I frequently am asked business-related questions that fall in the gray area between ethics and legality. Although ethics and law are separate domains, the issues we face in healthcare often intersect these areas. While the American Nurses Association Code of Ethics is the standard of ethical conduct, often nurses are confronted with issues that go beyond these principles.

Historically, healthcare ethics concerned patients' rights, including the right to be part of their healthcare decision-making. As nurses expand their scope of responsibility, we find ourselves faced with ethical decisions not involving only patients' rights and professional issues, but also issues relating to business and economic factors. Many ethical dilemmas involve the potential conflict of interest between the needs and interests of the patient and the desire of the practitioner to make more money.

Ethical vs. Legal Conduct

To begin with, it is helpful to distinguish between ethical conduct and legal conduct. For nurses and other medical professionals, behavior that might be considered unethical does not necessarily have to be illegal, but most illegal acts are always unethical. A nurse's behavior, if guided by moral imperatives, should ethically reach a level of responsibility and decision-making that stands apart from legal considerations.

Simply put, ethical standards govern our behavior and are based on honesty, responsibility and fairness. In this age of decreasing reimbursement, increased competition and higher business costs, it can be a challenge to maintain an ethical and profitable professional practice, even for nurses who are employed within large organizations. There may be situations when you conclude the needs of your patients or your community exceeds your capacity to provide uncompensated or under-compensated care. Other nurses have determined that in certain