Nurses’ Ethical Considerations During a Pandemic

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GUIDE. A publication developed with the CNA to provide ethical decision-making guidance for nurses working on the front lines of the COVID-19 crisis.


Nurses’ Ethical Considerations During a Pandemi: Abstract

Nursing ethics is a way of thinking about our practice by focusing on the values — such as safety, dignity, and social justice — that we are committed to in promoting health and wellbeing. Nursing ethics helps us to think through situations that involve making difficult choices, where we feel torn between two or more compelling courses of action. But nursing ethics is also
broader than difficult dilemmas. According to the Canadian Nurses Association (CNA) Code of Ethics for Registered Nurses (2017), the primary focus of nursing ethics is “everyday ethics.” This means that in all contexts, our everyday practice has important implications for the values that matter to us. This is especially true during a pandemic. In a global public health emergency, we may find ourselves questioning whether our existing ideas about what is good, right, and just continue to hold true, or whether we need to adjust our ethical beliefs because of the extreme situation we find ourselves in. This can be very unsettling. When we do not feel that we are able to practise in a way that upholds our ethical values, we are vulnerable to experiencing moral distress. At the same time, when we are able to identify and speak about ethical issues, we strengthen our capacity for moral community and for moral agency:

  • Moral distress: feelings of anger, frustration, or guilt when nurses are unable to act on their ethical judgment.
  • Moral community: a workplace in which individuals feel safe to be heard, and where there is alignment between publicly professed values and the lived reality.
  • Moral agency: the ability to direct one’s actions toward an ethical end, such as good outcomes for patients.

The opening cases presented above demonstrate a multitude of ways that a pandemic influences the everyday ethics of  nurses across a wide spectrum of care settings. Such influences happen on at least two levels: new ethical issues that are specific to a pandemic context, and an unveiling of existing ethical issues that are brought into fuller view by the
pandemic. Of course, the cases above do not speak to all the relevant ethical issues. Rather, by raising some ethical questions that arise in a pandemic, this paper aims to prompt individual reflection and stimulate conversation between nurses and their colleagues, employers, and the general public.

Everyday ethics: questions that are important to nursing during a pandemic:

  • How should we decide between our personal and professional responsibilities?
  • When we do show up, how should we be supported?
  • How do we honour the dignity of persons receiving care?
  • How do we uphold culturally safe care for First Nations, Inuit and Métis Peoples?
  • What leadership is needed?


To provide ethical decision-making guidance for nurses working on the front lines of the COVID-19 crisis.

For who ?

  • For nurses working on the front lines of the COVID-19 crisis.

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