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Ethical Principles as Applied to an Ethical Dilemma (Medication Compliance)


In the practice of nursing or any field in medicine, it is very difficult to follow a single principle due to the involvement of multiple variables that need to be considered. Through the practice of the nursing profession, four major principles serve as a guide that applies to most of the fields of nursing. The four principles are the principle of beneficence, the principle of nonmaleficence, the principle of justice, and the principle of respect for autonomy.

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Medical personnel, especially doctors and nurses face ethical dilemmas when caring for their patients. One of these ethical dilemmas especially nurse’s face is medication compliance. Say for example in mentally ill patients, the principle of beneficence and the principle of respect for autonomy may conflict. Thus, nurses and doctors should carefully balance the decisions to be made before its implementation. These practitioners should also be wise enough to make decisions that would benefit the patient and at the same time allowing the patient to actively participate in the decision-making as far as medication is concerned.

In facing ethical dilemmas, the four principles help health care practitioners decide what interventions are best for the patients. As to how these four principles help health care providers let us take a closer look at ethical principles and medication compliance.

The Ethical Dilemma

Medication compliance can be an instance wherein an ethical dilemma may exist. This situation is an issue especially when it comes to patients who are mentally ill as in this case.

A patient in a mental institution is to receive a Lithium medication. When the nurse is about to give the medication, the patient refuses the medication stating that he wants another medication that would not give him the specified side effects. This person is mentally ill, what would the nurse do?

The Principle of Beneficence

Beneficence is an action done for other people’s benefit. This action could be done to prevent or remove harm or just to improve the other’s situation (Pantilat, 2005). It is also the professional duty to do or to produce acts of kindness and charity (Soskolne, 2008).

In this principle, the nurse should give the patient the drug that he is required to take for the treatment of his disorder. For the client to get well he needs to take his medicines and what the nurse can do to the patient is explain the benefits of the said drug. The nurse should decide by what the action can do to the patient. The mentally ill patient may not know what the benefits are and should be given the information. The patient may not consider the explanation because he believes differently but the nurse knows that the drug that the patient has to take would do the patient well, thus he has to give it no matter what as long as it doesn’t harm the patient.

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The nurse’s decision based on the principle of beneficence may do the patient well. This may end in positive results since the nurse is sure that giving the medicine would do the patient well and that the patient benefits from the action of the nurse. The patient’s refusal could be answered by the nurse’s persuasive action. The nurse may be able to persuade the patient to take the medicine without causing harm to the patient. There would also be chances that the patient may not be persuaded but chances are he would take the medicine to depend on the therapeutic communication used by the nurse and the relationship the nurse has with the patient. The outcome would become satisfactory for both the patient and the nurse because the patient may not feel it but he would get well for as long as he takes the medicine.

The Principle of Non- Maleficence

The term nonmaleficence is derived from an ancient maxim “primum non nocere” meaning “first, not harm” (Soskolne, The same view is shared by Pantilat when he defined nonmaleficence as “no harm” (2005).

In the same case, this may apply. To not harm the patient would mean giving the medicine because drastic effects may happen as lithium is tapered off before it would be stopped or some drastic effects may happen. As the nurse utilizes the principle of nonmaleficence, she must give the medicine to the patient or the patient may experience something that may harm him. In utilizing this principle the nurse must do everything in her power to make the patient have his medicine but seeing to it that she won’t do any harm to the patient. Chances are the patient may refuse to have the medication but the nurse to not harm should give the medicine to the patient to ensure the patient’s safety. Since the nurse, guided by this principle knows that the potential benefits of giving the drug outweigh the harm it causes thus the outcome would be most likely satisfactory for the patient rather than the nurse because the nurse was able to do her job and prevented the harm that is caused by the patient’s decision.

Principle of Respect for Autonomy

The principle of respect for autonomy involves moral decision-making that the rational agents are involved in making informed and rational decision making (McCormick,, 2008).

Applying this principle in the case presented, this principle becomes an issue when the patient is not capable of doing a rational decision. As for normal people, they can discuss their concerns about a certain medication why they or they cannot or will not take it. As for mentally ill patients, do they have a choice for their medication compliance? If a mentally ill patient refuses to take medicine, does he have a choice? This has been an issue in medical compliance among mentally ill patients. The patient needs to take the medication however his choice not to is his right because he has the autonomy to decide along with the physician the treatment that he is to go through, however, the patient is not capable of making the rational decision, would the nurse apply this principle? The nurse would then need to balance the right of the patient versus the effect of not giving the drug to the patient.

In this case, with this principle, the nurse may still give the medicine to the patient but with a little persuasion or even trick the patient into taking it. The effects of not taking the medicine are way too dangerous to ignore just because the patient refused to without a rational reason. This action by a nurse may create a hostile feeling on the side of the patient but the nurse needs to do it to help the patient as well. Thus this action of the nurse may not produce a satisfactory result and the outcome may likely be more satisfactory for the nurse because she was able to do her job by giving the medicine to the patient and at the same time helping the patient to get well.

The Principle of Justice

In health care justice is usually defined as a form of fairness or “giving to each that which is his due” as Aristotle said ( McCormick, 2008). This would mean fair treatment to all the persons no matter what.

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Applying this principle to this case, what can the nurse do? Fair treatment is expected of every person no matter what or who the person is. Using this principle, the nurse may not give the medication to the patient because the patient said no. If mentally people are to be treated like normal people who can make rational decisions, the nurse may just have to let the patient sign a waiver that the patient refuses to take his medicine and whatever results from his refusal, the hospital is waived the said effects. The hospital or the nurse will not have any responsibility or liability towards the patient as far as medication compliance is concerned. The result of this action would not bring any satisfactory results to both the nurse and the patient thus the outcome of the action would not be satisfactory to either of them.

The similarities and the difference that in the focus of my analysis is that it revolves around the nurse’s action towards the patient’s refusal of taking his medicine guided by ethical principles. The important similarity in the analysis is that the nurse needs to think and balance the situation before doing an action. She must weigh the pros and cons first before deciding on what to do with the patient. Then an action, however right it is, is accompanied by certain restrictions as the patient has rights. The difference is that the nurse needs to consider the right of the patient affecting her quality of care.

Another is that important similarity they have that is in the action taken is that the nurse considers the patient before doing an action. She must see to it that the patient would benefit from what she has chosen to do. Their difference is that whatever the nurse considers being the right thing to do may not be necessarily followed as in the case of the principle of autonomy. The nurse may not be able to do her job effectively because she has been restricted by the right of the patient to refuse the medication.

Another important similarity that they have in terms of outcomes is that applying the principles may not necessarily produce the same outcomes because affected by the principles the nurse may have different decisions.

The principle that would likely result in a satisfactory outcome is the use of the principle of beneficence. I chose this principle because this considers the patient first before anything else. This principle is more concerned with the patient’s well-being than anything else. This principle produces more genuine actions from the nurse because she is more concerned about the actions that she would do to help the patient get well.

The differences of opinion among colleagues could be resolved as to what principle should take precedence is to consider the situation and diligently decide as to what principle applies best. They may have different opinions but the principles with their difference apply to different situations thus they may find one principle that they all believe applies to the situation.

One thing that I have learned upon completing this analysis is that patients have rights and the nurses action should be balanced between what she has to do and what the patient decides to receive.


Pantilat, Steven. (2005). Beneficence vs Nonmaleficence Beneficence. Web.

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Soskolne, Colin.(2008). Beneficence. Web.

Mc. Cormick, T. and Min, D.(2008). Principles of Bioethics. Web.

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StudyCorgi. "Ethical Principles as Applied to an Ethical Dilemma (Medication Compliance)." October 16, 2021.


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