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📋 Management of Care · Lesson 4 of 7 · 6 min

Six Ethical Principles the Exam Names by Name

⚖️ A client asks you not to tell the family about a terminal diagnosis. The family asks you not to tell the client. The exam will ask which principle you are honoring, and the answer has a specific name.

💡 Key idea

Autonomy, beneficence, nonmaleficence, justice, fidelity, veracity. When they collide, clarify values, inform the client, and support their choice rather than deciding for them; escalate to the ethics committee only if the team cannot resolve the conflict.

🧠 Why it matters

AUTONOMY: the client's right to make their own decisions, even ones you disagree with. BENEFICENCE: acting to benefit the client. NONMALEFICENCE: doing no harm, including not causing avoidable harm through omission. JUSTICE: fairness in the distribution of care and resources. FIDELITY: keeping promises and being faithful to commitments. VERACITY: telling the truth. An ETHICAL DILEMMA arises when principles conflict, such as autonomy versus beneficence when a client refuses a beneficial treatment. The nurse's role is to clarify values, provide information, support the client's informed choice, and use the ethics committee when the team cannot resolve the conflict. In the hook's scenario, when a competent client asks that the family not be told, autonomy and confidentiality (HIPAA) govern, and the nurse does not share the diagnosis with the family. When the family asks that the client not be told, their request conflicts with veracity and the client's autonomy. The nurse does not lie to or deceive the client, explores the family's concerns, and notifies the provider so the client's right to know is honored. Nurses may conscientiously object to participating in certain procedures but must notify the supervisor in advance so another nurse can be assigned, and must not abandon the client.

🏥 In the real world

🚭 A client with lung cancer continues to smoke. The nurse's beneficence says intervene; the client's autonomy says it is his choice. The nurse provides cessation information without judgment, documents the teaching and the client's decision, and keeps caring for him with the same respect. Honoring autonomy is not the same as agreeing.

📌 Takeaways

  • Autonomy means the client's informed choice stands
  • Fidelity is keeping promises; veracity is telling the truth
  • Clarify values and inform the client first; dilemmas the team cannot resolve go to the ethics committee; conscientious objection never means abandonment

✅ Test yourself

A competent client with a treatable infection refuses antibiotics for religious reasons. Which principle supports the nurse honoring the refusal?
  1. Justice
  2. Autonomy
  3. Nonmaleficence
  4. Beneficence

Answer: B · Autonomy

Autonomy is the client's right to self-determination, including refusing beneficial treatment.

A nurse promises a client to return in 10 minutes to help with repositioning and does so despite being busy. Which principle is this?
  1. Veracity
  2. Justice
  3. Autonomy
  4. Fidelity

Answer: D · Fidelity

Fidelity is faithfulness to promises and commitments.

A nurse objects on moral grounds to assisting with a legal procedure. What is the appropriate action?
  1. Notify the supervisor in advance so care can be reassigned
  2. Participate silently and raise the concern at the next staff meeting
  3. Tell the client the procedure is morally wrong and should be cancelled
  4. Refuse and leave the client without care until the shift ends

Answer: A · Notify the supervisor in advance so care can be reassigned

Conscientious objection is allowed, but client abandonment is not. The nurse notifies the supervisor in advance so care can be reassigned to another nurse.

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