AANN Core Curriculum, 7th Edition, Ch. 1 Ethical Considerations: Digital Version-Chapter 1

Chapter 1

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Neuroscience nurses regularly face ethical dilemmas involving patient care, professional conduct, resource allocation, privacy, and disagreements among patients, families, and care teams. Ethical questions may have no clear resolution, unlike legal questions governed by specific criteria. When nurses recognize the ethically appropriate action but cannot take it because of practical, institutional, or legal barriers, they may experience moral distress.<br /><br />Ethical decision making draws on concepts such as values, morals, and bioethics, and on frameworks including duty-based ethics, consequentialism, and cultural relativism. Core healthcare principles are autonomy, beneficence, fidelity, justice, nonmaleficence, and veracity. Advocacy, confidentiality, informed consent, paternalism, and the “double effect” also guide practice.<br /><br />Dilemmas often arise when principles conflict—for example, when respecting a patient’s choices may expose them to harm, or when a surrogate’s wishes differ from the treatment team’s view of medical futility. Neuroscience cases are especially complex because patients may lack decision-making capacity, recovery can be difficult to predict, and technology may prolong uncertainty.<br /><br />Nurses can seek support through self-reflection, patient advance directives or surrogates, collaboration with colleagues and interprofessional teams, ethics committees, and palliative care services. Professional codes and nursing standards provide further guidance. Education, debriefing, reflection, and structured decision-making can reduce moral distress and burnout. One model recommends stating the problem, checking facts, identifying relevant factors, generating and testing options, choosing an action, and reviewing the outcome.<br /><br />End-of-life practice involves understanding advance care planning, living wills, healthcare powers of attorney, withholding or withdrawing treatment, brain death, persistent vegetative state, and medical futility. Nurses help ensure that decisions reflect the patient’s wishes, support informed choices, and facilitate communication when disagreements arise.

Keywords

neuroscience nursing

ethical dilemmas

moral distress

patient autonomy

informed consent

confidentiality

advance directives

medical futility

ethics committees

end-of-life care