Exploring Ethical Dilemmas in Nursing: Balancing Medications, Side Effects, and Moral Complexities

September 21, 2023
Prof. Camilla Foster
Prof. Camilla Foster
Prof. Camilla Foster, a distinguished nursing expert at Stanford University, dedicated to advancing healthcare.
The field of nursing is a complex amalgamation of science, art, and ethics. It is a realm that demands unwavering commitment, acute attention to detail, and deep-rooted ethical grounding. However, it is also fraught with moral and ethical quandaries that test the boundaries of professional responsibilities and personal beliefs. For nursing students stepping into this world, one area that combines both technical skill and ethical responsibility is medication management. This blog aims to offer a comprehensive guide to understanding ethical dilemmas in nursing, particularly focusing on the common medications, their side effects, and safe administration practices. Alongside, we will explore real-world case studies that highlight these dilemmas and suggest possible resolutions and helping you to complete your nursing assignment.

Common Medications, Side Effects, and Safe Administration Practices

Before diving into the complex ethical challenges that nurses often face, it's imperative to first grasp the medical landscape that serves as the backdrop for these dilemmas. Nurses frequently deal with a wide array of medications, each presenting unique challenges that intertwine clinical practice and ethical considerations. From analgesics for pain management to antipsychotics for mental health conditions, every medication comes with its own set of side effects and administration guidelines. It's not just about administering a drug; it's about understanding its physiological impact, potential for harm, and ethical implications. Nurses need to judiciously balance the drug's benefits against its risks, all while respecting patient autonomy and adhering to ethical norms. This fundamental knowledge lays the groundwork for addressing the more intricate ethical questions that will inevitably arise in nursing practice. Here is a quick rundown:

Ethical Dilemmas in Nursing

Analgesics (e.g., Morphine, Fentanyl)

  • Side Effects: Analgesics, particularly opioids, have a wide range of side effects including nausea, vomiting, dizziness, and most critically, respiratory depression. When it comes to ethics, the dilemma often arises when a nurse must balance adequate pain control against the risk of severe respiratory issues or even opioid toxicity. Overdosing can have fatal consequences, but underdosing can result in unnecessary suffering.
  • Safe Administration: Accurate dosage is key. Nurses should not only be meticulous in calculating the correct dose but also vigilant in monitoring the patient’s vital signs, especially respiratory rate and oxygen saturation. Check for signs of opioid toxicity like pinpoint pupils and depressed consciousness. This practice is crucial because mismanagement can not only cause harm but also raise ethical questions around the nurse's competence and attentiveness.

Antibiotics (e.g., Penicillin, Cephalexin)

  • Side Effects: Allergic reactions to antibiotics can range from mild rashes to life-threatening anaphylactic shock. Other side effects include digestive problems and kidney dysfunction. Ethically, administering an antibiotic without confirming a patient's allergy history can lead to severe, avoidable harm.
  • Safe Administration: Always confirm the patient’s allergy history before administering any antibiotics. Dosing should be at regular intervals to maintain a therapeutic concentration in the blood. For antibiotics that are potentially nephrotoxic, renal function should be monitored regularly.

Antihypertensives (e.g., Lisinopril, Amlodipine)

  • Side Effects: Common side effects like dizziness and headaches may be annoying but are generally not life-threatening. However, these medications can also cause kidney damage over time, creating an ethical imperative for long-term monitoring.
  • Safe Administration: Nurses should always monitor blood pressure before and after administration. If blood pressure falls below a certain range, it may be ethically and medically appropriate to withhold the medication and consult with a healthcare provider.

Anticoagulants (e.g., Warfarin, Heparin)

  • Side Effects: Excessive bleeding is a significant risk with anticoagulants, as is hematoma and gastrointestinal issues. The ethical dilemma here involves a tightrope walk between preventing clotting disorders and risking excessive bleeding.
  • Safe Administration: Regular monitoring of INR (International Normalized Ratio) levels is essential. Warning signs of internal bleeding like dark stools, frequent nosebleeds, or unexplained bruising require immediate attention.

Antipsychotics (e.g., Risperidone, Quetiapine)

  • Side Effects: Antipsychotics come with their own ethical conundrums due to their severe side effects like weight gain, sedation, and cardiac arrhythmias. Overuse can lead to a condition known as Tardive Dyskinesia, a potentially irreversible movement disorder.
  • Safe Administration: Regular monitoring of weight and cardiac status is essential. Dosage should be adjusted to minimize sedation and other side effects. Given the severe repercussions of misuse, it’s imperative for nursing staff to continually assess the necessity and impact of these medications on patients.

Understanding these medications, their side effects, and how to administer them safely is not just good practice but is also crucial for navigating the ethical landscape of nursing. Mistakes can not only be dangerous but can also open the door to ethical violations, thereby emphasizing the need for nursing students and professionals alike to be continuously vigilant and informed.

Each medication's administration comes with a unique ethical dilemma, such as whether to administer pain medication that could potentially lead to respiratory depression or whether to administer antipsychotics that might have long-term metabolic impacts. Proper medication management involves a delicate balance between alleviating patient symptoms and ensuring their safety.

Ethical Dilemmas in Nursing: Case Studies and Resolutions

Case Study 1: End-of-Life Pain Management


A terminally ill cancer patient faces agonizing pain. The patient's family, witnessing their loved one's suffering, urges the medical team to escalate the opioid dosage, despite the potential of hastening the patient's death due to respiratory depression. This situation plunges healthcare professionals into an emotional and ethical maelstrom.


The crux of this dilemma lies in two ethical cornerstones of healthcare: beneficence, the commitment to act in the patient's best interest, and non-maleficence, the principle to do no harm. How does one prioritize relief from intolerable pain against the potential risk of expediting death?


Nurses, pivotal in managing patient care, can advocate for a multi-disciplinary approach. Involving a palliative care team provides expertise in alleviating suffering in end-of-life scenarios. Consulting an ethics committee can offer guidance on best practices, considering both medical and moral implications. It's also essential to engage in open, compassionate dialogues with the patient's family, informing them of the inherent risks and possible alternatives. By doing so, they can collaboratively navigate this challenging ethical terrain, ensuring the patient's dignity and comfort remain paramount.

Case Study 2: Non-compliance to Medication


An elderly patient vehemently refuses to take prescribed antihypertensive medication, expressing a deep-seated distrust of pharmaceutical companies and conventional medicine. The patient's decision substantially increases the risk of severe health complications like stroke or heart failure, putting the medical team in a predicament.


This situation manifests an ethical clash between the patient's autonomy and the nurse's ethical responsibility for beneficence. The patient has the right to make choices concerning their own body and healthcare, but this autonomy conflicts with the nurse's professional and moral duty to ensure the best possible care.


To navigate this ethical maze, a nuanced approach is required. First, the nurse can take the time to listen to the patient's concerns empathetically, seeking to understand the roots of their distrust. This opens the door for a more meaningful conversation. Second, the nurse can provide robust, evidence-based explanations for the medication's necessity, elucidating how it could prevent severe health issues. Finally, a compromise can be sought by exploring alternative treatments that may be more in line with the patient’s beliefs—be it lifestyle changes, herbal remedies, or other therapies, as long as they're supported by scientific evidence.

By respecting the patient’s autonomy while also fulfilling the obligation for beneficence, the nurse can create an ethical and potentially life-saving solution. This careful balancing act epitomizes the complexities nurses face in providing patient-centered care.

Case Study 3: Administering Placebo


A patient with chronic pain is adamant about receiving higher doses of pain medication, asserting that lower doses have not been effective. The medical team, however, has growing concerns about potential misuse, addiction, or even toxicity if the dosage is increased.


The ethical conflict here revolves around the principles of honesty and beneficence. On one hand, the healthcare team wants to relieve the patient's pain (beneficence). On the other hand, administering a placebo without the patient's informed consent would be deceptive, violating the principle of honesty and potentially eroding the trust that is foundational to the patient-provider relationship.


Given these complexities, an ethical solution calls for a comprehensive approach. First, conduct a thorough pain assessment to understand the patient's pain experience better. Utilize objective measurements and tools to assess the patient's pain level and response to medication thus far. Second, consider consulting with pain management specialists for an expert opinion on the best course of treatment. They may suggest alternative therapies or medications that could be effective without the risks associated with higher dosages of the current medication. Lastly, maintain transparent communication with the patient. Explain the medical risks and ethical concerns tied to increasing the medication dose and propose the alternative plans suggested by the pain management consultation.

By adopting this multi-pronged approach, nurses can adhere to both ethical and clinical guidelines, ultimately aiming for a solution that respects patient autonomy while minimizing potential harm.


Medication management in nursing is not just a procedural task but a complex responsibility that intertwines with ethical considerations. While it is essential to have a comprehensive understanding of medications, their side effects, and safe administration, it is equally crucial to navigate the ethical terrain with sensitivity and wisdom. Students entering the field of nursing should strive to be well-equipped, not only with technical knowledge but also with an ethical toolkit. They should be prepared to encounter moral dilemmas that challenge their understanding and beliefs and be ready to consult interdisciplinary teams, including medical, ethical, and legal experts, in navigating these challenges. It's a tough balancing act, but one that defines the nobility and complexity of the nursing profession.

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