Ethics legal aspect to nursing

 Ethics issue in nursing

 Normal values and ethics
 Ethical principles
 Ethical philosophy
 Analysis of Ethical Dilemma
 Legal issue in nursing
 Sources of law
 Standardized of care
 Patient bill of right
 Informed consent
 Torts and crimes
Ethics in nursing
• Ethics:- is the branch of philosophy concerned with determining right
from wrong on the basis of knowledge rather than on opinions.
• Ethics deals with one’s responsibilities (duties and
obligations) as defined by logical argument.
• It is not a religious dogma.
• Ethics looks at human behavior—what people do in
what circumstances. But ethics is not merely philosophical in
nature; ethical persons put their beliefs into action
•
Bioethics is the application of general ethical principles to
health care.
Ethics in…
Ethical practice has more importance in health care today for
several reasons.
Some of these reasons are:-
An increase in technology:-Advanced technology creates
situations involving complicated issue.
 Changing of our society:-Family structure is moving to
more single-parent families and non related groups living together as families.
 Ethical principles in nursing
• Ethical principles are widely accepted codes generally
based on the humane aspects of society that direct or govern
actions.
The nurse can become more systematic in solving ethical conflicts by using ethical principles
The major ethical principles :-
1.AUTONOMY:-the individual’s right to choose and ability to act on that choice. Each
person’s individuality is respected . Nurses must respect the client’s right to decide and must
protect those clients who are unable to decide for themselves .
Respecting autonomy means the nurse accepts client choices, even choices not in the client’s
best interests or choices that conflict with the nurse’s values .
Examples

Smoking after a diagnosis of emphysema(impaired gas exchange ) or lung cancer

Refusing to take medication

Refusing to receive a blood transfusion because of religious beliefs

Ethics principles cont…ed
• 2.Nonmaleficence:-is the obligation to cause no harm to others.
Harm can be physiological, psychological, financial, social, and/or
spiritual .
• Nonmaleficence is considered a fundamental duty of health care providers.
• Some clinical examples of nonmaleficence are:
Preventing medication errors (including drug interactions)
Being aware of potential risks of treatment modalities
Removing hazards (e.g., obstructions or water on the floor that might
cause a fall)
Ethics principles cont…ed
• 3.Beneficence:-is the duty to promote good and to prevent harm.
• Is often viewed as the core of nursing practice
• The nurse nurtures the client and incorporates the desires of the
client into the plan of care.
• 4.Justice:-The principle of justice is based on the concept of
fairness extended to each individual.
• The major health-related issues of justice involve the way people
are treated and the way resources are distributed.
• all people must be treated equally
Ethical principles cont…
• 5.Veracity:-means truthfulness (neither lying nor deceiving others).
• There are many forms of deception: intentional lying, partial disclosure of
information, or nondisclosure of information.
• 6.Fidelity:-which is the ethical foundation of nurse–client relationships ,
means faithfulness and keeping promises.
• Fidelity is demonstrated when nurses:
Share the client’s wishes with other members of the health care team
Keep their own personal values from influencing their advocacy for clients
Support the client’s decision, even if it conflicts with their own preferences
 Values
• Value
• A value is a personal belief about the worth of a given idea,
attitude, custom, or object that sets standards that influence
behavior.
• Values clarification
• Ethical dilemmas almost always occur in the presence of conflicting
values.
• To resolve ethical dilemmas, one needs to distinguish among
values, facts, and opinion.
ETHICS AND VALUES
• are closely related, both enlightening and complicating the nurse’s
balancing the ethical principles of the client with those of the health
care profession.
• Values influence the development of beliefs and attitudes rather
than behaviors, although they often indirectly influence behaviors.
• A value system is an individual’s collection of inner beliefs that guides
the way the person acts and helps determine the choices the person
makes in life.
• Values are similar to the act of breathing; one does not think about
them until a problem arises.
ETHICS AND VALUES cont….
• Values Clarification:-is the process of analyzing one’s own values to
better understand those things that are truly important.
• increase nurses’ self-awareness and help them better care for
clients whose values differ from their own
• . values are individual and not universal, the nurse should not
impose personal values on clients.
 ETHICAL DILEMMAS
• When two or more ideals or values are in conflict, there is an Ethical
Dilemmas.
• In an ethical dilemma, a choice is to be made between the conflicting
ideals or values.
• Areas where ethical dilemmas frequently occur are euthanasia, refusal of
treatment, and scarcity of resources.
• 1.Euthanasia:- comes from the Greek word euthanatos, which literally
means “good, or gentle, death.
• refers to intentional action or lack of action that causes the merciful death
of someone suffering from a terminal illness or incurable condition.
Euthanasia cont..ed
• Active euthanasia:-refers to taking specific action to hasten a client’s
death.
e.g. removing a client who is in a vegetative state from a respirator.
Assisted suicide:-a form of active euthanasia where another person
provides a client with the means to end his/her own life. Does assisted
suicide violate the principle of autonomy?” it might be argued that
refusing to assist a suicide violates a client’s autonomy
• Passive euthanasia:-is working with the client’s dying process.
e.g. not putting in a feeding tube to provide nourishment when the client
cannot or will no longer eat.
ETHICAL DILEMMAS Cont..ed
• 2.Refusal of Treatment:- The principle of autonomy is the basis of a
client’s right to refuse treatment.
• The values of most health care providers are challenged when a
client refuses treatment.
• Honoring the refusal of treatments that a patient does not desire,
that are disproportionately burdensome to the patient, or that will
not benefit the patient is ethically and legally permissible. (Curtin,
1995)
ETHICAL DILEMMAS Cont..ed
3.Scarcity of Resources
• The use of expensive services:-the length of a hospital stay, the
number of office visits allowed for individual clients.
• The availability of goods:-such as organs.
• Medication scarcity
ETHICAL DECISION MAKING
• Ethical questions (dilemmas) are not easy to answer.
• Ethical reasoning is the process of examining the issue in a methodical manner.
Ethical decisions should not be made based on emotions. Ethical decision making
is used in situations where conflicts of rights and duties exist.
• Kinsella (2001) identifies eight steps to guide ethical decision making:
1. Recognize the ethical dimension of the issue.
2. Identify the parties involved, their relationships to each other, and their rights and
responsibilities.
3. Examine the values involved, what ideals or principlesare at issue.
4. Compare benefits and burdens (positives and negatives)for each option
ETHICAL DECISION MAKING cont..
• 5. Evaluate similar cases or ask colleagues about situations of ethical
decision making.
• 6. Discuss, if possible, the issue with the relevant others.
• 7. Check legal and organizational policies so the decision meets legal,
professional, and organizational standards.
• 8. Assess your comfort level with the decision, if uncomfortable
reconsider
Ethics and Philosophy
• Deontology-Defines actions as right or wrong
• Utilitarianism-Proposes that the value of something is determined by
its usefulness
• Feminist Ethics- Focuses on the inequality between people
• Ethics of Care -Emphasizes the importance of understanding
relationships, especially as they are revealed in personal narratives
• Casuistry -Case-based reasoning
BASIC LEGAL CONCEPTS IN
NURSING PRACTICE
• Definition of Law:-The word law is derived from an Anglo-Saxon term
meaning “that which is laid down or fixed.”
 two types of law
1. public law:- which deals with the individual’s relationship to the
state, and
2.civil law, which deals with relationships among individuals.
Sources of Law
• at the federal and state levels public law has four sources.
1. Constitutional law:-set forth in the U.S. and state constitutions,
defines and limits the powers of government
2. Statutory law:- is enacted by legislative bodies. State boards and
professional practice acts, such as nursing practice acts, are created and
governed under statutory laws.
3. Administrative law (regulatory law):- is developed by those persons
appointed to governmental administrative agencies.
4. Criminal law, the most common example of public law, addresses
acts or offenses against the safety or welfare of the public.
Sources of Law cont…ed
• Under criminal law, there are two types of crime:
1.felony (a crime of a serious nature that is usually punishable by
imprisonment at a state penitentiary or by death or a crime violating a
federal statute that involves punishment of more than 1 year
incarceration) and
2. misdemeanor (offense less serious than a felony that may be
punishable by a fine or a sentence to a local prison for less than 1 year).
Sources of Law cont…ed
• At the federal and state levels, civil law has three sources
1 .contracts law:- is the enforcement of agreements among private individuals. The three essential
elements in a legal contract are:
• Promise(s) between two or more legally competent individuals that state what each individual
must do or not do
• Mutual understanding of the terms and obligations the contract imposes on each individual
• Compensation for lawful actions performed
2.torts law:- is the enforcement of duties and rights among individuals independent of contractual
agreements.
• A tort is a civil wrong committed by a person against another person or property
3.protective/reporting laws:- considered criminal law, depending on classification by the state. Two
examples of protective law are the Americans with Disabilities Act (ADA) and the Good Samaritan
laws.
 TORT:-
• Intentional Torts:- types • Unintentional Torts:-Types
1.Assault :-Threaten or attempt to touch another person/a 1.Negligence :-Failure to use such care as a reasonably
violent physical or verbal attack . prudent person would use under similar circumstances,
which leads to harm.
2. battery:-Unconsented touching
e.g.
3.defamation:-Verbal (slander) or written (libel) remarks
Client’s property is lost.
that may cause the loss of an individual’s reputation
A medication error occurs.
4.fraud:- is a wrong that results from a deliberate
deception intended to produce unlawful gain A client is burned from the improper use of equipment
5.false imprisonment:-Unwarranted restriction of the 2.malpractice:-Failure of a professional to use such care
as a reasonably prudent member of the profession would
freedom of an individual. A common example of this tort use under similar circumstances, which leads to harm.
is telling a client not to leave the hospital until the bill is
paid e.g.
An inaccurate nursing diagnosis
6.invasion of privacy:-All individuals have the right to
privacy and may bring charges against any person who Physician’s orders are not followed
violates this right
INFORMED CONSENT
• refers to a competent client’s ability to make health care decisions based on full
disclosure of the benefits, risks, potential consequences of a recommended
treatment plan, and alternate treatments, including no treatment, and the client’s
agreement to the treatment as indicated by the client’s signing a consent form.
• This detailed explanation, provided by the physician, lets the client make intelligent
decisions about treatment options.
• The physician is responsible for obtaining consent for medical or surgical treatment
• Nurses must obtain consent for nursing procedures.
• The nurse is obligated to explain what is to be done to the client and to receive at
least implied consent, as indicated by lack of objection .on the part of the client
INFORMED CONSENT cont…ed
• When a nurse has a client sign the informed consent form, the nurse is
verifying the following three things:
1. The client’s signature is authentic.
2. The client has the mental capacity to understand what was discussed
with the physician.
3. The client was not coerced into signing the form.
• The client should not sign the form if the client still has questions or if the
nurse is unsure about the client’s understanding.
• The nurse should document the client’s lack of understanding and contact
the physician.
INFORMED CONSENT cont…ed
• A typical consent form is used to obtain client permission for the
performance of invasive medical, surgical, or diagnostic procedures,
such as surgery, cardiac catheterization, or HIV testing.
• Consent for procedures that are not invasive can be either given
verbally or implied.
• Consent is implied when the client cooperates with the procedure
offered.