Medical-Surgical Nursing · Professional Medical-Surgical Nursing
Health Policy and Ethical Considerations
On this page 9 sections
In 30 seconds
Every shift, nurses face two kinds of questions: What should we do? (an ethics question) and What are we allowed, required, or paid to do? (a policy question). Ethics is the study of what is right and good in human conduct — for nurses, it is the moral framework that guides decisions about patients, families, and colleagues. Health policy is the set of laws, regulations, and payment rules that structure how health care is organized and delivered. The two constantly interact: an ethical duty to respect a patient's wishes is carried out inside a legal and institutional framework that determines who may consent, what documents are honored, and what care is covered.
Medical-surgical nurses confront these issues daily: witnessing Informed consent Voluntary agreement to a procedure after full explanation Full entry →, caring for a person with a do-not-resuscitate order whose family disagrees, protecting private health information, or explaining why insurance affects a discharge plan.
Why this matters
- Legal liability. Violating privacy laws, practicing without consent, or ignoring advance directives can have serious legal consequences for the nurse and the institution.
- Everyday dilemmas. Conflicts between what a patient wants, what a family demands, and what is medically offered are routine on med-surg units.
- Advocacy is a professional duty. The nursing Code of Ethics requires nurses to advocate for patients — including at the policy level.
- Exam content. Ethics principles, informed consent, advance directives, and HIPAA Federal law protecting health information privacy Full entry → are high-yield NCLEX topics.
- Moral distress Knowing the right action but feeling unable to do it Full entry →. Nurses who cannot act on what they believe is right experience moral distress, a real contributor to burnout — understanding the framework helps you respond constructively.
The college version
Core Concepts
Foundational ethical principles
- Autonomy Respecting a person's right to make their own health decisions Full entry →: respect a person's right to make their own health decisions. This underlies informed consent and the right to refuse treatment.
- Beneficence Acting in the patient's best interest: act in the patient's best interest.
- Nonmaleficence Doing no harm Full entry →: do no harm; weigh risks against benefits.
- Justice Fair treatment and fair distribution of resources Full entry →: distribute care and resources fairly; treat similar situations similarly.
- Fidelity: keep promises and be faithful to your commitments to the patient.
- Veracity: be truthful.
Principles often conflict — that is what makes a situation an ethical dilemma rather than a simple choice.
Informed consent and advance care planning
Informed consent means a person agrees to a procedure voluntarily, with adequate information (purpose, risks, benefits, alternatives) and the Capacity Ability to understand and decide about a specific matter Full entry → to understand and decide. The provider performing the procedure is responsible for obtaining it; the nurse's role typically includes verifying that the patient understands and that consent was obtained properly — exact duties vary by state law and facility policy. Capacity is the ability to understand and decide; it is assessed by providers, is decision-specific, and is not a diagnosis.
Advance directives let people state their wishes before they lose capacity: a Living will Written record of treatment wishes Full entry → records treatment wishes, a Durable power of attorney for health care Names a surrogate decision-maker Full entry → names a surrogate decision-maker, and POLST/MOLST forms translate seriously ill patients' wishes into medical orders. Nurses identify, honor, and help families understand these documents, always following facility policy and applicable law.
The Code of Ethics for Nurses
The ANA Code of Ethics for Nurses has nine provisions covering: compassionate, respectful care; commitment to the patient; advocacy; authority and accountability; duties to self (health, competence, integrity); improving the health care environment; advancing the profession; reducing health disparities; and integrating social justice. When cases are especially hard, ethics committees — interdisciplinary groups that consult on dilemmas — can help analyze options. Moral distress occurs when a nurse knows the right action but feels unable to carry it out; naming it and using ethical resources is part of professional self-care.
Health policy: how the rules get made
Legislation is law passed by elected bodies (for example, state nurse practice acts or federal funding laws). Regulation is the detailed rulemaking done by agencies such as the Centers for Medicare & Medicaid Services (CMS), which sets conditions that hospitals must meet to be paid. Facility policy is how an institution implements laws and regulations day to day. Nurses influence policy through professional organizations, institutional committees, and advocacy with legislators — policy is not something that happens to nursing; nurses help shape it.
Privacy and patient rights
HIPAA (the Health Insurance Portability and Accountability Act) protects patients' health information; share only what is needed for care, and never discuss patients in public spaces. Patients also hold rights: respectful care, participation in decisions, refusal of treatment, and designation of a representative. When wishes conflict with the team's recommendations: clarify the facts, consult documents and the Ethics committee Interdisciplinary group that consults on hard dilemmas Full entry → if needed, and follow institutional policy and law.
Common Confusions
| Do Not Confuse | With | Difference |
|---|---|---|
| Ethics | Law | Ethics guides what should be done; law dictates what must be done — something can be legal but ethically troubling |
| Living will | Durable power of attorney for health care | A living will records wishes; a POA names a person to decide |
| Advance directive | POLST/MOLST | Directives state wishes for future care; POLST/MOLST are actionable medical orders for seriously ill patients now |
| Capacity | Competency | Capacity is a clinical, decision-specific assessment; competency is a legal determination made by a court |
| Confidentiality | HIPAA | Confidentiality is the ethical duty to keep information private; HIPAA is the federal law enforcing privacy |
| Advocacy | Insubordination | Advocacy is a professional duty to speak for the patient's interests through proper channels |
| Ethics committee | Risk management | Ethics committees analyze moral dilemmas; risk management addresses legal/financial liability |
Eli explains
The same idea, in plain words
Explain it like I’m 10
Ethics is the rulebook for doing what is right, and health policy is the rulebook for how the hospital and the government run things — nurses follow both. Before a treatment, the doctor must explain it and the patient must agree, which is called consent. If a patient becomes too sick to decide, a paper they wrote earlier (an advance directive) tells everyone what they wanted. Laws like HIPAA keep a patient's health information private, like a secret you are trusted to keep.
Worked example
Mr. Okafor, 74, has advanced COPD and a living will stating he does not want to be intubated. He is admitted with severe respiratory distress and is too weak to talk. His daughter, his durable power of attorney, insists, "Do everything — he didn't mean that."
- The RN checks the chart: the living will and POA document are present and valid. The team assesses Mr. Okafor's capacity — he cannot participate in decisions right now, so the surrogate acts.
- The nurse recognizes the tension: autonomy (honor the written wishes) vs. beneficence (the family believes treatment is in his best interest) vs. nonmaleficence (avoiding harm from unwanted interventions).
- The RN supports the provider in explaining the documents to the daughter, involves the ethics committee, and ensures the plan follows institutional policy.
- Throughout, the nurse advocates: for the patient's documented wishes, for the family's need to understand, and for respectful communication.
The nurse did not make the medical decision — the nurse made sure the right process happened: documents honored, family heard, ethics consulted, policy followed.
Key takeaways
- The six core principles: autonomy, beneficence, nonmaleficence, justice, fidelity, veracity.
- Informed consent needs information, capacity, and voluntariness — the provider performing the procedure obtains it; the nurse verifies and witnesses per policy.
- Advance directives: living will (wishes), durable power of attorney for health care (surrogate), POLST/MOLST (medical orders for seriously ill patients).
- Capacity is decision-specific and assessed by providers; it is not the same as a diagnosis.
- The ANA Code of Ethics makes advocacy a professional duty.
- HIPAA protects health information; privacy violations carry legal and professional consequences.
- Ethics committees and moral-distress resources exist — use them.
- Policy and law vary by state and institution; nurses must know their own jurisdiction's rules.
Check yourself
5 review questions from the chapter. Try each one, then open the answer.
What three elements are required for informed consent?
Show answer
Adequate information (purpose, risks, benefits, alternatives), capacity to understand and decide, and voluntariness.
What is the difference between a living will and a durable power of attorney for health care?
Show answer
A living will records the person's treatment wishes; a durable power of attorney for health care names a surrogate who decides when the person cannot.
Why is capacity assessed per decision rather than once for a whole person?
Show answer
Because a person may understand some decisions (e.g., where to live) but not others (e.g., complex surgery) — capacity is specific to the decision at hand.
Name two core ethical principles and give a bedside example of each.
Show answer
Example: autonomy — honoring a patient's refusal of a treatment; beneficence — providing comfort measures and teaching that help the patient; nonmaleficence — double-checking before any intervention that could cause harm; justice — giving the same quality of care to every patient regardless of insurance.
What should a nurse do when the family's wishes conflict with a patient's documented Advance directive Documents stating health wishes ahead of time Full entry →?
Show answer
Clarify the facts and verify documents, involve the provider and, if needed, the ethics committee, follow facility policy and law, and support the family with clear, compassionate communication.
Study tools & related lessonsKey vocabulary · Related
Key vocabulary
- Autonomy
- Respecting a person's right to make their own health decisions
- Beneficence
- Acting in the patient's best interest
- Nonmaleficence
- Doing no harm
- Justice
- Fair treatment and fair distribution of resources
- Informed consent
- Voluntary agreement to a procedure after full explanation
- Advance directive
- Documents stating health wishes ahead of time
- Living will
- Written record of treatment wishes
- Durable power of attorney for health care
- Names a surrogate decision-maker
- Capacity
- Ability to understand and decide about a specific matter
- HIPAA
- Federal law protecting health information privacy
- Moral distress
- Knowing the right action but feeling unable to do it
- Ethics committee
- Interdisciplinary group that consults on hard dilemmas
Sources & references
This lesson was adapted from the open educational references above; their licenses and attributions are preserved. See Copyright & Licensing.
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