This paper presents an ethical analysis of a clinical scenario involving a 42-year-old patient diagnosed with malignant breast cancer who faces an immediate mastectomy. Through this case, the paper examines the evolving role of nurses in advocating for patient autonomy and informed consent, the conflict that arises between nursing advocacy and physician authority, and the legal and regulatory frameworks governing these interactions. Drawing on the ANA Code of Ethics and foundational nursing ethics literature, the paper explores how ethical principles such as patient advocacy, accountability, and honesty apply in real clinical settings, and how collaborative, multidisciplinary approaches can promote ethical justice in healthcare delivery.
In ancient times, nurses were expected to take orders from senior professionals and were only permitted to initiate routine procedures. Their intellectual skills and reasoning were neither valued nor fostered. Decision-making on medical and ethical issues was left entirely to the discretion of physicians. However, nurses in modern settings have recognized the therapeutic potential of involving patients in treatment decisions and care planning. Changes within the nursing profession reflect a growing desire to be contributory and accountable for patients' welfare (Peirce & Smith, 2013).
As a result, individuals who are directly affected by major medical decisions increasingly resist policies driven by unilateral decision-making. Tension emerges when nurses have sound reasons to act in a patient's best interest yet face professional consequences for doing so during the course of daily clinical work. Understanding how these tensions arise — and how they can be resolved — is central to the field of nursing ethics.
A 42-year-old woman was diagnosed with a malignant breast lump following numerous diagnostic tests. Her consultant called for an immediate mastectomy. Her distress and grief were evident throughout her two-night hospital stay. The ward nurse spent close to two hours consoling her on the first night, and surgery was scheduled for the following day (Fry, Veatch & Taylor, 2010).
As the day drew to a close, the patient sought information about her diagnosis and available treatment options. She inquired about the possibility of alternative forms of treatment. The nurse advised her to discuss these questions with the doctor before signing the consent form. When the house surgeon arrived at eight o'clock that evening, the patient presented him with a series of questions. Taken aback, the surgeon explained why the mastectomy was the best course of action. He left the patient visibly frustrated and later reprimanded the nurse for encouraging the patient to question the prescribed treatment (Butts & Rich, 2013).
The principle of informed consent is central to this scenario. Patients have the right to understand their diagnoses and treatment options before agreeing to any procedure. The nurse's actions were consistent with this principle, as she directed the patient toward dialogue with the physician rather than providing medical advice herself.
The nurse maintained that she had acted in the patient's best interest. She explained that she valued informed consent as it upholds the patient's right to seek information about alternative treatments (Peirce & Smith, 2013). The exchange did not diminish the house surgeon's irritation; he continued to express dissatisfaction with her conduct and reprimanded her again the following day.
"Accountability, curricula reform, and ethical decision-making"
"Professional codes governing nursing advocacy duties"
"Collaborative frameworks for ethical patient care"
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