Canadian Nurses Association
Ethical Types of Experiences and Situations
When nurses can name the type of ethical concern they are experiencing, they are
better able to discuss it with colleagues and supervisors, take steps to address it at
an early stage, and receive support and guidance in dealing with it. Identifying an
ethical concern can often be a defining moment that allows positive outcomes to
emerge from difficult experiences. In the
, the terms moral
and ethical are used
interchangeably based upon consultation with nurse ethicists and philosophers.
There are a number of terms that can assist nurses in identifying and reflecting on
their ethical experiences and discussing them with others:
ethical (or moral) agent.
Someone who has the capacity to direct their actions
to some ethical end, for example, good outcomes for patients (Storch, Rodney,
& Starzomski, 2013). Exercising that capacity would be ethical (or moral) agency.
ethical (or moral) courage.
When nurses stand firm on a point of moral principle
or a particular decision about something in the face of overwhelming fear or threat
ethical (or moral) dilemmas.
Arise when there are equally compelling reasons for
and against two or more possible courses of action, and where choosing one course
of action means that something else is relinquished or let go. An ethical dilemma is
a particular type of ethical problem.
ethical (or moral) disengagement.
Can occur when nurses normalize the disregard
of their ethical commitments. A nurse may then become apathetic or disengaged
to the point of being unkind, non-compassionate or even cruel to other health-care
providers and persons receiving care.
ethical (or moral) distress.
“Arises when nurses are unable to act according to
their moral judgment” (Rodney, 2017, s-7). They feel they know the right thing to do,
but system structures or personal limitations make it nearly impossible to pursue the
right course of action (Jameton, 1984; Webster & Baylis, 2000; Rodney, 2017).
Moral distress can lead to negative consequences such as feelings of anger,
frustration and guilt, yet it can also be a catalyst for self-reflection, growth and
advocacy (Rodney, 2017).
CNA acknowledges that not everyone concurs in this usage.
These situations are derived from CNA, 2004; Fenton, 1988; Jameton, 1984; and Webster & Baylis, 2000.