Ethics in NP: Autonomy and Beneficence

The four foundational bioethical principles (Beauchamp and Childress) -- autonomy, beneficence, nonmaleficence, and justice -- form the ethical framework for all NP clinical decision-making. AUTONOMY is the patient's right to self-determination: the right to make informed decisions about their own healthcare, including the right to refuse treatment, even when the clinician disagrees. Autonomy requires that the patient has decision-making capacity (not the same as legal competency), which is assessed by determining whether the patient can: (1) understand the relevant information, (2) appreciate how it applies to their situation, (3) reason about the options, and (4) communicate a consistent choice. Capacity is decision-specific and time-specific -- a patient may have capacity for one decision but not another, or may regain capacity after delirium resolves. BENEFICENCE is the obligation to act in the patient's best interest and promote their welfare. The tension between autonomy and beneficence creates the most common ethical dilemmas in NP practice: paternalism occurs when the clinician overrides patient autonomy 'for their own good' (e.g., pressuring a competent patient to accept a treatment they have refused). The NP must...