Ethical responsibility displacement: When treatment communication becomes separated from treatment authority

BackgroundInterprofessional collaboration is a component of healthcare. However, responsibilities distributed across professional boundaries may create ethical challenges concerning decision-making authority, communication responsibility and professional accountability. Treatment decisions may be made by one professional while another communicates information and facilitates patient participation.AimThis theoretical article introduces Ethical Responsibility Displacement (ERD), a phenomenon in which ethical responsibility within patient-facing treatment dialogue becomes separated from the professional authority responsible for the underlying treatment decision.MethodsThe article uses a conceptual approach informed by Walker and Avant's strategies for theory construction in nursing, concept synthesis and concept analysis. Literature concerning interprofessional collaboration, nursing scope of practice, patient advocacy, informed decision-making, professional accountability and communication was examined to delineate ERD and distinguish it from concepts. Particular attention was given to the relationship between ethical responsibility, professional agency, information and authority.DiscussionERD may occur when a healthcare professional is expected to facilitate an informed treatment decision without access to the reasoning, risk-benefit assessment and decision-making authority underlying the recommendation. ERD does not imply transfer of authority or that nurses should exceed their scope of practice. It identifies an ethical asymmetry when communication responsibility is separated from decision-making authority. The concept distinguishes this phenomenon from moral distress, which may result when responsibility-authority mismatches constrain professional moral agency. ERD does not challenge nurses' roles in patient education, advocacy, shared decision-making or treatment follow-up; instead, it highlights the implications when nurses assume responsibility for explaining or contextualising decisions initiated by another professional.ConclusionInterprofessional collaboration requires shared responsibility without obscured accountability. Clarifying the relationship between decision-making authority, communication responsibility and ethical responsibility may strengthen informed decision-making, professional accountability and collaboration. Research is needed to refine ERD and examine its implications for professional agency, moral distress and patient decision-making.