Feature ArticleMoral, Ethical, and Legal Decision-making in Controversial NPÂ Practice Situations

•Usually practicing legally ensures practicing ethically.•Ethical decision-making results in professionalism that benefits the common good, leaving the NP's moral integrity whole.•There are few studies on moral courage/moral distress experienced by NPs and NP students in controversial practice situations.•Student NPs may experience more moral distress than recognized.•Application of a decision-making tool may encourage dialogue among stakeholders.

Nurse practitioners motivated by beneficence initiate policy change, conduct research, provide testimony, compose position statements, and act in many ways that illustrate tough decisions. Strictly moral decisions are generated from within while legal decisions are mandated from without, but ethical decisions embrace a wider scope, placing most of their emphasis on the benefit of others. Ethical decisions balance principles of morals and legalities in analysis and usually require moral courage. An important aspect of decision-making is preserving moral courage and preventing moral distress associated with controversial practice situations.