Moral Courage in Health Care


This review critically analyzes the arguments placed by Colonel J.S. Murray, in his article “Moral Courage in Healthcare: Acting Ethically Even in the Presence of Risk”.  Murray argues that the nursing professionals used to face complex ethical dilemmas in their workplaces. According to him, moral courage instills ethical responsibility on them for taking action when confronted with ethical issues. However, nurses should not confuse moral courage with moral arrogance. The Code of Ethics for Nurses provides the differences between public and private morals, and warrants wholeness of character in nurses. They must integrate the personal and professional values in the system. The ethical values are shared across different cultures in the form of honesty, integrity, justice, respect, dependability, empathy, compassion, and courage. Strategies for improving moral courage, embrace open discussions about the ethical principles and systems, case studies, and role modeling, as well as rehearsals. The guidelines provided by Dr. Murray are exceptional, which can mold the nurses into leaders with strong ethical values, integrity and courage.


In the journal article, Murray, J.S., indicates that the healthcare professionals who are working in clinical practice, education, research, and administration usually encounter ethical dilemmas in their workplaces. According to him, inadequate staffing in delivering patient care, cost-effective measures, unification of healthcare organizations, and the failing leadership are the major elements that escalate ethical dilemmas faced by the nurses. Here, moral courage involves the readiness to speak out, and doing what is right, though vulnerable to risk. Murray unequivocally affirms that moral courage is the capability of the individual in triumphing over fear and standing up for values and ethical obligations, that one cherishes. This is evident in the principles stipulated by the American Nurses Association (ANA, 2001) Code of Ethics for Nurses for practicing professional nursing. Nurses with moral courage have the pre-notion about the undesirable consequences for their actions; yet they realize that adhering to integrity is more important than compromising with the consequences.


To address his arguments, Murray illustrates a case study of Emily, who was a novice nurse, employed at an academic medical center, the name unrevealed. Her peers respected her for her honesty, meticulous behavior, and strong work values. During the practice, she was confronted with a serious ethical issue in her workplace, and knowing that her mentioning about it would bring severe hostilities from the superiors, she sought guidance from the nurse Ethicist of the medical center. The guidance and support received from the Ethicist gave her courage to stand firm and stay determined in doing what she thought right. Likewise, healthcare institutions can insist for moral courage and ethical principles in their position descriptions, performance evaluations, and strategic planning programs. Moral courage is a great trait found in individuals, who overcome fears of adversities and personal risks in acting upon for the sake of others during ethical dilemmas.

Moral courage is the pinnacle of ethical behaviors embodied in commitments to ethical principles, in spite of potential risks, such as defamation, emotional anxiety, retaliation, isolation, and loss of employment. For the ancient Greeks, courage meant only the response to physical hazards, but, for the contemporary scholars it is one’s commitment to stand for his or her ethical beliefs, which is a vital virtue for the nursing professionals, today.  However, moral courage is different from moral arrogance, as the latter involves only the individual’s personal moral judgment about a controversial issue, though others think differently. Moral courage occurs when individuals adhering to ethical standards overcome their conflicting values. This is evident in the case of Emily, who refused to document the ungiven medical care, in spite of the repeated insistence of the administration.


This article has highlighted the critical need for healthcare professionals, who understand the importance of moral courage in the workplace, and are willing to take action when the ethical values are being compromised. Providing awareness about moral courage and its importance will help educators, researchers, and leaders in healthcare confront ethical challenges. Therefore, it is vital for the healthcare professionals to value and support their peers, who show courage against unethical behaviors. The strategies for improving moral courage include embracing open dialogue about ethical principles, case studies, and role modeling, as well as ethical and moral rehearsals. The guidelines provided by Dr. Murray are exceptional and executable, as they intend to make the nurses, the leaders with strong ethical values, integrity and moral courage.