Ethics: Advanced Ethical Frameworks

Nurse practitioners operate within advanced ethical frameworks including principle-based ethics (principlism), care ethics (emphasizing relationships and context), virtue ethics (character-driven moral reasoning), and public health ethics (balancing individual rights with population-level outcomes). Autonomy assessment at the advanced practice level involves formal capacity evaluation using standardized instruments, supporting informed refusal through shared decision-making and comprehensive risk-benefit counseling, and recognizing that capacity is decision-specific and may fluctuate. Prescribing ethics requires controlled substance stewardship with particular attention to opioid risk management strategies, addressing polypharmacy through systematic deprescribing, and maintaining transparency about pharmaceutical relationships and conflicts of interest. End-of-life ethics for NPs includes facilitating goals-of-care conversations, advance care planning, understanding jurisdictional regulations around medical assistance in dying, and navigating the withdrawal of artificial nutrition and hydration with ethical rigor and family engagement.