and conversations. Involving an ethics committee can help mediate between the care team and family while ensuring legal and ethical standards are upheld. Providing compassionate explanations to the family about the importance of dignity and self-determination may help reduce conflict while keeping patient-centered care as the priority.
9. Disclosing a Terminal Diagnosis When Family Asks Not To
A middle-aged man is diagnosed with pancreatic cancer. His wife pulls the nurse aside, pleading: “Don’t tell him yet—he’s not ready.” But the patient asks directly during rounds, “What are they not telling me?” The nurse is ethically obligated to promote honesty and informed decision-making, yet the family’s request is rooted in love and fear. Withholding truth may feel compassionate—but does it deny the patient agency?
Solution:
This dilemma highlights the conflict between veracity and perceived beneficence. Ethically, the nurse should prioritize the patient’s right to know their diagnosis in order to make informed decisions about their care. The nurse can involve the provider in a private, supportive disclosure that allows the patient to process the news with sensitivity. Simultaneously, the nurse should offer emotional support to the family and explain that honesty fosters trust and empowers the patient to make meaningful choices about their remaining time. Balancing compassion with transparency ensures integrity in the nurse–patient relationship.
10. Patient’s Partner Not Legally Allowed in Decisions
A young woman is admitted after a serious car accident. Her long-term partner, also a woman, arrives and requests updates. The patient’s estranged parents, listed as emergency contacts, deny the partner visitation and decision-making power. The nurse witnesses the emotional pain and exclusion. In states without inclusive laws, should the nurse advocate despite lacking legal standing—or follow the policy and risk eroding patient-centered care?
Solution:
This case brings forward the principle of justice and patient-centered care. While legal constraints may limit decision-making authority, the nurse can advocate for the partner’s involvement in discussions and emotional support, respecting the patient’s relationship and preferences. Where possible, the nurse can facilitate communication between the partner and medical team, ensuring updates are provided with the patient’s consent once they regain capacity. Additionally, the nurse can recommend legal documentation (such as healthcare proxies or advance directives) to safeguard patient rights in the future. Even within legal limits, empathy and inclusivity should guide nursing actions.
How Nurses Handle Ethical Dilemmas in Practice
Ethical decision-making isn’t just about intuition or personal beliefs. Nurses work in fast-paced, high-stakes environments where every action must be defensible—not only morally, but also legally and professionally. That’s why many healthcare organizations and nursing educators emphasize structured frameworks and reflection tools that help nurses make thoughtful, consistent ethical choices.
Let’s explore some of the most widely used decision-making models and support strategies that empower nurses to act with integrity—even in the grayest of situations.
Decision-Making Models
Ethical dilemmas often place nurses in complex clinical crossroads where no single choice feels “right.” Models like these help clarify competing priorities and guide thoughtful, justifiable decisions.
The Four-Box Method
Popular in medical ethics education, the Four-Box Method (also known as Jonsen’s Four Quadrants) organizes a case into four perspectives:
- Medical Indications – What is the clinical problem and prognosis?
- Patient Preferences – What does the patient want or refuse?
- Quality of Life – How will the patient’s life be affected?
- Contextual Features – What are the legal, cultural, or institutional factors?
This model helps nurses pause and weigh not just what can be done medically—but what should be done ethically, within the broader picture.
The ETHIC Model
Developed for nursing practice, the ETHIC model is a step-by-step guide that emphasizes empathy, transparency, and accountability:
- Examine the ethical dilemma
- Think about personal values and beliefs
- Honor obligations to patients and society
- Include all affected parties in the decision
- Conduct yourself professionally and reflectively
It encourages nurses to acknowledge their own emotions and biases while staying grounded in professional ethics.
ANA Ethical Decision-Making Framework
The American Nurses Association recommends a structured approach built on the nine provisions of its Code of Ethics. While the full framework is discussed later in the article, the ANA’s approach emphasizes:
- Clear identification of the ethical problem
- Engagement with ethics committees or mentors
- Documentation of decisions and rationale
- Continuous ethical self-education
The key message: nurses don’t have to navigate dilemmas alone. Structured reflection and peer support can prevent moral distress and promote ethical clarity.
Tools for Resolution
Frameworks guide decision-making, but day-to-day nursing also depends on supportive tools that keep ethical thinking active and integrated into practice.
Ethics Committees
Many hospitals and long-term care facilities have ethics committees made up of interdisciplinary professionals. Nurses can consult them when faced with particularly complex cases—like withdrawing life support, managing unrepresented patients, or handling conflicts with providers or families. These committees help ensure that decisions reflect both patient-centered care and ethical standards.
Reflective Journaling
Nurses are increasingly encouraged to keep reflective journals, especially during clinical rotations or after ethically challenging encounters. Writing about these situations—what happened, how it felt, what you learned—can help develop emotional insight and prepare you for future scenarios. Journaling has been linked to reduced burnout and increased moral resilience.
Nurse Mentorships
Ethical mentoring isn’t just about career advice—it’s also a space to process difficult cases, discuss professional boundaries, and explore moral uncertainties. New nurses, in particular, benefit from having experienced colleagues who can model ethical reasoning and offer a sounding board for concerns that aren’t always easy to bring to supervisors.
When ethical dilemmas arise in nursing, it’s not about being perfect—it’s about being prepared. These models and tools give nurses the clarity to respond with both courage and care, and to act in ways that honor patients, teams, and themselves.
The ANA Code of Ethics as a Guiding Framework
When the choices aren’t easy, and the consequences carry emotional and professional weight, nurses need more than instinct—they need a moral compass. The American Nurses Association (ANA) Code of Ethics serves as just that. First adopted in 1950 and regularly updated, the Code outlines nine provisions that define the ethical obligations and expectations of every nurse in the United States.
Rather than being a rigid rulebook, the ANA Code offers principled guidance across clinical, educational, and organizational settings. It asks nurses not only to act with competence but to do so with conscience, courage, and respect for human dignity.
Overview of the 9 ANA Provisions
To understand how the ANA Code applies to real dilemmas, it helps to briefly review its structure:
- Respect for Human Dignity – Every person, regardless of status or background, is worthy of compassionate, respectful care.
- Commitment to the Patient – The nurse’s primary commitment is to the patient, whether individual, family, group, or community.
- Advocacy for Patient Rights – Nurses protect the health, safety, and rights of the patient.
- Accountability and Responsibility – Nurses are accountable for their own actions and decisions.
- Self-Integrity and Professional Growth – Nurses owe the same duty of care to themselves as they do to others.
- Safe, Ethical Work Environments – Nurses must contribute to moral, just, and supportive workplaces.
- Advancement of the Profession – Nurses should engage in research, scholarship, and policy development.
- Collaboration Beyond Nursing – Ethical care involves interdisciplinary and global partnerships.
- Social Justice and Policy Advocacy – Nurses must promote equitable healthcare for all populations.
These provisions aren’t meant to be memorized like test prep—they’re designed to be lived, reflected upon, and practiced through ethical decision-making.
FAQs on Nursing Ethical Dilemma Examples
This final section addresses some of the most common questions nursing students, job applicants, and early-career nurses have when preparing to write about or discuss ethical dilemmas in clinical or academic settings. Whether you’re drafting a reflection, prepping for an interview, or navigating a real-time scenario, these concise answers will help you approach ethical issues with clarity and confidence.
What are the 4 main ethical principles in nursing?
The foundation of ethical decision-making in nursing rests on four widely recognized principles:
- Autonomy – Respecting a patient’s right to make their own decisions about care.
- Beneficence – Promoting good and acting in the best interest of the patient.
- Nonmaleficence – Avoiding harm, whether physical, emotional, or psychological.
- Justice – Ensuring fairness in care delivery, resource allocation, and access.
Nurses often find themselves balancing these principles when they come into conflict—such as when a patient’s choice (autonomy) could result in harm (nonmaleficence), or when limited resources challenge equitable care (justice).
How do you resolve an ethical dilemma in nursing?
Resolving an ethical dilemma in nursing typically involves a structured process:
- Recognize that an ethical issue exists.
- Gather information about the clinical, emotional, cultural, and legal aspects.
- Identify the stakeholders and the ethical principles in conflict.
- Consult nursing ethics frameworks (such as the ANA Code or ETHIC model).
- Discuss with the care team, supervisors, or an ethics committee.
- Document the decision-making process and patient involvement thoroughly.
- Reflect on the outcome and your emotional response afterward.
Importantly, resolution doesn’t always mean a perfect answer—but rather a well-reasoned and patient-centered course of action that aligns with professional standards.
Can you give me a short ethical dilemma to include in my assignment?
Certainly. Here’s a concise ethical dilemma you could adapt for a paper or presentation:
A 15-year-old patient diagnosed with leukemia refuses further chemotherapy due to emotional exhaustion and fear of side effects. His parents want to continue treatment immediately. The nurse must balance respect for the adolescent’s autonomy with the obligation to support beneficence and parental authority. How should the nurse advocate for the patient while also engaging the family in a constructive care plan?
This example is especially useful because it involves age-based consent, family dynamics, and patient-centered advocacy—themes that are common in clinical and academic settings alike.
