Navigating Conflicts of Duty in Contexts of Compassionate Care: Utilitarian Reasoning as a Practice-Oriented Framework.

Compassionate nursing practice frequently requires nurses to navigate competing obligations, conflicting patient needs and constrained resources. While compassion motivates responsiveness to suffering, it does not always provide sufficient guidance for determining how such conflicts should be resolved. We argue that contemporary forms of utilitarianism may offer a useful framework for structuring compassionate practice in nursing within ethically pluralistic clinical environments. Drawing on contemporary utilitarian thought, particularly preference utilitarianism, the paper examines how attentiveness to suffering, preservation of dignity and responsiveness to patient vulnerability may be reframed around ethical deliberation under competing demands. Through clinical examples, we explore how compassionate nursing practice often involves the weighing of competing preferences, the prioritisation of morally significant needs and the allocation of finite professional attention. We argue that preference utilitarianism can fruitfully provide a structured ethical resource for evaluating actions according to their capacity to reduce and prevent suffering while respecting individual preferences and circumstances. The paper does not propose a foundational moral theory for nursing. Rather, it argues that preference utilitarianism can function as a complementary ethical resource alongside care ethics, virtue-based approaches and other relational perspectives, particularly in situations where nurses must navigate conflicting ethical duties. It therefore demonstrates how compassionate actions can be morally justified and systematically assessed, supporting a move from isolated acts of care towards more sustained and context-sensitive ethical practices within healthcare systems.