Nursing Ethics Guide 2026: ANA Code of Ethics & Bioethical Principles

Contents: Four Principles of Bioethics ANA Code of Ethics (9 Provisions) Patient Rights Informed Consent Common Ethical Dilemmas Ethical Decision-Making Framework NCLEX High-Yield

Four Principles of Bioethics (Beauchamp & Childress)

Principle	Definition	Nursing Application
Autonomy	Respect the patient's right to make their own informed decisions about their care	Informed consent; honoring advance directives; respecting patient refusals even when you disagree; translating medical jargon into understandable language
Beneficence	Act in the best interest of the patient; do good	Providing evidence-based care; advocating for the patient; ensuring pain is managed; questioning orders that seem harmful
Nonmaleficence	Do no harm; avoid causing unnecessary harm	Following the five rights of medication administration; reporting unsafe staffing levels; questioning high-risk procedures when risks outweigh benefits
Justice	Treat all patients fairly; distribute resources equitably	No discrimination based on race, gender, religion, sexual orientation, or ability to pay; equitable triage; fair resource allocation

Remember: These four principles can conflict. A patient's autonomy (right to refuse treatment) may conflict with beneficence (nurse's desire to help). Ethical dilemmas arise when principles clash — there is rarely a single "right" answer.

ANA Code of Ethics: 9 Provisions

Provision	Core Focus
1	The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person
2	The nurse's primary commitment is to the patient — individual, family, group, community, or population
3	The nurse promotes, advocates for, and protects the rights, health, and safety of the patient
4	The nurse has authority, accountability, and responsibility for nursing practice; makes judgments; takes action
5	The nurse owes the same duty of care to self as to others; promotes health and safety; preserves personal integrity
6	The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment
7	The nurse, in all roles and settings, advances the profession through research, education, practice, and knowledge development
8	The nurse collaborates with other health professionals and the public to protect human rights and promote health diplomacy
9	The profession of nursing, through its collective membership, integrates principles of social justice into policy

Patient Rights (AHA Patient's Bill of Rights)

Right to respectful care regardless of race, religion, gender, age, disability, national origin, or sexual orientation
Right to complete, current information about diagnosis, treatment, and prognosis in understandable terms
Right to make decisions about care, including the right to refuse treatment
Right to privacy and confidentiality (HIPAA)
Right to informed consent before procedures
Right to know the names and roles of all care team members
Right to request or refuse experimental treatment
Right to be free from restraints unless clinically necessary
Right to designate a healthcare proxy/surrogate decision-maker
Right to formulate advance directives (living will, DNR, POLST)

Elements of Valid Informed Consent

Disclosure: Patient must receive complete information about the procedure, risks, benefits, alternatives, and consequences of refusal
Comprehension: Information must be in a language and at a literacy level the patient understands; interpreter required if needed
Voluntariness: Consent must be free from coercion, manipulation, or undue pressure
Competence: Patient must have decision-making capacity (able to understand, appreciate, reason, and communicate a choice)

The nurse's role in informed consent: Nurses witness the signature (confirming the patient signed voluntarily and appeared to understand). The physician is responsible for explaining the procedure and obtaining consent. If a patient says "I don't understand what I signed," the nurse must stop and notify the provider — witnessing a signature does NOT make you responsible for the explanation.

Exceptions to Informed Consent

Emergency exception: Implied consent when patient cannot consent and delay would cause death or serious harm
Therapeutic privilege: Rarely acceptable; withholding information that would cause immediate psychological harm; not an excuse to withhold inconvenient information
Waiver: Patient voluntarily waives right to detailed information; document the waiver
Public health authority: Communicable disease reporting, quarantine (overrides individual consent)

Surrogate Decision-Making (When Patient Lacks Capacity)

Legal guardian (court-appointed) — highest authority
Healthcare proxy / durable power of attorney for healthcare — designated by patient when competent
Substituted judgment: What would this patient have wanted? (requires knowing patient's values)
Best interest standard: What is objectively in the patient's best interest? Used when patient's wishes are unknown
Next of kin hierarchy (varies by state): typically spouse → adult children → parents → siblings

Common Ethical Dilemmas in Nursing

Dilemma	Ethical Tension	Nursing Approach
Patient refuses life-saving treatment	Autonomy vs. beneficence/nonmaleficence	Ensure patient has decision-making capacity; ensure truly informed (understood risks); document; respect the decision if competent; do not coerce; notify ethics committee if complex
Family wants "everything done" but patient had a DNR	Autonomy (patient's advance directive) vs. family wishes	The competent patient's prior directives supersede family wishes; advocate for the patient; involve social work, ethics committee, chaplain; document
Physician orders seem harmful or inappropriate	Advocacy (beneficence/nonmaleficence) vs. hierarchy	Question the order professionally; use chain of command if physician is unresponsive; document your concerns; never carry out an order you believe will harm the patient without escalating first
Patient discloses abuse or unsafe home situation	Confidentiality vs. duty to protect	Mandatory reporting laws override confidentiality for child abuse, elder abuse, and domestic violence in many states; consult social work; know your state laws
Resource scarcity (ICU beds, ventilators, organs)	Justice — who gets the resource?	Follow established triage protocols and institutional policies; allocation decisions should not be made by bedside nurses alone; ethics committee involvement
Nurse objects on moral grounds (conscientious objection)	Personal beliefs vs. professional obligation	Nurse may conscientiously object to participating in certain procedures (e.g., abortion) but CANNOT abandon the patient; must arrange transfer of care; patient safety is not negotiable

Ethical Decision-Making Framework

Identify the ethical problem: What is the dilemma? Who are the stakeholders?
Gather information: Clinical facts, patient's wishes, advance directives, legal requirements
Identify all options: What are the possible courses of action?
Apply ethical principles: How do autonomy, beneficence, nonmaleficence, and justice apply?
Make the decision: Choose the option that best balances all principles
Evaluate the outcome: Was the decision consistent with the patient's values and best interests?
Consult resources: Hospital ethics committee, ethics consultation service, social work, chaplain

NCLEX High-Yield Points

The FIRST action when a patient says they don't understand the consent they signed: STOP, do not proceed, notify the physician — the nurse's role is to witness, not explain
Competent adult patients have the absolute right to refuse treatment, even life-saving treatment
Autonomy = self-determination; beneficence = do good; nonmaleficence = do no harm; justice = fairness
Patient's documented advance directive (living will, DNR) supersedes family wishes
Implied consent = emergency situations where patient cannot consent and delay = harm or death
ANA Code of Ethics Provision 2: primary commitment is to the PATIENT
Conscientious objection: nurse may object but cannot abandon the patient; must arrange transfer of care
Mandatory reporting laws override confidentiality for abuse, certain communicable diseases

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Nursing Ethics Guide 2026: ANA Code of Ethics & Bioethical Principles

Four Principles of Bioethics (Beauchamp & Childress)

ANA Code of Ethics: 9 Provisions

Patient Rights (AHA Patient's Bill of Rights)

Informed Consent

Elements of Valid Informed Consent

Exceptions to Informed Consent

Surrogate Decision-Making (When Patient Lacks Capacity)

Common Ethical Dilemmas in Nursing

Ethical Decision-Making Framework

NCLEX High-Yield Points

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