ETHICO-MORAL ASPECTS IN NURSING

Ethics
- Ethos - comes from Greek work w/c means character/culture
- Branch of Philosophy w/c determines or study morality (right and wrong)
- Systematic inquiry into principles of right, from good & evil as they relate to conduct
Moral - personal/private interpretation from what is good and bad.

TYPES OF ETHICS
Those of particular concern to the nurse are:
1. BIOETHICS - branch of ethics that studies moral values in the biomedical sciences
2. CLINICAL ETHICS – concerned with ethical problems “at the bedside” that arise within the context of caring for actual
patients
Ex.: Informed consent & how one ought to respond to requests for assisted suicide
3. NURSING ETHICS – study of ethical issues that arise in the daily practice of nursing & of the analysis used by nurses to
make ethical judgement
Ex.:cost-containment, breaches of patient’s confidentiality, illegal practices of colleagues

Ethical Principles:
1. Autonomy – the right/freedom to decide (the patient has the right to refuse despite the explanation of the nurse) Example:
surgery, or any procedure
2. Nonmaleficence – the duty not to harm/cause harm or inflict harm to others (harm maybe physical, financial or social)

3. Beneficence - for the goodness and welfare of the clients

4. Justice – equality/fairness in terms of resources/personnel

5. Veracity - the act of truthfulness

6. Fidelity – faithfulness/loyalty to clients

Moral Principles:
1. Golden Rule
2. The principle of Totality – The whole is greater than its parts
3. Epikia – There is always an exemption to the rule
4. One who acts through as agent is herself responsible – (instrument to the crime)
5. No one is obliged to betray herself – You cannot betray yourself
6. The end does not justify the means
7. Defects of nature maybe corrected
8. If one is willing to cooperate in the act, no justice is done to him
9. A little more or a little less does not change the substance of an act.
10. No one is held to impossible

Law - rule of conduct commanding what is right and what is wrong. Derived from an Anglo-Saxon term that means “that which
is laid down or fixed”
Court -body/agency in government wherein the administration of justice is delegated.
Plaintiff – complainant or person who files the case (accuser)
Defendant – accused/respondent or person who is the subject of complaint
Witness – individual held upon to testify in reference to a case either for the accused or against the accused.

Written orders of court

Writ – legal notes from the court

Subpoena
1. Subpoena Testificandum – a writ/notice to an individual/ordering him to appear in court at a specific time and
date as witness.
2. Subpoena Duces Tecum- notice given to a witness to appear in court to testify including all important
documents

Summon – notice to a defendant/accused ordering him to appear in court to answer the complaint against him

Warrant of Arrest - court order to arrest or detain a person

Search warrant - court order to search for properties.

Private/Civil Law - body of law that deals with relationships among private individuals
Public law - body of law that deals with relationship between individuals and the State/government and government agencies. Laws
for the welfare of the general public.

Private/Civil Law can be :

Contract law – involves the enforcement of agreements among private individuals or the payment of compensation for
failure to fulfill the agreements

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 Ex. Nurse and client nurse and insurance
Nurse and employer client and health agency
- An agreement between 2 or more competent person to do or not to do some
lawful act.
- It maybe written or oral = both equally binding
(2) Types of Contract:
1. Expressed – when 2 parties discuss and agree orally or in writing the terms and conditions during the creation of the
contract.

Example: Nurse will work at a hospital for only a stated length of time (6 months), under
stated conditions (as volunteer, straight AM shift, with food/transportation allowance)

2. Implied – one that has not been explicitly agreed to by the parties, but that the law considers to exist.

Example: Nurse newly employed in a hospital is expected to be competent and to follow

hospital policies and procedures even though these expectations were not written or
discussed.

Likewise: the hospital is expected to provide the necessary supplies, equipment needed to
provide competent, quality nursing care.

Feature/Characteristics/Elements of a lawful contract:

1. Promise or agreement between 2 or more persons for the performance of an action or restraint from certain actions.
2. Mutual understanding of the terms and meaning of the contract by all.
3. A lawful purpose – activity must be legal
4. Compensation in the form of something of value-monetary

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Persons who may not enter into a contract: minor, insane, deaf, mute and ignorant
TORT LAW – is a civil wrong committed against a person or a person’s property.
- Person/person’s responsible for the tort are sued for DAMAGES
- Is based on:
ACT OF COMMISSION –something that was done incorrectly or
ACT OF OMMISION – something that should have been done but was not.

Classification of Tort
1. Unintentional
a. Negligence – misconduct or practice that is below the standard expected of ordinary, reasonable and prudent person
- Failure to do something due to lack of foresight or prudence
- Failure of an individual to provide care that a reasonable person would ordinarily use in a similar circumstance.
- An act of omission or commission wherein a nurse fails to act in accordance with the standard of care.

Doctrines of Negligence:
1. Res ipsa loquitor – the thing speaks for itself – the injury is enough proof of negligence
2. Respondeat Superior – let the master answer command responsibility
3. Force majuere – unforeseen event, irresistible force

b. Malpractice – stepping beyond one’s authority

(6) elements of nursing malpractice:

1. Duty – the nurse must have a relationship with the client that involves providing care and following an acceotable standard
of care.

2. Breach of duty – the standard of care expected in a situation was not observed by the nurse
-is the failure to act as a reasonable, prudent nurse under the circumstances
-something was done that should not have been done or nothing was done when it should have been done

3. Foreseeability – a link must exist between the nurse’s act and the injury suffered

4. Causation – it must be proved that the harm occurred as a direct result of the nurse’s failure to follow the standard of care
and the nurse should or could have known that the failure to follow the standard of care could result in such harm.

5. Harm/injury – physical, financial, emotional as a result of the breach of duty to the client
Example: physical injury, medical cost/expenses, loss of wages, pain and suffering

6. Damages – amount of money in payment of damage/harm/injury

2. Intentional Tort

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 Unintentional tort – do not require intent bur do require the element of HARM
Intentional tort – the act was done on PURPOSE or with INTENT
- No harm/injury/damage is needed to be liable
- No expert witnesses are needed
1. Assault – an attempt or threat to touch another person unjustifiably
Example: (1) A person who threatens someone with a club or closed fist.
(2) Nurse threatens a client with an injection after refusing to take the meds orally.

2. Battery – wilful touching of a person, person’s clothes or something the person is carrying that may or may not cause harm but
the touching was done without permission, without consent, is embarrassing or causes injury.
Example: (1) a nurse threatens the patient with injection if the patient refuses his medsorally. If
the nurse gave the injection without client’s consent, the nurse would be committing battery
even if the client benefits from the nurse’s action.

3. False Imprisonment – unjustifiable detention of a person without legal warrant to confine the person
– Occurs when clients are made to wrongful believe that they cannot leave the place
Example: (1) Telling a client no to leave the hospital until bill is paid
(2) Use of physical or chemical restraints
(3) False Imprisonment Forceful Restraint=Battery

4. Invasion Of Privacy – intrusion into the client’s private domain

 Right to be left alone

Types of Invasion the client must be protected from:

a. use of client’s name for profit without consent – using one’s name, photograph for advertisements of HC
agency or
provider without client’s permission
b. Unreasonable intrusion – observation or taking of photograph of the client for whatever purpose without client’s
consent.
c. Public disclosure of private facts – private information is given to others who have no legitimate need for that.
d. Putting a person in a false/bad light – publishing information that is normally considered offensive but which is
not true.

5. Defamation – communication that is false or made with a careless disregard for the truth and results in injury to the
reputation of a person

(2) Types:
Libel >defamation by means of print, writing or picture
Example:
1. writing in the chart/nurse’s notes that doctor A is incompetent because he didn’t respond
immediately to a call
Slander >defamation by the spoken word stating unprivileged (not legally protected) or
false word by which a reputation is damaged
Example:
1. Nurse a telling a client that nurse B is incompetent
2. Person defamed may bring the lawsuit
3.The material (nurse’s notes) must be communicated to a 3rd party in order that the person’s
reputation maybe harmed

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Public Law:

Criminal Law – deals with actions or offences against the safety and welfare of the public.

HOMICIDE > Killing of any person without criminal intent may be done as self-defense
ARSON > Burning of property
THEFT > Stealing
SEXUAL HARASSMENT
ACTIVE EUTHANASIA
ILLEGAL POSSESSION OF
CONTROLLED DRUGS

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EGB’June09 4
ETHICO-MORAL ASPECTS OF (5) VALUES ESSENTIAL FOR PROFESSIONAL NURSES
NURSING PRACTICE 1. Altruism >The concern for the welfare &
well-being of others
Nurses need to:
2. Autonomy >The right for self- determination
 Develop sensitivity to the ethical
of professional practice
dimensions of nursing practice
Ex.: When the nurse respects
 Examine their own & client’s value patient’s right to make decisions
 Understand how values influence their about their health care
decisions 3. Human - Respect for the inherent worth &
 Think a head about the moral problems dignity uniqueness of individual &
they are likely to face. Ex.: birth, death, populations
marriage Ex.: when the nurse values &
respects all patient’s & colleagues
*Values are important because they influence 4. Integrity - Acting in accordance with an
decisions & actions, including nurses’ ethical appropriate code of ethics &
decisions even though they may be unspoken standards of practice
questions of values underlie all moral dilemmas Ex.: when the nurse is honest &
provides care based on ethical
VALUES framework that is accepted within
- enduring beliefs or attitudes about the profession
worth of a person, objects, idea or action 5. Social - Upholding moral, legal &
- concepts/ ideas that give meaning to Justice humanistic principles.
one’s life & provide a framework for one’s Ex.: when the nurse works to
decision ensure equal treatment under the
laws & equal access to quality
BELIEFS (OPINIONS) care.
- Interpretations or conclusions that people
hold as true PROFESSIONAL BEHAVIORS ASSOCIATED
- Based more on faith that fact & may/ may WITH 5 VALUES
not be true 1. Demonstrate understanding of cultures,
- Beliefs do not necessarily involves values belief & perspectives of others
Ex.: If I study hard, I will get good grade 2. Demonstrates accountability for own
actins
ATTITUDES 3. Documents accurately & honestly
- Mental positions/ feelings toward a person, 4. Designs care with sensitivity to individual
object or idea patient needs
- Often judged as bad or good, positive or 5. Advocates for patients particularly the
negative, beliefs are judged as correct or most vulnerable
incorrect. 6. Take risks on behalf of patients &
colleagues
VALUES 7. Plans in partnership with patients
- Are learned through observation & 8. Honors the rights of patient & families to
experience & are heavily influenced by a make decisions about healthcare
person’s sociocultural environment that is 9. Provide information so patients can make
by: informed choices
o Societal traditions, cultural, ethical, 10. Provide culturally competent & sensitive
religious groups, family or peer care
groups 11. Protects the patients privacy &
confidentiality
PROFESSIONAL VALUES 12. Provides honest information
- Are acquired during socialization from 13. Promotes universal access
nursing experience, from teachers, peers 14. Seek to remedy errors made
& code of ethics 15. Support fairness
16. Encourage legislation
*Nurses & nursing students need to examine
the values they hold about life, death &
illness. One strategy for gaining awareness of ETHICS came from the Greek word ETHOS meaning
personal values is to consider one’s attitude custom/character or moral duty
about specific issues as abortion/ euthanasia  Method of inquiry that assist people to
understand the morality of human
VALUES CLARIFICATION behaviour
- Process by which people identify, examine  Refers to the expected standards of moral
& develop their own individual values behavior
 How people make judgement in regard to right or
wrong

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  Critical reflection about morality and rational Is nursing a profession?
analysis about it YES. It is a calling, vocation, occupation based on
 JOHNSTON- examination of all ethical and bio- scientific body of knowledge which needs training both
ethical issues from the prospective of nursing theory in theory and practice guided by a Code of Nursing
and nursing ethics Ethics, governed by the Nursing Act of 2002, to SERVE
 VERCOE- the fields of nursing ethics be focused on mankind for a FEE or FREE.
the needs and experiences of practicing nurses, the
exploration of its meaning and that of ethical practice PROFESSION
in terms of the perception of these nurses  An occupation or calling requiring advance
training
BIOETHICS  Experience in some specific or specialized
body of knowledge
 Also known as “applied or practical ethics”  Provides service to society in that special
 Specific domain of ethics that focuses on moral field
issues in the field of health care  The term profession is honoric and should
 Result of life and death dilemmas faced by health be carried with pride and honor
care practitioners
 Systematic study of human behaviour in the field of PROFESSIONAL NURSE
life science and health care in the light of moral  Completed a basic nursing education
values and principles program
 Licensed in his/her country or state to
NURSING ETHICS practice professional nursing
- Refers to the ethical issues that occur in nursing
practice NURSING PRACTICE
- Refers to the conduct or behaviour which by reason  Primary responsibility promotion of health and
of public approval or practice has become customary prevention of illness
among professional  Collaborate with other health care providers
o Curative
MORALS/ MORALITY o Preventive
 Greek work MORALIS o Rehabilitative aspects of care
 Refers to private, personal standard of o Restoration of health
what is right & wrong in conduct, o Alleviation of suffering
o Towards a peaceful death
character or attitude
 Nurses should distinguish MORALITY &  Provide nursing care through the utilization of the
LAWS. nursing process
 LAWS – reflect the moral values of o Therapeutic use of self
o Executing health care techniques and
society, they offer guidance in determining
what is normal procedures
o Essential primary health care
 An action can be moral but not legal, on
o Comfort measures
the other hand, an action can be moral
o Health teachings
but illegal
o Administration of written prescription for
 Morality is what you believe is right and good
treatment
Health Care Ethics o Therapies
 Division of ethics that relates to human health o Oral
 Realm of human values, morals, customs, personal o Topical
o Parenteral medications
beliefs and faith
o Internal examination during labour in the
absence of antenatal bleeding and delivery
MORAL DEVELOPMENT
o Suturing of perineal laceration
- The process of learning to tell between
 Establish linkages with community resources
right & wrong & of learning what ought not  Coordination with the health team
to be done  Provide health education to individuals, families and
- Complex process that begins in childhood communities
& continues throughout life  Teach, guide and supervise students in nursing
- 2 well known theorist: education programs
o Lawrence Kohlberg  The nurse is required to maintain competence by
 Rights & formal reasoning continual learning through continuing professional
o Carol Gilligan education
 Emphasizes care &
QUALIFICATIONS AND ABILITIES OF A
responsibility
PROFESSIONAL NURSE

 Professional Preparation
NURSING o Have a license to practice
 An occupation requiring a unique body of o Bachelor of science degree in nursing
knowledge and skills and which serves o Be physically and mentally fit
society  Personal Qualities and Professional Proficiencies
o Interest and willingness to work and learn

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 o Warm personality and concern for people  Basic rightness or wrongness of an act depends on
o Resourcefulness and creativity, well the intrinsic nature rather than upon the situation or
balanced emotional condition its consequences
o Capacity and ability to work cooperatively  Greek word DEON meaning DUTY
with others  Immanuel Kant- rational human being with freedom
o Skill in decision making and social worth
 A person is morally good and admirable if his actions
DEFINITION OF LICENSE are done from a sense of duty and reason
 A legal document given by the government that
permits a person to offer to the public his or her skills 3. RELATIONSHIP BASED OR CARING
and knowledge in a particular jurisdiction THEORIES
- Stress courage, generosity, commitment &
CONTRACT need to nurture & maintain relationship
 Meeting of minds between two persons whereby one
binds himself, with respect to other, to give Other Moral Theories:
something or to render some service FLETCHER’S GUIDELINES FOR MAKING ETHICAL
 A promise or a set of promise which the law DECISIONS
recognizes as a duty and when that duty is not
performed the law provides a remedy 1. Consideration for people as human beings
2. Consideration of consequences
3. Proportionate good to come from the choices
4. Propriety of actual needs over ideal or potential
MORAL THEORIES needs
- Provide framework 5. A desire to enlarge choices and reduce chance
6. A courageous acceptance of the consequence of the
(3) TYPES OF MORAL THEORIES decision
1. CONSEQUENCE-BASED (Theological
theories) W.D ROSS- PRIMA FACIE DUTIES- WHAT ONE
- Looks to the consequences of an action in SHOULD DO WHEN OTHER RELEVANT FACTORS IN
judging whether the action is right of A SITUATION ARE NOT CONSIDERED
wrong
 Duties of fidelity- telling the truth, keeping promises
- Focus on issues of fairness
 Duties of reparation- righting the wrong we have
- UTILITARIANISM
done to others
o Views the good act as one that  Duties of gratitude- recognizing the service others
bring the most good for the greater have done for us
number or the least harm for the  Duties of justice- preventing distribution of pleasure
greatest number or happiness that is not in keeping with the merit of
- PRINCIPLE OF UTILITY people involved
o From the utilitarian perspective, th  Duties of beneficence-helping to better the condition
point of morality is to promote of other beings
what is intrinsically good by  Duties of self improvement- bearing ourselves with
maximizing benefits & minimizing respect to virtue or intelligence
 Duties of nonmaleficence- avoiding or preventing
harm
injury to others
TELEOLOGICAL APPROACH VIRTUE ETHICS APPROACH
 Greek word TELOS or goal or end  ARETIC, Greek word ARETE, heart of the person
 The right thing to do is the good thing to do
performing the act
 Act utilitarianism- good resides in the promotion of
 Traits and virtues of a good person, courage,
happiness or the greatest net increase of pleasure over
temperance, wisdom, and justice
pain
 If the act helps people, then it is a good act DIVINE COMMAND ETHICS
 If the act hurts people then it is a bad act
 Supreme or divine that sets down rules to
2. PRINCIPLE-BASED (Deontological
theories)
provide guidance to moral decisions
- Involve logical & formal processes &
emphasize individual rights, duties & (5) ATTRIBUTES OF CARING
obligations 1. Compassion – sorrow for the suffering or
- The morality of an action is determined trouble of another, with an urge to HELP.
not by its consequences but whether it is 2. Competence – condition in qualification of
done according to an important objective being able to perform according to STANDARD.
3. Commitment – DEDICATION to a long-term
course of action, engagement or involvement.
DEONTOLOGICAL APPROACH OR DUTY
4. Confidence – belief in ones own abilities, to feel
ORIENTED THEORY CERTAIN.

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5. Conscientious – doing things according to what
is right, showing care and precision, HONEST
(held in respect, HONORABLE)
MORAL PRINCIPLES
- Broad general concepts such as autonomy
& justice, they provide the foundation for
moral values
PRICIPLES
- useful in ethical decisions because even if
people disagree about which action is right
in situation, they may be able to agree on
the principle that apply
(5) BASIC ETHICAL PRINCIPLES
1. >Our bodies, our life, our human
Stewardship nature & everything in this earth
are gifts we have dominion over
>This means we are responsible
for them. We should not harm
them, but rather improve & care
for them
>Ex.: Caring for one’s body is a
sign of good stewardship
2. Totality >Refers to the whole. Every
person must develop, use for &
preserve all his parts & functions
for themselves as well as the good
of the whole
3. Doubt >When an act is foreseen to have
Effect both good & bad effects, the
principle of double effect is
applied.
>In order that such act be
permissible the following
conditions should be met:
1. The action itself must be good
or at least neutral
2. The good effects is the one
directed intended by agent & not
the evil effect
3. The good effect is not produced
by means of the evil effect
4. The foreseen beneficial effect
must be equal to or greater than
the foreseen harmful effect
4. >The participation of one agent
Cooperation with another agent to produce a
particular effect or joint effect
>Cooperation becomes a problem
when the action of the primary
agent is morally wrong
>Cooperation may be:
1. FORMAL
When the 2nd agent willingly
participates as when one agrees,
advice, counsels, promotes or
condones
2. MATERIAL
When the 2nd agent does not
willingly participate
5. Solidarity >Means to be one with others. In
the provisions of health care, it is
important for the provider to be in
solidarity with the patient when
seeking the latter’s best interest
>This is most important when
dealing with the poor,
disadvantaged & marginalized
>Ex.: Should the strong help the
weak?
MAJOR BIOETHICAL PRINCIPLES
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1. Respect for person
a. The recognition of the equality
possessed by every human being
as unique, worthy, rational, self
determining creature having the
capacity & the right to decide what
is best for himself
b. Responsibility of all to treat persons
as an end never as a means
c. The respect for person’s autonomy
(self governance). The person
should be allowed to determine his
own destiny, to choose according
to his own values to act accordingly
d. Best practiced in the principle of
free & informed consent
e. The role of autonomy is refusal,
confidentiality & veracity
CONSENT
1. Implied – indicates agreement/
nonverbal
2. Expressed – verbal
(3) Components of informed consent
1. Must be given voluntary
2. The consent must be given to a client
with
capacity to understand
3. Given enough information to be the
ultimate
decision maker
Exceptions in giving consent
1. Minor
a. Adult who have mental
capacity of a child
b. Married who are minors
c. Pregnant minors
d. Parents & members of the
military
2. Severely injured
3. Mentally illed person
2. Justice
 Also termed fairness, means to give to
each one what the deserves or what is due
 Means to treat equals equally
3. Inviolability of life
 Also proposed sanctity, dignity or
respect for human life
 It means choosing life to protect it
 This principle includes measures for the
survival of the human species & the
freedom to have children
 It is be against violence, pollution of
environment, drug/alcohol addiction,
euthanasia, suicide & capital punishment
4. Non-maleficence
 Duty to do NO HARM
Violations of the Principle
1. Physically harming a person as in
suicide, abortion, infanticide
(person who murder infant),
violence
2. Harming a person’s reputation &
honor by revealing confidential
information
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 3. Exposing the person to harm as in
subjecting the person to ETHICAL DILEMAS
unnecessary treatment - Exist when the right thing to do is not
clear/ members of health care team
5. Beneficence cannot agree what the right thing to do
 Means to do well, provide a benefit
 Bringing the action & choosing the most LEAGL RIGHTS, ROLES & RESPONSIBILITY OF
benefit & least harm THE NURSE
”PRICIPLE UTILITY”
ROLE RESPONSIBIL RIGHT
Circumstances/ Issues Involving
ITY
Maleficence
1. Provider of To provide safe Right to
- Situations where in not prolonging life is
allowed service care, adequate &
- Obligatory or optional treatment commensurate classified
- Euthanasia with the assistance as
nurses’ necessary
UNIVERSAL PRINCIPLES OF BIOMEDICAL ETHICS preparation
 To determine right or wrong in regard to value issues experience &
 Autonomy-
circumstances
1. Greek word AUTOS meaning self and
2. Employee or >To fulfill the >Right to
nomos meaning governance
contractor of obligations of adequate
2. Self determination
3. Freedom to choose and implement one’s service contracted working
decision service with condition
4. Informed consent the employer >Right to
5. Allowing the patient to refuse treatment if he >To respect compensation
decides so the right & for services
6. The person making the decision must be responsibilities rendered
deemed competent, intellectual capacity, of other >Right to
legal age healthcare reasonable &
 Veracity providers prudent
Health care providers are bound to tell the conduct
truth 3. Citizen >Protect the >Right to
 Beneficence right of the respect by
Promotes the doing acts of kindness and recipients of others of the
mercy that directly benefit the patient care nurse’s own
 NONMALEFICENCE- >To inform role &
1. To do no harm
2. Not assisting in or performing abortion clients of the responsibility,
3. Not to assist people to commit suicide consequences right to
4. Be involved in mercy killing of various physical safety
 JUSTICE alternative of >Right to
1. The right to demand to be treated justly, outcome of reasonable &
fairly and equally care prudent
>To provide conduct for
adequate clients
CODE OF ETHICS supervision &
- A set of ethical principle that all member
evaluation of
of a profession generally accept
others for
- Sets the group expectation & standard of
whom the
behaviour
PRINCIPLES UNDERLYING CODE OF ETHICS nurse is
responsible
1. Refers to the execution of duties
SCOPE OF NURSING
Responsibility associated with the nurse’s role
- A person shall deemed to be practicing
2. Ability to answer for your own
nursing when she/he singly or in
Accountability action
3. Requires that those with access collaboration with another which initiates
Confidentiality with health information to a 3rd & performs nursing services to individual,
party without consent family, community in any health care
4. Judgement Ability to form opinion or draw setting
- Nurses are primarily responsible for the
sound conclusions
5. Advocacy >Giving patients information promotion of health prevention illness
- Nurses shall collaborate with other health
they need to make decision to
care provider for the curative, preventive,
support those decision
>Implies caretaker is drive to rehabilitative aspects of care, restoration
understand & clearly state of health, alleviation of suffering & when
patient’s point of view to other recovery is not responsible towards a
health care provider peaceful death

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ROLE Assist in maintaining a standard of nursing
- Expectation about how a person practice by making nurses accountable
occupying one position behaves toward a under the law
person occupying another position
TYPES OF LAWS PERTINENT TO NURSES
RIGHTS PUBLIC LAW
- Privileges or fundamental powers that - deals with relationships of between
individuals poses, unless they are revoke individuals & government agencies
or given up voluntarily
CRIME
RESPONSIBILITIES - an act in violation of public law &
- Obligations associates with rights or state punishable by a fine or imprisonment
of being accountable - Crimes may be classified as:
o FELONY
IT SHALL BE THE DUTY OF THE NURSE TO:  Crime of serious nature such
Provide nursing care thru the utilization of the as murder, 1 2nd degree
nurse murder called manslaughter
Establish linkages with community resources (killing of another person)
& coordination with the health team  Ex.: Patient who died due to
Provide health education incompatible blood
Teach, guide & supervise students in nursing transfusion or drug dose
education programs including the o MISDEMEANOUR
administration of nursing services in  An offence of less serious
varied settings nature & punishable by a
Undertake nursing & health human resource fine or short term jail
development training & research sentence or both
The nurse is duty bound to observe the code
of ethics for nurses & uphold the standard CIVIL LAW
of safe nurse practice - Comprises of laws that affect the
The nurse is required to maintain by individual rather the whole society
continued learning.
TORT
STANDARD OF CARE - A civil wrong committed against a person
- Skills & learning commonly possessed by or person’s property
members of the professional. - Classified as:
- Purpose: to protect consumer o Unintentional
- The standards are used to evaluate the o Intentional
gravity of care of nurses & therefore o Quasi-intension tort
become legal guideline for nursing
practice I. UNINTENTIONAL
 Act committed against person or his
STANDARD OF PROFESSIONAL property
PERFORMANCE  Classified as:
Quality of care A. NEGLIGENCE
Performance Appraisal  Failure to comply with the
Education standards of due care either by
Collegiality omission or commission
Ethics  A misconduct or practice that is
Collaboration below the standard expected of an
Research ordinary reasonable & prudent
Resource utilization
person
SELECTED LEGAL ASPECTS OF NURSING
Doctrines related to Negligence:
PRACTICE Respondeat Superior or
LAW Respondent supervisor
- A system of principles & processes by Let the superior answer
which people attend to control human An employee as well as
conduct in an effort to minimize the use of the employer is liable for
force the any failure

Functions of LAW in Nursing: Res ipsa loquitor

Provide a framework for establishing which Let the thing speak for
nursing action in the care of the client are itself
legal Shows sufficient proof on
It differentiates the nurse’ responsibilities the person’s duty & his
from those of other health professionals neglect to perform it
It helps establish boundaries of independent
nursing action B. MALPRACTICE

EGB’June09 10
 Professional negligence that
occurred while the person was
performing as a professional
The failure of the professional to
act as a reasonable & prudent
professional with the same
education & experience would act
in similar situation
TYPES OF MALPRACTICE
1. Failure to make referral to
provide the patient with
appropriate teaching before
discharge
2. Learning a foreign object inside
patient’s abdomen after surgery
3. Negligence on supervision of
subordinate
(6) ELEMENTS OF HOW TO PROVE
MALPRACTICE
1. Duty
Relationship with a client
2. Breach of duty
Failure to act as a reasonable
prudent
3. Forseeability
Link must exist between the
nurse’s act & injury suffered
4. Causation
Must prove that harm
occurred that resulted a nurse’s
failure
5. Injury/ harm
Client must demonstrate
some type of injury
6. Damages
The nurse is held liable for
damages to be compensated
COMMON MALPRACTICE ACT
1. Medication error
2. Burning of client
3. FALLS from the bed/ crib
4. Ignoring a client complaint
5. Mistaken identity
II. INTENTIONAL
o The person executed the act with
purpose or intent
o Classified as:
 Assault
 Battery
 False imprisonment
ASSAULT
An attempt or threat to harm
person unjustifiability
BATTERY
Willful touching of a person or
something the person is carrying
that may or may not cause harm
FALSE IMPRISONMENT
Illegal detention of a person
without his consent
III. QUASI-INTENTION TORT
o Voluntary act that directly cause
injury or distress
o Types:
 Slander (Verbal)
A false oral statement that
unjustly damage a person’s
name
 Libel (written)
A false written or
representational statement
that unjustly damages a
person’s name
 Invasion of Privacy
A violation of the person’s
right against unreasonable,
unwarranted interference
with his personal life
Ex.: Releasing info. About
patient to a 3rd party
allowing unauthorized
person
LEGAL PRECAUTIONS FOR NURSES
- Function within the scope of your
education, job description of area/ scope
of nursing practice
- Follow the procedures & policies of
employing agency
- Observe & monitor client accurately
- Communicate & record significant changes
in the client’s condition to AP
- Check any order that client
asked/questioned
- Modify the client before initiating any
interventions
- Protect the client from falls & preventable
injuries
PROHIBITIONS IN THE PRACTICE OF
NURSING
Practicing nursing must have certificate of
registration (COR)
Who uses his own license/ COR of another
Who uses expired/ revoke COR
Who gives false evidence to the board of
nursing in order to obtain COR
Who poses as RN that conveyed that he/she is
RN
Who appends BSN/TN to his name without
being confirmed with a degree
Uses names in advertisement
(5) LEGAL PROTECTION
1. Good Samaritan act
 A nurse who renders first aid or treatment
at the scene of an emergency and who
does so within the standard of care, acting
in good faith, is relieved of the
consequences
2. Carrying out physician’s order
3. Provide competent care
4. Record Keeping
5. Incidental report
Components of incidental report
1. Name
2. date, time
3. describe the facts of incidence

EGB’June09 11
 4. Client’s account for incident  Ex. Nurse recommends
5. Witnesses of incident patient to another clinic for
6. Identify equipment, name of doses abortion but does not want
7. signature
to perform
6. No one is obliged to betray himself/herself
NURSES’ BILL OF RIGHTS  No one can force any person
1. Registered nurses promote and restore health to answer a question if such
2. Prevent illness will incriminate him/her
3. Protect the people entrusted to their care 7. The end does not justify the means
4. Alleviate suffering  Giving sleeping tablets to
5. Provide services that maintain respect for
someone who has chronic
human dignity
illness
8. Defects of nature may be corrected
PATIENT’S BILL OF RIGHTS
 Corrected by plastic surgery
1. Considerate and respectful care 9. If one is willing to cooperate in the act, no
2. Relevant, current and understandable
injustice is done to him/her
information  With patient’s consent
3. Make decisions regarding his care plan 10. A little more or less does not change the
4. Have advance directive (living will)
substance of an act
5. Every consideration of his privacy
 Stealing
6. Confidentiality of communications and
11. The greatest good for the greatest number
records  Have more good effects for
7. Review his records concerning his medical
more people than a smaller
care
group
8. Be informed of business relationship among
12. No one is held to the impossible
the hospital educational institution  Do not promise impossible
9. Consent or decline to participate
things
experimental research affecting his care
13. The morality of cooperation
10. Reasonable continuity of care when
 Formal cooperation is an
appropriate and be informed of other care
evil act and never allowed
options 14. Principle relating to the origin and
11. Be informed of hospital polices and
destruction of life
practices  Thou shall not kill
LVING WILLS OR ADVANCE DIRECTIVE
1. Accept or refuse any treatment, service or
procedure used to diagnose or treat physical CODE OF GOOD GOVERNANCE
or mental condition
2. Decision to provide or withhold life-  Service to others
sustaining measures o Commitment to a life of sacrifice and
3. This living will is signed by the patient genuine selflessness in carrying out their
4. Witnessed by two other persons who is not professional duties
designated as the person’s health care  Integrity and Objectivity
representative o Perform their responsibilities with the
5. Directive has force of law highest sense of integrity
 Professional Competence
MORAL PRINCIPLES o Knowledge, technical skills, attitudes and
1. The golden rule experience
 Do unto others what you
 Solidarity and teamwork
would like others do unto o Maintain and support one professional
you organization
2. The two fold effect  Social and Civic Responsibility
 May have bad and good o Shall always carry out their professional
effect
duties with due consideration of the broader
 Must be morally good
 Good effect must be willed interest of the public
 Global Competitiveness
and the bad effect merely
o Shall remain open to challenges of a more
allowed
 Good effect must not come dynamic and interconnected world
 Equality of All professions
from an evil action
o Shall treat their colleagues with respect and
 Good effect must be greater
strive to be fair in their dealings with one
than the bad effect
3. The Principle of Totality another
 The whole is greater than
any of its parts
4. Epikia
AMENDED CODE OF ETHICS FOR NURSES
 Exception to the general
rule
5. One who acts through an agent is himself
responsible

EGB’June09 12
 Section 3 Republic Act No. 877 known as the Philippine
Nursing Law and Section 6 of P.D No. 223 the amended
Code of Ethics of Nurses
 Article I
o Preamble- health is a fundamental right of
every individual
 Article II
o Values, customs and spiritual beliefs held by
individual shall be represented
o Consider the individuality and totality of
patients when they administer care
 Article III
o Human life is inviolable
o Quality and excellence in the care of patients
are the goals of the nursing practice
o Accurate documentation of actions and
outcomes of delivered care is the hallmark
of nursing accountability
 Article IV
o The registered nurse is in solidarity with
other members of the healthcare team in
working for the patient’s best interest
 Article V
o Preservation of life, respect for human rights
and promotion of healthy environment
o Promotion in local, national, and
international efforts to meet health and
social needs of the people
 Article VI
o Maintenance of loyalty to the nursing
profession and preservation of its integrity
are ideal
 Article VII
o The certification of registration of the
registered nurse shall either be revoked or
suspended for violation of any provisions of
this code.
DEFINITION AND MEANING OF LAW
 The sum total of rules and regulations by which
society is governed
 Man mad regulates social conduct in a formal and
binding way
 Rule of conduct pronounced by controlling authority
and which may be enforced
o Authority or right to declare that the rule
exists
o Rule is pronounced or expressed
o Source can be defined
o A right to enforce the same must be
provided
 Controlling authority in our system is the government
 Fundaments law of the government is the constitution
 Principal sources of pronouncements
o Constitution
o Statutes or legislations
o Executive branch
o Case decision/judicial opinions
o Presidential decrees
o Letters of instructions
RESONSIBILITY AND ACCOUNTABILITY FOR THE
PRACTICE OF PROFESSIONAL NURSING
 Professional Negligence
o Commission or omission of an act,
pursuant to a duty
EGB’June09
 Existence of a duty on the
part of the person charged
to use due care under
circumstances
 Failure to meet the standard
of due care
 The foresee ability of harm
resulting from failure to
meet the standard
 The fact that the breach of
this standard resulted in an
injury to the plaintiff
 Article 19 of the civil code
o One shall act with justice, give
every man his due, observe honest
and good faith
 Article 20
o Those who in the performance of
their obligations through
negligence causes any injury to
another, are liable for damages
 Common acts of negligence
o Burns resulting from hot water
bags, heat lamps, vaporizers, sitz
bath
o Objects left inside the patient’s
body; sponges suction tips, loose
dentures lodged in the patient’s
trachea
o Falls of the elderly; confused,
unconscious, sedated patients
o Falls of children whose bed rails
were not pulled up and locked
o Failure to observe and take
appropriate action
o Failure to report observations to
attending physicians
o Failure to exercise the degree of
diligence which the circumstances
of the particular case demands
o Mistaken identity- drug given to the
wrong patient
o Wrong medicine, wrong
concentration, wrong route, wrong
dose
o Defects in the equipment
o Errors due to family assistance
o Administration of medicine without
a doctors prescription
Acts of negligence:
(1) THE DOCTRINE OF RES IPSA LOQUITUR
 Injury was of such nature that it would not
normally occur unless there was negligent
act
 Injury was caused by an agency within
control of the defendant
 Plaintiff himself did not engage in any
manner that would tend to bring about the
injury
MALPRACTICE
 The idea of improper or unskilful care of a
patient by a nurse
13
  Stepping beyond one’s authority with o Right to privacy is the right to be left alone
serious consequences o Right to be free from unwarranted publicity
 Carelessness of professional personnel o Exposure to public view
 LESNIK- negligent act committed in the o Divulge information from patient’s chart to
course of professional performance improper sources or unauthorized person
 Defamation
(2) DOCTRINE OF FORCE MAJEURE o Character assassination
o Slander-oral defamation
 Irresistible force; unforeseen or inevitable o Libel-written words
 No person shall be responsible for those events which o There must be a third person who hears or
cannot be foreseen read the comment before it can be
 Floods fire, earthquakes considered defamation

(3) DOCTRINE OF RESPONDEAT SUPERIOR

CRIMES, MISDEMEANORS, AND
 Let the master answer for the acts of the subordinate FELONIES
 The liability is expanded to include the master as well
as the employee CRIME
 An act committed or omitted in violation of
INCOMPETENCE the law
 Two elements
 Lack of ability, legal qualifications or fitness to o Criminal act
discharge the required duty o Evil/criminal intent
 Conspiracy to commit a crime
CONSENT TO MEDICAL AND SURGICAL o Two or more persons agree to
PROCEDURES commit a felony
 Principals- who take a
 Consent direct plan/part
o Free and rational act that presupposes  Accomplices- cooperate in
knowledge of teh thing to which consent is the execution
being given by a person who is legally  Accessories- having
capable to give consent knowledge of the
o Signed by the patient or authorized commission of the crime
representative/legal guardian  Criminal Actions
o An authorization by a patient or a person o Acts or offenses against public
authorized by law to give the consent on the welfare
patient’s behalf  Criminal negligence
o Nurse secures the consent of the patient o Reckless imprudence- person does
upon admission an act or fails to do it voluntarily
 Informed Consent but without malice
o Established principle law that every human o Simple imprudence- did not use
being of adult years and sound mind has the precaution and the damage was not
right to determine what shall be done with immediate or the impending danger
his own body was not evident or manifest
o May choose whether to be treated or not  Criminal Intent
 Proof of Consent o States of mind of a person at the
o A written consent should be signed to show time the criminal act is committed
that the procedure is the one consented to that he/she knows that an act is not
and that the person understands the nature of lawful and still decide to do it
the procedure anyway

TORTS WILLS

 Definition: A legal wrong, committed against  A legal declaration of a person’s intentions upon
a person or property death
 Assault and Battery  Testamentary document takes effect after the death of
o Imminent threat of harmful or offensive its maker
bodily contact  Decedent- person whose property is transmitted
o Unjustifiable to tough another person or to through the succession whether or not he left a will
threaten to do so  If he left a will he is called a testator
 Battery  Woman is testatrix
o An intentional, unconsented touching of  Heir- called to succession either by the provision of a
another person will or by operation of law
 False Imprisonment of Illegal Detention  A person who dies leaving a will is said t have died
o Unjustifiable detention of a person without a testate
legal warrant within boundaries  One who dies without will is said to have died
 Invasion of Right to Privacy and breach of intestate
confidentiality  Validation of the will in a court is known as probate

EGB’June09 14
  A will which is written, dated and signed by the
testator is called holographic will
 An oral will is called nuncupative will or
nuncupation- made during the person’s last illness,
that it be done in the place in which he died, one or
more witnesses to the will
 Testator must have the expressed intention of making
a will
 Must be right of age
 Under 18 cannot make a will
 Required to have sound mind
 Think clearly ability at the time of its execution

NURSES OBLIGATIONS IN THE EXECUTION OF A

WILL

 The nurse should note the soundness of the patient’s

mind
 There was freedom from fraud or undue influence
 Make a notation on the patient’s chart of the apparent
mental and physical condition of the patient at the
time of making the will

EGB’June09 15