Abstract
Nurse case managers often face ethical dilemmas as they advocate for their critically ill and critically injured patients. They experience the tension that exists between advocating for the critically ill, the patient's right to self-determination, and the payer source constraints. When there are no good alternatives for the patient or the list of options include none that are desirable, the nurse case manager may experience an ethical dilemma. Working with the critically ill and injured inherently presents a spectrum of biopsychosocial complexities, which present potential ethical dilemmas for the nurse case manager. The three case studies presented posed particular challenges to the nurse case managers and deal with the ethical principles of beneficence, autonomy, veracity, and justice.