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CA- PA Day 2-3

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• License
a legal document given by the government that
permits a person to offer to the public his or her
skills and knowledge

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• Purposes of Registration/Licensure

1. Establish minimum standards

2. tool for legal control

3. gather statistical data

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•Registration
Recording of names of persons
qualified to practice their profession
• Entered in a registry or registration
book

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• RA 9173 Sec. 12 and 20 state that the
license to practice nursing shall be issued

a) to those who pass the licensure


examination

b.)by reciprocity
“do ut des” - I do that you may give

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• Sec. 13 Qualifications for Admission
to the Licensure Examination
1. a) he/she is a citizen of the
Philippines, or a citizen or a subject
of a country which permits Filipino
nurses to practice within its
territorial limits on the same basis as
the subject or citizen of such country

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2.He/she is of good moral character

3.He/she is a holder of a Bachelor’s


degree in Nursing from an accredited
college or university

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• Sec. 15 Ratings.- In order to pass the
examination, an examinee must:
a.) obtain a gen. average of at least 75% or
higher
with no rating below 60% in any subject
b.) repeat the examination on the subject
where he/she got below 60% and obtain a
grade of 75% on the repeated subject
c.) take the removal examination within
two years after the last failed examination

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Reconsideration of Ratings
- may be requested only on
grounds of mechanical, clerical,
or clear errors in the rating of
papers within 90 days from the
release of the official results of
the exam

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• Sec.16 Oath. – All successful candidates
in the examination must first take an oath
of profession before the Board, a
Commission official designated by it, or
any government official authorized to
administer oaths before entering upon the
practice of nursing.
Mass oath-taking is usually scheduled 15
days after the release of the licensure
exam results

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• Sec. 17. Issuance of Certificate of
Registration/Professional License and
Professional Identification Card. – All
successful candidates shall, upon payment
of prescribed fees, be issued the following:
a.)Certificate of Registration/Professional
License bearing the: full name of the
registrant, serial number, signature of the
Chairperson of the Commission,
signatures of the members of the Board,
and the official seal of the Commission of
the Board; and

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b. ) Professional Identification Card, duly
signed by the Chairperson of the
Commission, bearing the date of
registration, license number, date of
issuance and expiration date

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• Renewal of License
done in the PRC every 3 years not later
than the date indicated in the PRC card
- a surcharge of 20% is charged for each
calendar year that payment has not been
made.
- a lapse of 5 years may mean suspension
of the certificate; name shall be dropped
from the annual roster

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• Suspension or Revocation of License

Suspension – the nurse is not allowed temporarily


to practice nursing until final judgment of her
case is resolved; license is not confiscated

Revocation – license to practice is confiscated


either temporarily or permanently.

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*Re-Issuance of Revoked Certificate
Upon proper application and payment of
required fees:
• After the expiration of the maximum
period of 4 years from the date of
revocation
• When the cause for revocation has
disappeared, cured or corrected

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• Replacement of Certificate/License
On conditions of loss, destruction,
mutilation
• Prohibitions in the practice of Nursing:
• No certificate of registration/license to
practice or temporary special permit
• Using the certificate or license of
another

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3. using an invalid certificate or
license

4. posing or advertising as
registered licensed nurse or uses
any means to convey the impression
that he/she is a nurse

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5. Who appends BSN, RN or any title after
his/her name
6. who, as license nurse, abets or aids in the
illegal practice of a person not lawfully
qualified to practice
7. Any person who undertakes in-service
educational programs or who conducts
review classes both local or foreign
without permit or clearance from the
Board

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8. any person or employer of nurses who
violate the minimum base pay of nurses
and the incentives and benefits that
should be accorded
9. Any person or the Chief Executive of
any judicial entity violating any
provisions of RA 9173

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Professional Regulatory Board of
Nursing
• The government agency in the Philippines
which regulates the practice of nursing
(created under Sec. 3, Art.3 of RA 9173)
• Composed of a Chairman and six
members representing the 3 broad areas
of nursing: service, education, community
health
• Is under the supervision and control of the
PRC
• Term of office is 3 years

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• The Chairman and 6 members of the
BON are appointed by the President of
the Philippines upon the recommendation
of the PRC and confirmed by the
Commission on Appointments

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• Members of the BON may be appointed
through:

- Regular appointment
Recommendees from the PNA (at least 3
per vacancy) are submitted to the PRC
which then ranks them then submits 2
nominees to the President of the
Philippines

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- Ad Interim appointment
temporary appointment of a board member
to fill in a vacancy or perform the duties of an
office during the absence of a regular
incumbent.

- Doctrine of Hold-Over
- A member is permitted to perform the
functions relative to its office even after the
end of his term until a replacement comes

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Qualifications of the Members to
the Board of Nursing
• Natural born and resident of the Philippines
• a member of good standing of the accredited
professional organization of nurses
• An RN, MAN
• With at least 10 years of continuous practice of
the profession the last 5 years of which shall be
in the Philippines
• Not have been convicted of any offense involving
moral turpitude (an act of baseness, vileness or
depravity in social or private duties)

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• Powers and Functions of the Board
1.Regulatory
enforcement of legislations
regulating an act or activity in a
particular area
2. Quasi- judicial
investigate facts and draw
conclusions from them as basis for
legal action
3.Legislative

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Grounds for Removal or
Suspension
• Continued neglect of duty or
incompetence

• Commission or toleration of irregularities


in the licensure examination

• Unprofessional, immoral or dishonorable


conduct

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Legal Aspects and the Nurse
• Professional Negligence
omission or commission of an act, that a
reasonably prudent person in similar
circumstances would or would not do and
the action or inaction is the proximate
cause of injury to another person or his
property

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Elements of Professional Negligence

• Existence of a duty on the part of the


person to exercise due care
• Failure to meet the standard of due care
• Forseeability of harm resulting from
failure to meet the standard
• The breach of standard resulted to injury
to the plaintiff

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Doctrine of “Res Ipsa Loquitor”
• “the thing speaks for itself”
• 3 conditions that need to be present:

• Nature of the injury would not normally


happen unless there was negligence on the
part of the nurse
• Injury was caused by an agency/means
within the control of the accused
• The plaintiff did not do anything to bring
about the injury

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Defenses in Negligence Cases

• Exercise of the required standard of care

• Plaintiff’s own negligence is the proximate


cause of the injury

• “Force majeure” – an event which could not


be foreseen, or which though foreseen, was
inevitable

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Other Doctrines Related to
Negligence
• Respondeat superior : “ let the master answer for
the acts of the subordinate”
- The liability is expanded, not shifted, to include
the employee and the employer
• Captain of the Ship Doctrine
- The surgeon, being the head of the operating
team is responsible for anything that goes
wrong in the operating room (ex. A lap pack
left in the patient’s abdomen)

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Other Cases
- Malpractice
-Improper or unskillful care
-Stepping beyond one’s authority with serious
consequences

Incompetence
- The lack of ability or legal qualifications which
makes a nurse unfit to discharge the required duties

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- Parricide
killing of mother, father, or a child or
anyone among one’s ascendants or
descendants/relatives
- Infanticide
Killing of a child less than 3 years old
- Abortion
expulsion of a fetus resulting to death
whether non-viable or full term. May be
intentional or
unintentional

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• Murder – killing of another with pre meditated
intent (abortion,euthanasia)
• Homicide – unintentional killing of another person
• Giving Assistance to suicide
• Mutilation – intentional removal of an essential
organ of reproduction or any body part
• Physical Injuries- wounding, beating or assaulting
another person

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• Illegal Detention- false imprisonment or depriving a
person of his liberty

• Robbery – taking another person’s property thru


violence against or intimidation of persons

• Theft – taking another person’s personal property


without his consent but without the use of violence,
force or intimidation

• Rape – forcible penetration of an organ of copulation


or any object or instrument to any body orifice of the
offended party who is either conscious, unconscious,
under 12 years old or is demented

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• Sexual Harassment ( violation of the Anti-Sexual
Harassment Law RA 7877) committed by a person
in authority, of influence, or moral ascendancy, in a
work, education or training-related environment,
by asking, requesting, or demanding a sexual favor,
resulting in an
intimidating, hostile , or offensive environment.

• Falsification of Documents
-imitating any handwriting or signature of another
person to make it appear in that he participate
(making false entries in the patient’s chart,
simulation of birth)

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• Simulation of birth – entering in a birth
certificate a birth which did not occur

•Criminal Negligence (Reckless Imprudence)


Ex. failure to perform a skin test before
administering an antibiotic resulting to
anaphylactic shock

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• Violation of the Comprehensive Dangerous
Drugs Act of 2002 (RA 9165)
Dispensing, delivering, transporting,
distributing, possessing or using regulated
drugs without being authorized by law.

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Classification of Felonies According
to the Degree of Execution
• Consummated- all acts necessary for
execution and accomplishment are present
• Frustrated – all acts of execution are
performed but the objective of the act was
not achieved
• Attempted – offender commences to
commit the crime but does not perform all
the necessary acts for completion

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Classification of Felonies According
to the Degree of Punishment
* Grave – afflictive punishment

* Less Grave – correctional punishment;

*Light – punishable only when they are


consummated, except those committed against a
person or property

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CIRCUMSTANCES AFFECTING
CRIMINAL LIABILITY

Justifying
Circumstance
s – where no
criminal
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Exempting – exemption from criminal liability
- imbecile or insane except when the crime was
committed during lucid interval
- under 9 years of age
- over 9 under 15 years old unless he acted with
discernment
-a lawful act done with due care but resulted to
accidental injury which was not intentional

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- act done under compulsion of an irresistible
force
- act done under the impulse of an uncontrollable
fear of an equal or greater injury
- failure to perform a act required by law, due to
some lawful or insuperable cause

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3. Mitigating circumstances – reduce the
degree of moral culpability
- incomplete justifying or exempting
circumstances
- over 15 but less than 18 years old unless
he acted with discernment
- lack of intent to commit so grave a wrong
voluntary plea of guilt

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4. Aggravating circumstances – increase the
penalty

- offender took advantage of his position


- abuse of confidence
- crime was committed at night
- crime was committed during conflagration,
earthquake, shipwreck, calamity
- crime was committed by means of inundation,
poison

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CIVIL CASES
• One by which a party sues another for the enforcement
or protection of a right or the prevention or redress of a
wrong.

• That which may arise from any of the following:


1. Breach of contract
failure to perform an agreement, whether expressed or
implied, without cause.
2. Tort
a legal wrong committed against a person or property
in which a remedy in the form of money as payment
for damages /injury is given

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Crimes of Tort

• Assault & Battery

• False Imprisonment or Illegal Detention

• Invasion of the Right to Privacy & Breach of


Confidentiality

• Defamation (Slander and Libel)

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Contract
• a meeting of minds between two persons whereby
one binds himself to give something or render
service to the other

• May be written or oral , or may require a particular


form in order to be effective or enforceable.

• Essential Requisites
• Consent of the contracting parties- concurrence of
the offer and requires the legal capacity of both
parties ( 18 yrs. Old & above, literate, not insane)
- must be free and spontaneous

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2. Object of the contract
- thing, right or service ( ALL WITHIN THE
COMMERCE OF MAN) which is the subject matter
of the contract

3. Cause- essential reason of both parties to enter


into a contract

*** unless all requisites are present, there can be no


contract

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Kinds of contracts
• Formal – a written agreement (as required by law)
between contracting parties like marriage contract,
deed of sale)
• Informal – results from a previous correspondence
or oral discussion between contracting parties
• Express – wherein the terms and conditions of the
contract are given orally or in writing by the
concerned parties
• Implied - results from acts of conduct of the
concerned parties to which the law ascribes an
objective intention to enter into a contract

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• Void contract – that which is non existent from
the very beginning and therefore not
enforceable

• Illegal contract – one that is expressly


prohibited by law

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• Breach of contract
failure to perform an agreement, whether or
implied, without cause.
- in the nursing service, this would include:
• Failure to perform due to inconvenience or
difficulty
• Abandonment of duty
• Substitution of performance
• Failure to use due care

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Legal excuses in refusing, neglecting,
or failure to perform a contract
• Discovery of material misrepresentation

• Where performance would be illegal

• Performance is impossible by reason of illness

• Performance is impossible due to death of


patient or nurse

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Special Considerations in Nursing
Practice
• A. Medical Orders – execution is a
dependent function
➢ written orders are legal orders
➢ must be clear, specific, and legible

• B. Telephone Orders – should be limited


only
➢ in cases of extreme emergency and,
➢ when there is no doctor around

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• How does the nurse protect herself?
- Nurse reads back the order to the doctor
- Nurse writes the name of the physician who made the
order per his/her own and note the time when the
order was made
- Such order should be signed by the physician on his
visit within 24 hours
- If problem/s arise, refer back to the ordering
physician

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• Drugs and Medications
- RA 6675 (Generics Act) states that only
registered medical, dental and veterinary
practitioners are authorized to prescribe drugs
- IV Therapy
- - Nurses should follow the Intravenous Nursing
Standards of Practice developed by ANSAP
- Blood Transfusion should be checked for the correct
type and if proper cross-matching was done

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• C. WILLS
- Declaration about how a person wants his
property to be disposed upon his death

- Types of Wills:
- 1. Notarial Will written according to the formalities
set by the law
- 2. Holographic will – written, dated and signed by
the testator himself

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• The person making the will should:
• Be of sound mind and
• Free from undue Influence

Nursing Responsibility
• Notify your supervisor prior to signing a will
• Nurse should not be a beneficiary
• Note in the patient’s chart the physical and mental
condition of the patient when the will was made

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• ADVANCE DIRECTIVE
- Voluntary written document
- patient specifies what type of medical care he/she wants
in the future if he loses his capacity to make decisions. It
includes the following:

A. Health Care Proxy


- - client gives another person the power to make
decisions regarding medical treatment

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- must at least be 18 years old, and of sound mind
- His/her power to decide ends when the patient dies
- Proxy cannot decide regarding organ donation

- Who can decide for organ donation? (accdg. to


priority or in case the patient has not decided
on his own
- A. spouse
- B. son or daughter at least 18 years old
- C. Patient’s brother or sister at least 18 years old
- D. guardian appointed by a court

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B. Living Will
- A document that provides specific instructions about
health care decisions

C. Consent- authorizes a person to give specific


treatment/care
- absence of this makes the members of the health
team liable for criminal, civil and administrative
offense.

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• Elements:
• Voluntary
• Patient is given full information
• Given by a person with legal capacity
Informed Consent
• Fair explanation of the condition, procedure and
possible risks and benefits
• Possible alternatives
• Enough time for patient to make a decision
• Absence of undue pressure

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Refusal to consent
• Patient can refuse
a. If full information was given, and patient still refuses
to consent, patient should sign a waiver
b. Note in the chart if patient refuses to sign and notify
appropriate authorities

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Exception to the Rule

• A. In case of life or limb emergency


• B. when such disclosure would threaten the
patient or cause him harm/suffering
• C. When the patient chooses not to hear. Waiver
should be signed. The intended procedure should
be discussed with the relatives.
• D. when the patient has prior knowledge

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• Restraints and Seclusion
- Any involuntary method (chemical or
physical) of restricting an individual’s
freedom of movement, physical activity

- A. Chemical restraint- theuse of sedating


psychotropic drug to manage or control
behavior

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B. Physical restraint –
- direct application of physical fore to a
patient without his permission to restrict
his freedom of movement.
( use of human force or mechanical devices)

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• * Seclusion
- involuntary confinement of a person in a
locked room.

- *Therapeutic holding
- Physical restraint of a child who has lost
control of behavior to regain control of
strong emotions

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Reminders Regarding the use of
Restraints
1. obtain informed consent
2. with written order from a physician or as part of
hospital protocol
3. if no written order, obtain telephone order within
an hour after instituting the procedure
4. not to be used as discipline or convenience
5. do not be persuaded by relatives who offer to sit
with the patient just to avoid the use of restraints
6. observe the principle of least restriction

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7. assess restraints every 30 minutes or as often as
needed
8. release restraints every 2-4 hours :ROM
exercises if not contraindicated
9. do not leave the patient unattended when
restraints are temporarily removed
10.Watch out for pallor, cyanosis, coldness in the
area or client’s complaint of a tingling sensation,
pain or numbness. Release the restraints and
exercise the limb

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7. assess restraints every 30 minutes or as often as
needed
8. release restraints every 2-4 hours and provide
ROM exercises if not contraindicated
9. do not leave the patient unattended when
restraints are temporarily removed
10.Watch out for pallor, cyanosis, coldness in the
area or client’s complaint of a tingling sensation,
pain or numbness. Release the restraints and
exercise the limb

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Guidelines in documenting the use
of restraints
1. time limitation
2. start and end times
3. type of restraint
4. frequency of monitoring
5. clinical justification of the necessity of restraints
6. a written order which complies with hospital policy
7. Measures taken to protect the rights, dignity and
well-being of the patient

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DOCUMENTATION
• Records are legal documents; admissible
evidence in court
• Accuracy must be observed. “if it was not
charted, it was not done or given.”
brief, accurate, legible, chronologic, made on
chronologic lines and appropriately signed.
• Falsification is a crime.
• Patients have the right to confidentiality of their
record.

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** The information in the chart belongs to the
patient but the physical chart belongs to the
hospital to be kept by the Records Officer.

*** Disposal of records in government hospitals


such as the patient’s chart must be done in
coordination with the National Archives Office
as mandated by the National Archives Act of
2007 (RA 9470)

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Code of Good Governance
• Promulgated by the PRC on July 23, 2003
• - states that the hallmark of all
professionals is their willingness to accept
a set of professional and ethical principles
which they follow in the conduct of their
daily lives.
• Adopted by the PRC and the 42
Professional Regulatory Boards

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General Principles
• 1. Service to Others
• 2. Integrity and Objectivity
• 3. Professional Competence
• 4. Solidarity and Teamwork
• 5. Social & Civic responsibility
• 6. Global Competitiveness
• 7. Equality of all Professions

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