Health care environment
Two of the prompt's three scenarios are genuine dilemmas. The third, a colleague pocketing a patient's oxycodone, is a reporting obligation wearing a dilemma's clothes.
Editorial process
Last reviewed · August 25, 2026
One of these three is not a dilemma
The prompt lists three situations as if they were the same kind of problem, and they are not. Respecting a suffering patient's wish to die with dignity and honouring a health surrogate's decision to withdraw life support are genuine dilemmas: real values conflict, beneficence pulls against autonomy, and a reasonable nurse could land on either side while still practising well. Watching a colleague keep one of two ordered oxycodone tablets is not that. It is drug diversion, it is a patient going untreated for pain, and every board of nursing and every employer policy requires it to be reported. What makes it feel like a dilemma is loyalty, fear of being wrong about a colleague, and knowing what a report will do to someone's licence, and those feelings are worth writing about honestly, but they are not moral uncertainty about the right action. None of them amounts to genuine uncertainty about what the right action is.
That distinction gives your own example a standard to meet. When you describe the dilemma you faced, name the two goods that were actually in conflict rather than the difficulty you felt, because a hard decision is not the same as a dilemma and markers read for that. Then answer the process question the prompt asks in its own words, how you came to the decision, using ethical vocabulary as description rather than decoration: whose autonomy was at stake, what harm was foreseeable, what your professional code obliged, and who else you brought in, since an ethics consultation or a charge nurse is part of the answer. The question about feelings is not filler either. Moral distress has a specific meaning, knowing the right action and being constrained from taking it, and it is the difference between an honest reflection and a performance of one.
Likely learning objectives
- Distinguish an ethical dilemma from a situation with a clear obligation.
- Identify drug diversion as a reporting duty rather than a moral question.
- Name the two competing goods in your own case.
- Use moral distress in its specific sense rather than as a synonym for difficulty.
Assignment instructions
Read the full question
Review every instruction before using the planning guidance that follows.
Today’s health care environment gives nurses many reasons to be conflicted. Genetic testing, abortion, and end of life care are just some of the areas in which nurses may face ethical dilemmas. Consider how you feel about the following issues: Respecting the wishes of a suffering client that he is permitted to die with dignity, Respecting the health surrogate’s wishes regarding termination of life support, Or even observing another nurse take two tablets of oxycodone as ordered but keeping one for herself. Then give an example of an ethical dilemma you may have confronted in your own clinical experience or workplace. How did you come to the decision you made? What feelings did you experience while coming to that choice? (If you have not yet faced an ethical dilemma, research one and comment on it, answering the same questions.)
What this discussion asks for
- 01A response considering the three scenarios the prompt lists.
- 02An example of an ethical dilemma from your own clinical experience or workplace, or a researched one.
- 03An account of how you came to the decision you made.
- 04A description of the feelings you experienced while making the choice.
From the scenarios to your own case
What makes a dilemma a dilemma
Define it as a conflict of goods, not a difficult choice.
What the assessor is likely looking for
A definition that can sort the prompt's three cases.
Dying with dignity
Set out the autonomy and beneficence conflict in the first scenario.
What the assessor is likely looking for
Both sides argued, not one asserted.
The surrogate's decision
Address substituted judgement and where a surrogate's authority ends.
What the assessor is likely looking for
The surrogate standard named correctly.
The diverted oxycodone
Identify diversion, the untreated patient, and the reporting obligation.
What the assessor is likely looking for
Obligation distinguished from moral uncertainty.
Your own dilemma
Describe the case, the competing goods and the decision route.
What the assessor is likely looking for
Two goods named, and a process rather than an outcome.
What it felt like
Describe the affect precisely, using moral distress in its proper sense.
What the assessor is likely looking for
Precision about feeling rather than performance of it.
Where the ethics and diversion guidance sits
Recommended databases
- NCBI Bookshelf
- PubMed Central
- American Nurses Association
- MedlinePlus
Search sequence
- 1.Read a nursing ethics overview for the principle vocabulary.
- 2.Look up the professional code's provisions on reporting impaired or unsafe practice.
- 3.Read the moral distress literature for the term's specific meaning.
- 4.Check guidance on surrogate decision-making standards before writing the second scenario.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Nursing Ethical Considerations
StatPearls, NCBI Bookshelf · 2023
Nursing ethical considerations, for the principles and where they conflict.
The Limbic Brain, Moral Distress and Ethical Decision-Making in Nursing Practice
PMC / National Library of Medicine · 2025
Moral distress and ethical decision-making in nursing, for the term's specific meaning.
Nursing Scope and Standards of Practice
American Nurses Association · 2021
Nursing scope and standards, for the obligation in the third scenario.
Compassionate care and moral distress in nursing: the mediating role of organizational citizenship behavior
PMC / National Library of Medicine · 2025
Compassionate care and moral distress, for the organisational context of the feelings.
Ethical Issues in Academic Medicine
StatPearls, NCBI Bookshelf · 2023
Ethical issues in academic medicine, for the reporting and colleague-conflict problem.
Before you post
Common mistakes
- Treating the oxycodone scenario as a dilemma about loyalty.
- Describing a difficult decision that involved no conflict of goods.
- Naming ethical principles without applying them to the facts.
- Omitting who else was consulted in the decision.
- Using moral distress loosely to mean any discomfort.
Submission checklist
- Have you said which of the three scenarios is not a dilemma, and why?
- Does your own example name two competing goods?
- Is the decision process described, including anyone consulted?
- Are the feelings described in specific rather than general terms?
- Is the professional code or policy referenced where an obligation exists?
Use this guide to plan and review your own work. Follow your institution's rules and read Brinevia's academic-integrity policy.
Written by
Maren Caldwell
MSN, RN, CNE
Medical-surgical nursing, pharmacology and NCLEX preparation
Maren is a registered nurse with over 15 years of clinical and educational experience in medical-surgical nursing. She writes on NCLEX preparation, patient care fundamentals, pharmacology and evidence-based practice.
Reviewed by
Dr. Tessa Redmond
DNP, RN, CNE
Evidence-based practice and clinical education
Tessa is a doctorally-prepared nurse educator. She reviews Brinevia content for clinical accuracy and alignment with current evidence-based guidelines.