If you are faced with difficult questions, it can be helpful to consider the following points when making a decision:

1. Establish the relevant clinical facts of the case.
2. Assess the wishes of the patients and those important to them.
3. Consider the legal perspective for the patient, those important to them and you as a health care professional.
4. Consider the ethical perspective.
5. Be aware of the processes needed to support the decision-making process.

Nurses frequently encounter moral and ethical challenges in their practice, particularly when a patient's treatment choices diverge from the nurse's personal or professional beliefs. Although the NMC Code (2018) offers a comprehensive framework for ethical decision-making, it remains essential to have a clear understanding of the four foundational principles of ethical care: autonomy, beneficence, non-maleficence and justice.

The NMC highlights the significance of respecting patient choice and upholding dignity within the Code (2018). All registered nurses, midwives, and nursing associates are expected to adhere to the Code, which outlines the professional standards applicable across all clinical settings.

As a cornerstone of nursing and midwifery practice, the NMC Code ensures that care is delivered in a manner that honours individual preferences and preserves patient dignity and confidentiality.

In addition, conscientious objection is a recognised aspect of health care, allowing practitioners to decline certain treatments on moral or ethical grounds. The NMC addresses this in paragraph 4.4 of the Code (2018), requiring nurses, midwives and nursing associates to inform their manager, colleagues, and the patient, and to ensure a suitably qualified professional assumes responsibility for the patient’s care.

However, all nurses, midwives and nursing associates are still expected to carry out tasks that are in the normal range of their work and keep to the NMC Code (2018).

Each person will have cultural, spiritual, and religious beliefs that will shape the care you give.

Be mindful that:

• For some people spirituality may be linked to a belief system, and for others it may be about finding meaning in what is happening.
• Having a conversation and listening to people will help you understand and meet their needs.
• You don’t need to share a person’s values to respect them.
• A person may have rituals that they may need you to support them with before or after death.
• You won’t know what is important to people unless you ask them.
• It is not possible to provide all the answers, and a person may need further support by referral to a specialist team.

Further information

• Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment 
• The Spiritual Distress Assessment Tool: An Instrument to Assess Spiritual Distress in Hospitalised Elderly Persons
• Evaluation of the FICA Tool for Spiritual Assessment
• The Urgency of Spiritual Care: COVID-19 and the Critical Need for Whole-Person Palliation.