Exploring Ethical Principles of Nursing

The 2009 drama film My Sister’s Keeper by written by Jodi Picoult and directed by Nick Cassavetes discusses the medical, legal and ethical issues related to long-term illness. Picoult tells the life story of two sisters whose lives would be entangled beyond their control leukemia (Johnson et al.

, 2009). Kate, the older sister is living with a rare genetic disease called acute promyelocytic leukemia (Johnson et al., 2009). Anna, who is three years younger was conceived to be a genetic match for Kate leukemia (Johnson et al., 2009). In the process of prolonging Kate’s life, the family faces many other obstacles both legally and ethically.

The purpose of this paper is to discuss the ethical nursing principles of autonomy, beneficence, nonmaleficence and justice in relation to genetics.

Ethical Principles in The Nursing Practice

As a nurse, there is a responsibility to identify the ethical principles that affect patients. These ethical principles are provided in the American Nurses Association’s Code of ethics. The various elements that emphasized are advocacy, teamwork with others, the maintenance of patient safety, patient’s rights and accountability (Milliken, 2017).

Nurses in their daily practice are required to make decisions that extend beyond subjective and objective, and into the contested and ethical (Milliken, 2017). As human beings, nurses often have morals that are apart of them, however, when in contact with patients the ethical role takes responsibility and priority.


The main ethical principle involved in this film is autonomy. The principle of autonomy is the ability to have a say about your own well-being (Doody & Noonan, 2016).

Withholding any form of information from a patient can have an impact on their decision and furthermore takes away their right to decide their own wellbeing (Doody & Noonan, 2016). In the film, Anna’s request for medical emancipation and Kate’s wish to die highlights the ethical principle of autonomy. As Anna grew older she realized that the donations to her sister were given at her own expense, therefore she requested to be free. Everyone including children has the right to act in their best interest. However, as a minor patient autonomy is not considered a straight forward circumstance (Doody & Noonan, 2016). Priority is taken when the minor is developmentally able to comprehend the situation (Doody & Noonan, 2016). In contrast, Sarah, the mother of Anna and Kate, acts only on her own interests to save Kate. In this circumstance what Sarah finds acceptable for Anna, is neglectful against Anna’s autonomy. Another instance of autonomy in the film is seen when Kate says that she is ready to die, however, Sarah does not respect her decision. Autonomy allows healthcare teams to respect and support the decisions of patients. Nurses are known as patient advocates; therefore, it is their duty to make sure that their patients receive all the necessary information, including, potential risks, benefits and any complications that can occur (Doody & Noonan, 2016).


Beneficence is an action that is done for the benefit of others or to prevent or remove harm by improving the situation of others (Doody & Noonan, 2016). In the film, Sarah exhibits beneficence by creating Anna to be a genetic donor for Kate. Sarah’s intent for conceiving Anna is to prolong Kate’s life. She does not see it as a biased decision, or that Anna will have to constantly be a physical compensator for her sister. Throughout Anna’s life, she is subjected to pain and risks. Another instance of beneficence is seen when Kate requested that she wanted to go to the beach. The approval of this wish by Kate’s parents encourages the act of doing good. In the nursing practice, patients often assume that nurses are there for their benefit and will act with compassion and kindness towards them (Doody & Noonan, 2016). This element of trust makes it easier for healthcare providers to treat patients. The decision to portray beneficence requires going above the minimum standards of care and considering the patients’ needs and feelings (Doody & Noonan, 2016). In the healthcare setting practicing beneficence can be challenging. Often, nurses are in circumstances where they must deliver the bad news that will have a negative effect on the patient (Doody & Noonan, 2016). However, delivering this news with a small act of compassion allows the patient to feel as if the nurse still cares.


The ethical principle of nonmaleficence in the nursing practice is defined as the obligation to do no harm to patients (Fowler, 2016). Sarah portrayed nonmaleficence by subjecting Anna to unnecessary surgeries and procedures. At this time, Anna had no knowledge of what was going on, therefore, she did not have a say in the things she wanted. In this circumstance, Sarah assumed that by conceiving Anna as Kate’s genetic donor, that she would be doing a good act for her first-born. Thus, Sarah would constantly have Anna as a backup for when there was a medical issue with Kate. In the nursing practice, nonmaleficence is used by selecting various interventions that will cause the least amount of harm to achieve a valuable outcome (Fowler, 2016). However, nonmaleficence can often become a challenging task for nurses. This principle is intended to be the goal of a nurses’ decisions (Fowler, 2016).

Therefore, consideration must be taken to determine if the patient can be harmed by the decision made. Justice The principle of justice refers to the element of fairness in relation to a medical decision (Bruce, 2018). In the film, justice is portrayed when the judge rules in favor of Anna’s request to be medically emancipated from being a donor for her sister Kate. However, towards the end of the film, Anna becomes brain-dead because of a car collision, and her organs are still donated to Kate.

Consequently, in a sense Anna still received her justice for that short period. Unfortunately, some patients are not treated with the same degree of respect as others. Subsequently, the principle of justice can be considered the engine for autonomy (Bruce, 2018). Supporting the patients right to make their own decisions supports justice.

Legal and Ethical Issues in Nursing

The ethical issues in the nursing practice as mentioned include autonomy, beneficence, nonmaleficence and justice. These principles serve as a guide to nurses making daily decisions. The ethical standard for nurses covers all settings, levels and roles in the healthcare profession (Milliken, 2017). In relation to current ethical issues, the film portrays autonomy as one of the greatest. Autonomy also includes the right of a patient to consent medical treatment. A patient should not be treated without the informed consent of the patient or their lawful surrogate except for emergencies (Milliken, 2017). Young adults, like Anna, are at high risks for becoming victims of lack of informed consent. However, an opposing view of this ethical issue is the understanding of a minor not being developmentally stable to make such decisions (Milliken, 2017). There are many legal issues in the practice of nursing. In the film Sarah conceiving Anna to be a genetic donor for Kate is considered the greatest legal issue. Anna is perceived as a ‘designer baby’, with the sole purpose of living to physically and medically support her sister Kate (Cohen, 2015). Legally, this is seen as an unjust act. However, the issue can be observed from various viewpoints. Sarah’s point of view for conceiving Anna was to prolong Kate’s life, she sees this as the act of beneficence. Another point of view interprets this dilemma as a selfish decision or even portraying favoritism.


In conclusion, the film My Sister’s Keeper manages to incorporate many ethical and legal issues within the nursing practice. Nurses are constantly confronted with multifaceted concerns in their practice. The ethical issues mentioned in the film apply to the scope of nursing and to patients. It is the nurse’s responsibility to be an advocate for the patient to successfully promote the ethical principles.

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