Abstract
Nursing ethics today is often guided by policies, professional codes, and principle-based frameworks. These structures are essential for protecting patients and ensuring professional accountability. However, ethical practice cannot be reduced to following rules alone. Many nurses continue to experience moral distress, emotional strain, and loss of professional meaning, even when they comply with institutional guidelines. This suggests that ethical principles, while necessary, are not sufficient to sustain morally grounded practice in complex healthcare environments. This paper argues that nursing ethics requires a stronger focus on moral agency – the capacity of nurses to act with integrity, reflection, and moral responsibility in challenging clinical situations. Drawing on Islamic ethical frameworks, particularly its emphasis on moral intention, trust (amanah), human dignity, and proportional responses to harm, the discussion offers a complementary perspective for strengthening ethical practice. In this sense, Islamic ethics is not presented as a replacement for existing frameworks; it is presented as a moral tradition that can enrich ethical reflection in diverse and plural healthcare settings. Through a structured normative conceptual analysis informed by contemporary scholarship in nursing ethics and Islamic bioethics, this paper proposes a reframing of nursing ethics that supports the development of reflective, ethically grounded practitioners in contemporary healthcare.
Keywords
Introduction
Nursing ethics has long relied on principle-based frameworks to guide professional conduct and safeguard patient welfare. These frameworks remain essential. However, the persistence of moral distress and ethical fatigue within contemporary healthcare suggests that rule-based approaches alone are insufficient to sustain morally grounded practice. Ethical competence requires more than knowledge of principles; it requires the cultivation of moral agency.
Moral agency is central to this discussion because it concerns the capacity of nurses to engage in reflective deliberation, act with integrity, and remain accountable within complex and often constrained clinical environments. Despite extensive scholarship on moral distress, resilience, and ethical decision-making, the formation of moral agency itself remains underdeveloped within nursing ethics discourse. This gap becomes particularly significant in healthcare systems where institutional pressures, resource limitations, and hierarchical structures may constrain ethical action.
In increasingly plural healthcare contexts, there is also a growing recognition that ethical reflection cannot be confined to a single philosophical tradition. Engaging diverse moral traditions offers an opportunity to expand the conceptual resources available to nursing ethics. Within this context, Islamic ethical frameworks provide a structured moral framework that emphasises intention (niyyah), entrusted responsibility (amanah), human dignity, and proportional deliberation.
This paper aims to contribute to contemporary nursing ethics by developing a structured, normative account of moral agency informed by Islamic ethical frameworks. It does not seek to replace existing ethical frameworks, nor is it limited to supporting Muslim practitioners. This paper proposes that Islamic moral vocabulary may be understood as a plural-applicable ethical architecture that can enrich ethical reflection, professional formation, and nursing practice in diverse healthcare settings. This approach aligns with the growing recognition that nursing ethics must engage plural moral perspectives to remain relevant in diverse healthcare contexts.
Methodological approach
This paper adopts a conceptual and integrative normative analysis instead of an empirical or systematic review design. The aim is not to exhaustively synthesise all available literature, but to critically engage selected bodies of scholarship in nursing ethics, moral distress, virtue ethics, and Islamic ethical frameworks in order to develop a coherent theoretical reframing of moral agency.
Relevant literature was identified through iterative scholarly engagement with key works in nursing ethics, particularly publications addressing moral distress, moral resilience, and virtue-based approaches. Foundational texts in bioethics and moral philosophy were included to situate the argument within broader ethical discourse. Islamic ethical sources were selected based on their relevance to moral agency, intention, accountability, and proportional reasoning in healthcare contexts.
The analytic process involved normative conceptual analysis. Core concepts were examined for internal coherence, philosophical alignment, and applicability to contemporary nursing practice. In contrast to a systematic integrative review with predefined inclusion and exclusion criteria, this paper advances a structured argumentative synthesis aimed at clarifying conceptual relationships and identifying theoretical gaps in current nursing ethics discourse.
The scope of the claims is therefore theoretical rather than empirical. The paper does not seek to generalise findings across settings, but to propose a conceptual framework that may inform further scholarly debate, empirical inquiry, and professional reflection.
This paper argues that cultivating moral agency can help address challenges associated with moral distress, and draws on selected Islamic ethical concepts to develop a structured framework for ethical formation.
Defining moral agency and the limits of procedural ethics
The development of structured ethical frameworks has strengthened nursing as a profession. Codes of ethics and principle-based approaches provide shared language, promote accountability, and protect patients from arbitrary or harmful practice.1,2 In complex healthcare systems – where decisions must be justified to institutions, regulators, and courts – such clarity is indispensable. Ethical principles function as stabilising anchors in situations of uncertainty.
However, a growing body of scholarship has questioned whether principle-based ethics alone adequately captures the lived moral experience of nursing practice.3,4 While principles guide decision-making, they do not automatically generate moral clarity in situations where values conflict or where institutional constraints limit available options. Nurses frequently describe ethical challenges not as failures of knowledge, but as tensions between professional expectations, personal conscience, and organisational realities.5,6
This concern is closely related to the concept of moral distress. Jameton originally described moral distress as arising when practitioners recognise the ethically appropriate action but are constrained from acting upon it due to institutional barriers. 7 Subsequent scholarship has demonstrated that moral distress remains persistent across diverse clinical settings and is often rooted in structural conditions, not individual weakness.5,8 Recent conceptual analyses in Nursing Ethics argue that traditional definitions of moral distress may be too narrow, and that the phenomenon is embedded within institutional power relations and systemic constraints, not merely individual emotional responses. 9 Nurses may identify what they believe to be ethically justified yet feel unable to pursue it because of resource limitations, hierarchical authority, policy restrictions, or fear of professional repercussions. In such cases, compliance with institutional directives does not eliminate moral unease; it may instead intensify a sense of compromised agency. For example, a nurse may recognise that continuing aggressive treatment for a terminally ill patient offers little benefit and may prolong suffering, yet feel unable to advocate for withdrawal due to family demands or institutional policy. In such cases, ethical knowledge is not lacking, but the capacity to act in accordance with moral judgement is constrained, illustrating the erosion of moral agency in practice.
The literature further suggests that moral distress is both systemic and cumulative within healthcare environments.5,7,8 Morley and colleagues argue that moral distress should be understood not merely as an emotional response but as a structural feature of healthcare systems characterised by competing obligations and power asymmetries. 10 Empirical reviews within nursing ethics have shown that unresolved moral distress contributes to burnout, withdrawal, and erosion of professional integrity.8,11 In response, the concept of moral resilience has emerged as an attempt to strengthen practitioners’ capacity to sustain ethical commitment under constraint. 12 However, recent editorial scholarship cautions that reframing moral distress solely in terms of resilience risks shifting attention away from deeper questions concerning moral agency and ethical formation within professional identity. 13 While resilience represents an important shift toward supporting the individual practitioner, it does not fully address the deeper formation of moral agency itself.
The increasing proceduralisation of healthcare ethics – where ethical competence becomes equated with documentation, protocol adherence, and risk mitigation – can inadvertently narrow the space for reflective moral deliberation. When ethics is primarily framed as rule compliance, the moral dimension of nursing risks being reduced to technical execution. Yet, nursing has long been understood not merely as task performance but as a moral practice grounded in relational responsibility and human dignity. 3
These concerns suggest that the central challenge for contemporary nursing ethics is not the absence of principles, but the underdevelopment of a richer account of moral agency. For the purpose of this paper, moral agency is defined as the capacity of nurses to engage in reflective moral deliberation, act intentionally in accordance with ethical commitments, and remain accountable for those actions within relational and institutional contexts.14,15 Moral agency therefore encompasses intentionality, practical judgement, and responsibility. It is not reducible to compliance with external rules, nor is it limited to emotional responses to ethical tension. 16
Moral agency must also be distinguished from related but distinct concepts such as moral courage and moral resilience. Moral courage refers to the willingness to act ethically despite fear, risk, or opposition. 17 Moral resilience describes the capacity to sustain integrity and recover from moral adversity within constrained environments. 12 While both are important dispositions within professional life, they presuppose moral agency and do not define it. Moral agency concerns the foundational capacity to deliberate and act as a moral subject, whereas courage and resilience describe responses to specific forms of ethical pressure.
Moral agency involves more than selecting among competing norms; it includes intentionality in action, cultivation of character, proportional judgement in the presence of harm, and accountability within professional and communal relationships.14,15 Such an account requires engagement with moral traditions that shape identity and provide coherent visions of ethical purpose.
Reframing nursing ethics in this way does not require abandoning established frameworks. It invites a broader conversation about how ethical principles are interpreted and embodied by practitioners situated within diverse moral and cultural traditions. It is within this expanded understanding of moral agency that insights from Islamic ethical frameworks may offer constructive contributions.
Moral traditions, ethical formation, and professional identity
Ethical practice does not arise in a conceptual vacuum. Nurses do not enter clinical settings as morally neutral actors who simply apply abstract principles. They are shaped by educational experiences, professional cultures, social communities, and moral traditions that influence how they understand responsibility, dignity, suffering, and care. To speak meaningfully of moral agency, therefore, is also to speak of moral formation.
Philosophical accounts of moral practice have long recognised that ethical reasoning is embedded within traditions that give coherence to moral concepts and orient practitioners toward shared goods. 15 MacIntyre argues that moral agency develops within historically situated practices shaped by narratives, communal standards of excellence, and shared understandings of purpose. 15 From this perspective, ethical action cannot be reduced to rule application; it involves participation in practices that cultivate character and orient individuals toward certain moral ends. In healthcare, these ends include healing, alleviating suffering, protecting vulnerability, and preserving dignity.
Within nursing scholarship, similar concerns have been raised regarding the limits of purely principle-driven models of ethics. Virtue ethics has been proposed as a corrective to procedural approaches, emphasising character formation, moral courage, and the cultivation of professional integrity.18,19 Armstrong argues that a strong virtue ethics for nursing supports the development of moral character and moves beyond reliance on external regulation alone. 18 Likewise, Sellman highlights the relevance of MacIntyre’s account of practices and virtues for understanding nursing as a morally grounded profession. 19 These perspectives suggest that ethical competence involves not only knowing what to do, but becoming a certain kind of practitioner.
Gallagher’s work on moral courage further illustrates this point. 17 Nurses often face situations where acting in accordance with patient welfare may conflict with institutional pressures or hierarchical authority. Moral courage, in this context, is not merely an emotional trait but a cultivated disposition shaped by professional identity and moral conviction. Such scholarship reinforces the idea that moral agency must be understood as a developmental process embedded within communities of practice.
In increasingly plural societies, nurses draw upon diverse moral and religious backgrounds that inform their ethical outlook. These moral sources are not inherently opposed to professional standards; rather, they may deepen a practitioner’s sense of accountability and purpose. Presenting nursing ethics as culturally neutral risks overlooking the fact that all ethical frameworks are shaped by intellectual histories and moral traditions. 20 Engaging these traditions openly can strengthen ethical discourse while maintaining coherence. This perspective resonates with pluralist accounts of nursing ethics, which argue that professional moral reasoning can legitimately draw upon multiple ethical traditions without compromising coherence or professional standards. 21
Recognising the formative role of moral traditions does not entail importing sectarian doctrine into professional practice. Instead, it acknowledges that ethical identity is shaped by narratives, values, and moral commitments that extend beyond institutional policy. Within this broader landscape of moral reflection, Islamic ethical frameworks represent one such tradition with a structured account of intention, accountability, dignity, and proportional judgement. Examining selected concepts from this tradition allows for exploration of how moral agency can be strengthened within plural healthcare environments without displacing established professional norms.
In addition to broader Islamic bioethics scholarship, there is a growing body of work that has begun to articulate Islamic nursing ethics as a distinct yet related domain.22,23 While Islamic bioethics has traditionally focused on medical decision-making, jurisprudential reasoning, and physician-centred dilemmas, Islamic nursing ethics extends these foundations into the relational, practice-oriented context of caregiving. Scholars such as Lovering have highlighted the integration of spiritual care, compassion, and holistic patient engagement within Islamic nursing practice, 22 while more recent work has explored the conceptual development of Islamic nursing ethics as an applied framework grounded in both professional and religious values. 23 In this sense, Islamic nursing ethics may be understood not as a separate system but as an applied and relational extension of Islamic bioethics that is particularly attentive to care, vulnerability, and ongoing patient interaction. This distinction is important, as it situates the present discussion within both broader bioethical discourse and the specific moral realities of nursing practice.24,25
The following section does not propose Islamic ethics as an alternative framework, but illustrates how one moral tradition concretely operationalises the agent-centred account outlined above.
Key concepts from Islamic ethical frameworks
Islamic ethical frameworks represent a long-standing moral tradition that places strong emphasis on the formation of the moral agent. Islamic ethics is structured around intention, accountability, and responsibility within a moral community, not isolated rules.26,27 This orientation aligns with established philosophical accounts of virtue and character-based ethics while offering a distinctive moral vocabulary relevant to contemporary healthcare discourse. Recent scholarship has also highlighted the importance of adab (ethical comportment) in Islamic medical ethics, further emphasising the integration of character and practice in professional conduct. 28
Several core concepts within Islamic ethical frameworks are particularly pertinent to discussions of moral agency in nursing practice. The following discussion presents selected concepts in a structured sequence, moving from inner moral orientation (intention), to relational responsibility (amanah), to foundational ethical commitment (dignity), and finally to applied moral reasoning (harm prevention).
Moral intention and accountability
A foundational principle in Islamic ethics is the centrality of intention (niyyah). Classical Islamic moral scholarship maintains that the ethical value of an action is closely tied to the intention motivating it. 26 This principle is grounded in the well-known Prophetic tradition: ‘Actions are judged by intentions’ (innama al-a’mal bi al-niyyat), which establishes intention as central to moral accountability in Islamic thought. Intention does not replace outward conduct, but it determines moral quality and accountability. Contemporary Islamic bioethics continues to affirm that ethical evaluation requires attention to both action and motive.27,29 Contemporary scholarship further systematises Islamic medical ethics within modern clinical contexts, clarifying its normative foundations and applicability to professional healthcare practice. 30
This emphasis on intention strengthens an agent-centred understanding of ethics. In clinical practice, two practitioners may comply with the same institutional policy yet differ significantly in their moral orientation – whether acting from sincere concern for patient welfare, defensive practice, or routine compliance. By foregrounding intentionality, Islamic ethical frameworks emphasise the inner dimension of moral agency and encourage reflective deliberation instead of mechanical execution.
Such attention to intention resonates with broader discussions in virtue ethics, where moral character and motivation are central to ethical assessment.15,18 For nursing practice, this reinforces the importance of reflective self-examination as part of professional formation.
Trust (amanah) and entrusted responsibility
The concept of amanah, often translated as trust or entrusted responsibility, further deepens this account of moral agency. In Islamic moral frameworks, individuals are understood as bearers of responsibility entrusted to them by others and ultimately accountable for how that trust is fulfilled. 26 This framing situates moral action within relational networks, not purely individual choice.
The concept of amanah is also grounded in Qur’anic teaching, where trust and responsibility are described as a moral burden entrusted to humankind (Qur’an 33:72), reinforcing the idea that professional roles carry ethical accountability beyond procedural obligation. Within healthcare, this notion closely parallels discussions of fiduciary duty and professional trust. 31 Nurses are entrusted with patients’ vulnerability, confidentiality, and well-being.
Interpreting professional practice through the lens of entrusted responsibility shifts ethical reflection from minimal rule adherence toward conscientious stewardship. It invites practitioners to consider not only whether an action is permitted, but whether it honours the trust placed in them. By conceptualising care as entrusted responsibility, moral agency becomes relational and accountable, reinforcing attentiveness to power imbalances and patient vulnerability. For instance, a nurse caring for a vulnerable patient with limited family support may go beyond minimal procedural requirements to ensure comfort, dignity, and emotional reassurance. Interpreting care as entrusted responsibility (amanah) reframes such actions not as discretionary kindness, but as integral to ethical practice.
Human dignity as foundational commitment
Human dignity occupies a central place in Islamic ethical reasoning.27,29 Human worth is regarded as inherent and not contingent upon social status, cognitive capacity, productivity, or stage of life. This foundational commitment informs Islamic perspectives on vulnerability, disability, and end-of-life care. The concept of human dignity is rooted in the Qur’anic affirmation that ‘We have certainly honoured the children of Adam’ (Qur’an 17:70), which establishes dignity as inherent and universal, not contingent on capacity or status.
Dignity is likewise a core value within global nursing codes and human rights frameworks.1,20 However, grounding dignity within a coherent moral vision strengthens its practical application. In contexts where institutional pressures prioritise efficiency or resource optimisation, a dignity-centred moral orientation safeguards against reductionist approaches that evaluate patients primarily through functional or economic criteria.
For nursing ethics, this reinforces relational practice and equitable treatment while offering deeper moral grounding for commitments already embedded within professional standards.
Proportional deliberation and prevention of harm
Islamic ethical reasoning incorporates structured principles for evaluating harm and benefit. A widely recognised maxim within Islamic jurisprudential ethics affirms that harm should be prevented, and that greater harm may justify tolerating lesser harm when unavoidable.26,27 This proportional approach to moral reasoning – grounded in weighing harms and benefits within specific contexts – encourages contextual deliberation beyond rigid application of rules. The prevention of harm is further supported by the Prophetic principle ‘There should be neither harm nor reciprocating harm’ (la darar wa la dirar), which serves as a foundational maxim in Islamic ethical reasoning.
Such proportional reasoning parallels established discussions in contemporary bioethics concerning risk–benefit analysis and the management of competing moral claims. 2 Comparative analyses have also examined the relationship between Islamic ethical reasoning and the four principles of biomedical ethics, highlighting areas of convergence as well as distinctive emphases. 32 By embedding proportional judgement within a broader moral commitment to dignity and responsibility, Islamic moral frameworks highlight a structured method for navigating ethically complex situations.
For nursing practice, proportional deliberation is particularly relevant in areas such as end-of-life decisions, disclosure of sensitive information, and allocation of limited resources. It supports nuanced judgement while maintaining a clear commitment to minimising harm and preserving human welfare. A practical example can be seen in decisions regarding disclosure of sensitive information. A nurse may need to balance respect for patient autonomy with the potential psychological harm of immediate disclosure, particularly in cases involving serious diagnoses. Proportional deliberation supports careful judgement that seeks to minimise harm while preserving trust and dignity.
Integrating these insights
Taken together, these concepts – moral intention, entrusted responsibility, dignity, and proportional deliberation – illustrate how Islamic ethical frameworks frame moral agency as an integrated process involving character, accountability, and relational awareness. Instead of functioning as a replacement for established professional codes, these insights expand the moral vocabulary available to nursing ethics.
By engaging Islamic ethical frameworks as an intellectual tradition instead of a culturally exclusive framework, nursing ethics scholarship may draw upon their conceptual resources to strengthen ethical formation and reflective practice in plural healthcare environments.
Reframing moral agency: An integrative proposal
The preceding discussion suggests that nursing ethics would benefit from a more explicit account of moral agency – one that situates ethical principles within a broader framework of character, intention, relational responsibility, and proportional judgement. Drawing on insights from Islamic ethical frameworks, this section proposes an integrative reframing of moral agency that complements existing professional frameworks without displacing them. The originality of this proposal lies not in reasserting the importance of moral agency, which is already well developed within virtue and care ethics scholarship, but in demonstrating how Islamic moral vocabulary offers a structured and internally coherent architecture for agent formation – particularly under conditions of institutional constraint.
Moral agency as intentional and reflective practice
First, moral agency requires intentional and reflective engagement, not merely procedural execution. Principle-based ethics identifies what ought to be done, but moral agency requires the practitioner to internalise and critically examine why a particular action is chosen. By foregrounding moral intention, ethical practice becomes a conscious and value-driven act beyond routine compliance. This strengthens integrity and reduces the risk of ethical disengagement. 14
In practical terms, this reframing encourages structured ethical reflection within nursing education and clinical supervision. Reflection is not only about evaluating outcomes but also about examining motivations, assumptions, and relational impact. Such an approach deepens moral awareness and strengthens accountability.
Moral agency as entrusted responsibility
Second, moral agency may be reframed as entrusted responsibility. Viewing professional practice through the lens of amanah shifts ethical evaluation from minimal obligation toward conscientious stewardship. The nurse is not simply a rule-follower but a trustee of patient welfare, dignity, and vulnerability. This understanding of stewardship may also be connected to the Qur’anic concept of humans as vicegerents (khalifa) on earth (Qur’an 2:30), entrusted with responsibility to act ethically and justly within the world.
This perspective aligns with discussions of professional integrity and fiduciary responsibility in healthcare ethics. 31 By framing practice as entrusted responsibility, moral agency becomes relational and accountable, moving beyond individualistic assumptions. It reinforces attentiveness to power dynamics, vulnerability, and the moral weight of clinical decision-making.
Moral agency as dignity-centred care
Third, moral agency is grounded in a sustained commitment to inherent human dignity. While dignity is widely recognised within professional codes, 1 its application often depends on contextual interpretation. Integrating a dignity-centred moral orientation ensures that efficiency, productivity, or institutional pressures do not override respect for personhood.
This orientation strengthens ethical judgement in situations involving marginalised populations, end-of-life decisions, and resource constraints. It situates nursing practice within a consistent moral vision that affirms the worth of every patient.
Moral agency as proportional deliberation
Finally, moral agency involves proportional deliberation in the presence of competing harms. Healthcare decisions frequently require balancing risks and benefits in imperfect conditions. A proportional approach encourages nurses to evaluate actions contextually, aiming to minimise harm while preserving essential goods.
This does not replace existing bioethical reasoning but enriches it by embedding proportional judgement within a moral commitment to dignity and responsibility. Such integration supports nuanced decision-making in morally complex cases where rigid rule application may be insufficient.
Toward a coherent moral architecture
Principles remain essential, but they operate within a larger structure shaped by intention, entrusted responsibility, dignity, and proportional reasoning. Taken together, these dimensions suggest that Islamic ethical frameworks provide not merely additional moral vocabulary, but a structured ethical architecture for the formation of moral agents. By linking intention, entrusted responsibility, dignity, and proportional deliberation within a coherent normative framework, it offers a structured basis for ethical guidance in contexts marked by institutional constraint and moral complexity.
By reframing nursing ethics around moral agency, the profession may move beyond procedural compliance toward a more reflective, relational, and meaning-oriented practice.
Implications for nursing ethics, education, and practice
Reframing nursing ethics around moral agency has implications at multiple levels: individual practice, professional education, institutional culture, and broader ethical discourse.
Implications for clinical practice
At the level of clinical practice, a moral agency framework encourages nurses to move beyond minimal compliance toward reflective engagement with ethical challenges. Practitioners are invited to consider intention, relational responsibility, and the preservation of dignity, not only whether an action aligns with policy. This deepens ethical awareness in everyday decisions, particularly in situations involving vulnerable patients, end-of-life care, and culturally sensitive interactions.
By emphasising entrusted responsibility and proportional deliberation, nurses may develop greater confidence in navigating morally complex situations. Ethical competence becomes not merely knowledge of guidelines, but the cultivated ability to reason carefully, act conscientiously, and remain accountable to both professional standards and moral commitments.
Implications for nursing education
In educational settings, the development of moral agency requires more than instruction in ethical principles. While foundational knowledge of professional codes remains essential, 1 curricula may benefit from greater emphasis on ethical formation, reflective practice, and moral dialogue. Structured reflection on intention, responsibility, dignity, and proportional reasoning can help students connect ethical theory to professional identity. Recent scholarship suggests that early-career nurses are particularly vulnerable to moral distress when ethical formation is insufficiently supported, underscoring the need for agent-centred ethical education. 9
Integrating perspectives from diverse moral traditions, including Islamic ethical frameworks, may also prepare students to practice in plural healthcare environments. Exposure to different ethical frameworks does not impose belief systems but broadens conceptual understanding and strengthens intercultural ethical competence. Such engagement aligns with the growing recognition that nursing education must prepare practitioners for culturally and spiritually diverse patient populations.
Implications for institutional ethics
At the institutional level, recognising moral agency may help address the systemic dimensions of moral distress. When ethical practice is framed solely as compliance, practitioners who experience tension between policy and conscience may feel isolated or silenced. Encouraging open ethical dialogue and acknowledging the moral reasoning capacities of nurses can contribute to healthier ethical climates.
Institutions that support reflective practice, ethics consultation, and interdisciplinary dialogue create space for moral agency to flourish. While policies remain necessary, they function best when embedded within cultures that value moral deliberation, not mere procedural adherence.
Implications for nursing ethics discourse
Finally, this reframing has implications for the development of nursing ethics as a scholarly field. Engaging moral traditions beyond dominant Western frameworks expands the conceptual resources available to ethical inquiry. In this sense, such engagement can enrich ethical discourse without fragmenting it by introducing alternative ways of understanding intention, responsibility, and dignity.
Islamic ethical frameworks, when approached as an intellectual tradition rather than a narrowly bounded or culturally exclusive framework, offer one example of how moral agency may be conceptualised in a coherent and structured manner. Incorporating diverse traditions into nursing ethics scholarship reflects the global nature of the profession and supports dialogue across cultural and philosophical boundaries.
In this sense, the contribution of this paper is not to replace existing ethical frameworks but to invite broader reflection on how moral agency is understood, cultivated, and sustained within contemporary nursing practice.
Conclusion
This paper has argued for a reframing of nursing ethics that places greater emphasis on intention, entrusted responsibility, human dignity, and proportional deliberation. Drawing on insights from Islamic ethical frameworks, it has proposed a complementary moral architecture that strengthens reflective and relational dimensions of practice. This approach does not replace established frameworks; it situates ethical principles within a broader vision of character, accountability, and professional identity. Its contribution lies in articulating how Islamic moral vocabulary can function as a structured, plural-applicable architecture for agent formation within contemporary healthcare systems.
Engaging diverse moral traditions in nursing ethics does not fragment the discipline. Instead, it reflects the global and plural nature of contemporary healthcare. By expanding the conceptual foundations of moral agency, nursing ethics may better support practitioners navigating complex clinical realities while maintaining integrity, dignity, and moral clarity.
Reframing moral agency in this way invites continued dialogue across traditions and disciplines. In doing so, it contributes to a more inclusive and resilient understanding of ethical practice – one that recognises nursing not merely as a technical profession but as a deeply moral practice grounded in responsibility and care.
Footnotes
Author contributions
MFMI conceptualised the study and drafted the manuscript.
FE provided critical revision, conceptual refinement, and intellectual input.
SZS provided critical revision and conceptual refinement.
MBMR provided critical revision and conceptual refinement.
All authors approved the final manuscript and agree to be accountable for the work.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.