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Introduction
The healthcare profession is full of complex situations that pose challenging ethical
dilemmas for nurses and other healthcare providers. Acting with integrity and upholding one’s
ethical duties as a nurse must guide decision-making, even when the morally right choice is
difficult or risky personally (Burston et al., 2019). This essay will analyze an ethical dilemma
involving a medication administration error using a structured ethical decision-making
framework to determine the most principled course of action.
The scenario centers around a nurse who accidentally administers the wrong medication
to a patient, leading to an allergic reaction and anaphylactic shock. Upon recognizing the error,
the nurse now faces an ethical conflict between reporting the mistake promptly or attempting to
conceal it out of fear of potential repercussions like job loss or professional discipline. This
situation surfaces tensions between human fallibility and the high standards of accountability
within nursing practice. It also highlights competing ethical obligations between doing what is
right versus acting in one’s self-interest.
To systematically work through this morally challenging dilemma, the Four Component
Model developed by James Rest will be utilized. This model provides a structured framework for
ethical analysis and decision-making based on four key factors: moral sensitivity, moral
judgment, moral motivation, and moral character. Examining the situation through each of these
ethical lenses will provide comprehensive reasoning to support the most ethical course of action.
This model was chosen because it moves beyond moral intuition to provide a more objective,
step-by-step process for ethical problem solving.
First, moral sensitivity involves identifying the ethical dimensions and implications of the
situation. Next, moral judgment focuses on determining which ethical principles should take
priority given the specifics. Moral motivation centers on being sufficiently compelled to act on
the moral judgment, which then must be translated into moral character and action. Working
through each component builds understanding of the fundamental ethical issues involved and
clarifies the most ethical path forward.
In applying this model systematically to the given scenario, internal conflicts surface
between core nursing values like transparency, accountability and duty to report and natural selfprotective urges when a mistake occurs. The model requires examining potential arguments both
for disclosure and concealment to make a well-reasoned ethical determination that avoids kneejerk reactions in favor of the moral high ground. This provides structure for working through
subjective emotions to uphold ethical priorities and professional duties. By methodically
analyzing this medication error dilemma through the lens of the Four Component Model, this
essay will demonstrate a principled thought process for ethical healthcare decision-making
(Vordermark, 2019). The step-by-step framework moves beyond emotion or intuition to offer
logic-driven conclusions grounded in ethical theory and nursing professional standards.
Identifying the Ethical Dilemma
The key ethical dilemma in this scenario centers around how the nurse should proceed
after recognizing the medication administration error and its resulting harm to the patient. The
nurse made a mistake and now must determine whether to promptly report it or try to cover it up.
Reporting the error is aligned with principles of honesty, transparency and learning from
mistakes to prevent future errors. However, the nurse may fear punitive consequences for
disclosing the mistake, such as termination or loss of their nursing license, and feel pressure to
hide it instead to avoid these outcomes. This creates a challenging ethical conflict for the nurse
between doing what is professionally responsible versus what is in their personal self-interest.
The nurse may experience guilt and apprehension about potential damage to their reputation and
career if transparent, versus feeling shame if they conceal the error against protocol. This
complex situation surfaces core tensions the nurse must grapple with between professional
ethical duties and natural self-protective urges when an error with serious implications occurs.
Description of the Ethical Dilemma
Specifically, the ethical dilemma involves weighing the nurse’s professional responsibility
to immediately report medication errors that result in patient harm against the natural selfprotective urge to avoid potential negative repercussions by hiding the mistake. Key ethical
principles in conflict include veracity (honesty), nonmaleficence (avoiding harm), accountability
and the duty to report. Emotions like fear and guilt also factor into the nurse’s decision-making
process. The nurse may feel anxious about losing their job or license if transparent, but also feel
shame and remorse if they conceal the error, which violates professional standards. There are
risks both to the nurse’s livelihood and the patient’s well-being depending on how the nurse
proceeds.
This dilemma highlights fundamental tensions between human fallibility and the high
standards of competency, accountability and transparency within nursing practice. The
competing obligations force the nurse to choose between self-interest and professional duty. The
nurse took an oath to act with integrity and ethics, yet the mistake creates strong motivations to
hide the error in self-protection. However, concealment could allow further patient harm if the
reaction is not properly documented and addressed. The transparency needed to prevent harm
conflicts with the nurse’s natural desire to avoid potential severe career consequences such as
termination or revoked nursing license.
At the core is a tension between the duty to report and nonmaleficence on one hand, and
self-preservation and non-transparency on the other. The nurse may experience intense guilt and
shame about the accident, and be tempted to bury these feelings through concealment. However,
this prevents organizational learning to avoid recurrence. The dilemma cuts to the heart of what
it means to act with ethics and courage in nursing practice versus taking the easier path in one’s
self interest. It requires the nurse to deeply examine why they chose this profession and whether
they are willing to rise to its moral challenges when confronted with the human realities.
Ultimately, it necessitates reflecting on who the nurse wants to be and what they stand for when
tested.
Chosen Position on the Dilemma
After thoroughly examining this dilemma, I believe the most ethical choice is for the
nurse to promptly and fully disclose the medication error to the appropriate supervisory staff and
assist with documentation, reporting and intervention to stabilize the patient. Although incredibly
uncomfortable and professionally risky for the nurse, choosing transparency regarding errors
most closely aligns with nursing ethics, mitigates additional unnecessary harm to the patient, and
promotes organizational learning to prevent future mistakes. Despite the nurse’s fears about
potential job loss or discipline, reporting the error demonstrates integrity and upholds the duty of
candor that is foundational to ethical healthcare practice (Briggs & Hamilton, 2021). While
emotionally difficult, ethically the nurse must rise above self-interest and make the disclosure to
do right by the patient, the institution, and the nursing profession.
Reasoned Arguments Supporting Chosen Position
Applying the Four Component Model provides structured reasoning to support full disclosure as
the most ethical option:
Moral Sensitivity – The nurse demonstrates moral sensitivity by recognizing the ethical
dimensions and implications of the error, including potential harm to the patient and threats to
the nurse’s career. The nurse understands that ethical principles are in conflict, creating a true
dilemma.
Moral Judgement – In terms of moral judgment, the nurse must determine which ethical
principles should take priority. Here, nonmaleficence and accountability outweigh the nurse’s
self-interest. Prompt reporting enables rapid intervention to help the patient, while transparency
upholds professional integrity.
Moral Motivation – The nurse must be sufficiently motivated to follow through on the
moral judgment. Despite fear of consequences, the nurse’s core commitment to ethical practice
should drive them to report the error.
Moral Character – Finally, the nurse must exhibit courage and moral character to act on
their ethical judgment, even under social pressure. Moral character involves transforming ethical
thinking into ethical action.
In summary, the Four Component Model supports immediate disclosure as the
appropriate ethical response, avoiding further unnecessary harm to the patient and allowing the
nurse to take responsibility for the mistake.
Examination of Potential Objections to Chosen Position
While full disclosure is the most ethical option, there are several arguments that could be made to
challenge or provide context around this position:
• Disclosing the error violates the nurse’s self-interest in protecting their reputation and
career. Being transparent about the mistake could threaten the nurse’s job security or
professional license if they face termination or suspension as a result of the disclosure.
Some may argue that the nurse has reasonable grounds to avoid reporting the error to
protect their livelihood and career.
• The patient is already stabilized from the initial reaction, so further harm has been
averted. Therefore, one could argue that nondisclosure does no further active damage and
the ethical imperative to report is diminished. Since the anaphylaxis was caught and
treated early, the patient is no longer in immediate danger.
• Medication errors unfortunately occur somewhat commonly in the high-pressure
environment of nursing. While not acceptable, some degree of human error is inevitable.
Given this reality, one could argue that punishing one nurse harshly for an honest mistake
seems unfair when medication errors are not entirely preventable. Imposing overly
punitive consequences when a nurse does report an error could discourage transparency
and reduce future error reporting overall.
• The error was unintentional, not malicious or negligent. It could be argued that
transparency is more critical with deliberate or reckless breaches of ethics, whereas here
the nurse made an accidental single mistake with otherwise sound nursing judgement and
practice. The intent matters, and unintentional errors may warrant more understanding.
• Institutional factors like under-staffing, overload, and pressure may share some blame for
the error. The nurse may have been placed in a demanding situation prone to mistakes.
Seeking individual punishment without addressing systemic issues that increase error risk
seems imbalanced and ineffective.
These arguments have reasonable motivations around protecting nurses’ livelihoods,
allowing some grace around human fallibility, and recognizing that institutional factors also
enable errors. However, they do not provide sufficient ethical grounds to justify concealing the
error:
• The duty to be transparent exists regardless of potential career impacts. Accepting
professional consequences with integrity is part of ethical practice, even at personal cost.
• Further unnecessary harm to the patient is perpetuated through concealment, delayed
intervention, and damaged trust, outweighing the nurse’s self-interest. Ethically the
patient’s well-being takes priority.
• Transparency around errors, even those perceived as common, helps uphold standards
rather than normalizing lapses. Increased reporting can build a safer culture.
• While intent matters, the effects of errors necessitate transparency regardless of whether
they were accidental or deliberate.
• Addressing systemic factors is important, but does not negate the individual nurse’s
ethical responsibility in that instance.
In summary, these counterarguments provide important context regarding the nurse’s
fears and institutional variables that increase risk. However, they ultimately do not provide
sufficient ethical grounds to justify concealing the error and overrule the obligation to be
transparent. While the objections have validity, disclosure remains the priority ethically.
Conclusion
In conclusion, using the structured Four Component Model brings clarity to the complex
ethical dilemma presented in this scenario. Despite potential professional risks, the nurse has an
ethical obligation to promptly report the medication error and resulting patient reaction to their
supervisor and assist with documenting and addressing the situation. Concealing the mistake
violates core nursing values like accountability and transparency that are essential for building
trust and improving practice. While difficult personally, disclosure aligns with ethical priorities
like nonmaleficence and veracity that supersede the nurse’s self-interest. Through courage and
moral character, the nurse can transform ethical thinking into ethical action by being fully
transparent regarding the error. The principles and reasoning within the Four Component Model
provide a systematic strategy for working through difficult ethical dilemmas in healthcare.
Reference
Burston, A., Estefan, A., & Tuckett, A. (2019). Practicing Ethical DecisionMaking.Empowerment Strategies for Nurses: Developing Resiliency in Practice, 85.
Vordermark II, J. S. (2019).An introduction to medical decision-making: practical insights and
approaches. Springer Nature.
Briggs, K. M., & Hamilton, P. M. (2021). Ethics and Law in Occupational Therapy Practice.
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