By Kimberly Soreca, BSN, RN, and Addi Watters, MSN, RN, AGPCNP-BC, OCN®, BMTCN®

Oncology nursing is a complex world that continues to evolve rapidly. However, one challenge that remains consistent is the ethical dilemmas nurses face when caring for patients with cancer. Complex care needs and lengthy hospital stays are common in our patient population and allow opportunity for nurses to develop relationships with patients and their families. Over the course of treatment, various ethical issues may arise, which nurses are at the forefront of identifying and acting on.

Why Nurses Belong on Ethics Committees

Since 1992, an accreditation requirement mandated that hospitals establish a mechanism to consider clinical ethical issues, which led many healthcare facilities to formally develop institutional ethics committees. Ethics committees are a great resource for the entire patient care team and should be used to facilitate resolution to the ever-so-challenging ethical dilemmas that arise in oncology nursing.

In their daily work, point-of-care nurses obtain firsthand knowledge about a patient’s preferences, feelings, attitudes, reactions, beliefs, and goals surrounding their care. A nurse can have significant input on a committee’s understanding, ruling, and outcome of ethical cases.

Ethics committees must include nurses during the patient’s data collection and analysis process to ensure ethical competence from each member of the interdisciplinary team, which upholds both patient autonomy and providers’ ethical values.

Primary Position for Patient Advocacy

Who better to take part in patient’s ethical consults than the care provider on the front lines? Point-of-care nurses are in constant communication and continued interactions with patients and families, which allows for numerous trust-building and educational opportunities. Those who provide this level of direct care on the interprofessional team are in a difficult, yet optimal position to best identify an ethical dilemma. All nurses have a responsibility to voice their concerns and feel empowered to call an ethics consult if needed.

Clinical Recommendations

Ethical dilemmas must be recognized and addressed as early as possible to minimize complications deliver the best quality care. Nurses are often the first to identify the situations and can intervene early. We have a responsibility to notify the interprofessional team of a patient’s decision to stop a course of treatment, even if we do not agree. 

Additional examples of how nurses can mitigate ethical dilemmas are:

  • Assess a patient’s understanding of the clinical situation.
  • Assess the family’s knowledge.
  • Clarify treatment types, even after patients consent.
  • Educate patients and families on long-term repercussions.
  • Listen to patients and identify uncertainty.
  • Further explore outlets that may lead to ethical dilemmas.

Every institution has their own resources such as ethics committees, clinical nurse specialists, and nursing education programs that can assist nurses in ethical situations. Using those resources and an interdisciplinary approach will always benefit the nurse and patient.