Bedside decisions become ethically difficult when clinically defensible options implicate competing patient values, professional obligations, relationships, prognostic uncertainties, or institutional constraints. Clinical ethics offers multiple reasoning traditions and decision frameworks, yet these approaches differ in what they treat as morally salient and how they organize disagreement. Their relationship to the reasoning work clinicians perform in practice remains incompletely integrated. An integrative review combined normative, conceptual, qualitative, quantitative, clinical-ethics, educational, and methodological scholarship relevant to bedside value conflict. Targeted multidisciplinary searching used PubMed/MEDLINE-indexed discovery, publisher and journal-site searching, DOI-indexed retrieval, and citation chaining. Fifty-two candidate-record manifestations were registered; four duplicates or version manifestations were removed, 48 unique records were screened, 41 reports underwent full-text assessment, and 34 sources were included. Evidence was appraised according to source type rather than through a single common quality score. The literature does not support reducing bedside ethical reasoning to one framework or decision rule. Instead, different traditions foreground principles and obligations, cases, narratives, relationships, care and practical judgment, or structured deliberative procedure. Across these traditions, the review identifies recurring but non-sequential reasoning work involving recognition, interpretation, contextualization, comparison, prioritization, negotiation, justification, action, documentation, and reconsideration. Bedside value conflict is best understood as a multidimensional deliberative problem rather than a purely informational deficit. The review develops a proposed integrative reconstruction of how heterogeneous ethical considerations become clinically actionable while preserving uncertainty, reasonable disagreement, contextual variation, and the distinction between defensible reasoning and validated clinical effectiveness.
