Research Article| Volume 70, ISSUE 6, P807-819, November 2022

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The principle of double effect and external whistleblowing in nursing

  • Alan J. Kearns
    Corresponding author: Alan J. Kearns, Ethics, School of Theology, Philosophy, and Music, Dublin City University, Dublin, Ireland.
    School of Theology, Philosophy, and Music, Dublin City University, Dublin, Ireland
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Published:November 15, 2022DOI:


      • Examines external whistleblowing from the perspective of its permissibility vis-à-vis the negative effect it may have on a health care organization or service.
      • Proposes the Principle of Double Effect as an ethical criterion to assess the permissibility of external whistleblowing in the context of a negative effect.
      • Argues that external whistleblowing by a nurse when understood as an advocacy act with two effects (i.e., the effect of defending a patient and the further negative effect on the health care organization or service) can be ethically permissible through meeting the conditions of the Principle of Double Effect.


      Nurses are generally expected to raise concerns when a harm or wrongdoing is committed against patients. Should their concerns not be adequately addressed, then nurses may take the decision to engage in external whistleblowing. Given that it could have a negative effect on the health care organization or service, nurses may question whether they should engage in external whistleblowing. Consequently, is there an ethical criterion to discern whether the negative effect on the health care organization or service is ethically permissible? This paper argues for the suitability of the Principle of Double Effect as an ethical criterion. The position of this paper is that external whistleblowing by a nurse when understood as an advocacy act with two effects (i.e. the effect of defending a patient and the further negative effect on the health care organization or service) can be ethically permissible through meeting the conditions of the Principle of Double Effect.


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