Updated by Dr.

Salmah Alghamdi
2nd Update: Dr. Rasha Alsaigh

2/9/20
Objectives

At the end of this presentation, students will be able to:

o Define the basic concepts of legal and ethical issues

o Define the importance of children’s rights
o Identify the Declaration of the child rights
o Demonstrate comprehension of Islamic view of children rights
o Determine the common malpractice in paediatric unit
o Recognize the elements of informed consent

2/9/20
Introduction

 The major goal for pediatric nursing is to improve the quality

of health care for children and their families.

Legal and ethical issues arise frequently, and are commonly

encountered in certain fields such as medicine, healthcare and
politics. In some instances, legal regulations prohibit people from
carrying out certain tasks, such as administering life-saving
support, that are considered morally permissible actions

2/9/20
 ETHICS

 Ethics is the study of the rightness or wrongness of human

conduct. Declarations of rights and formulations of laws are, at
least in democratic systems, derived from ethical reasoning.

 The main ethical principle of all pediatric activities is the demand

to do everything in the “best interests” of children.

 The difficulty for doctors is that they can never be entirely certain
what the best interests of children are in an individual situation.

2/9/20
 TERMINOLOGY

 Negligence is defined as an occasion when a person owes a duty to

another and, through failure to fulfil that duty, causes harm. In tort
law, negligence applies to harm caused by carelessness, not
intentional harm.

 Malpractice occurs when a hospital, doctor or other healthcare

professional, through a negligent act or omission, causes an injury to a
patient. The negligence might be the result of errors in diagnosis,
treatment, aftercare or health management.

 A type of negligence; it is often called "professional negligence". It

occurs when a licensed professional fails to provide services as per the
standards set by the governing body ("standard of care"), subsequently
causing harm. 2/9/20
 ETHICAL PRINCIPLES
 Autonomy: the patient’s right to be self-governing

 Beneficence: the obligation to promote the patient’s well-being “do

good”

 Maleficence: is to not intentionally bring harm or injury to the

patient “do no harm”

 Justice: All clients are cared for in same manner regardless of

culture, religion, ethnicity or socioeconomic status

 Veracity: Truth-telling , full, honest disclosure

 Fidelity: Do as you say you will do , keep promise or word

2/9/20
  “A 12-year-old girl collapses in the street complaining
of severe acute pain in her right abdomen. A surgeon
happens to be passing and examines the girl,
suspecting that she is on the brink of rupturing her
appendix. The surgeon decides the best course of
action is to remove the appendix in situ, using his
trusty pen-knife.”

10/29/2020
 CONFIDENTIALITY

o Confidentiality is one of the core duties of medical practice. It

requires health care providers to keep a patient’s personal health
information private unless consent to release the information is
provided by the patient.

o Nurse has a duty of confidentiality (disciplined by both employer

and state board of nursing).

o Nurse responsible to maintain client confidentiality though

• Medical records
• Communication
o Nurse should not discuss families and cases with friends or co-
workers not directly involved in care.

2/9/20
 WHEN CAN A NURSE BREAK CONFIDENTIALITY

• In case of child abuse

• Injury by a weapon or criminal act

• Infectious diseases

• Warn third parties

2/9/20
 Minor

Who is Minor?
Is a person who has not yet reached the age at which he/she is
considered to have the rights and responsibilities of an adult.

• Each country has its own age definition for minor to give consent
for care “18 or 21 years”.
Minor in Saudi Arabia <18 years

2/9/20
 IMPORTANCE OF CHILDREN’S RIGHTS

o A unit of the societies and future of the countries

o Too young to identify their own needs; need special safe

guards and care

2/9/20
 ISLAMIC VIEW OF CHILDREN RIGHTS:
• To be called in good name
• To be called to his/her father name
• Lactation and weaning
• To rare the children in good manner and on good religious principles,
teach him/her the right and wrong, good and bad, what is forbidden
and acceptable as a Muslim
• To educate, play and to be kind with children
• Gives girls thier equal rights in all aspects of life e.g. parent
inheritance
• Care for orphan and keep their rights and their money while they are
young
• Forbidden adoption
• The rights for illegitimate to be able to live well with dignity and keep
his humanity
• Keep privacy of children, separate between girls and boys at age of 7.
2/9/20
 THE DECLARATION OF THE
RIGHT OF THE CHILD

Although countries may have cultural differences, guidelines

supporting the approach of pediatricians and other doctors caring for
children to the best interests of children and adolescents in the daily
practice do exist. They are included in the “Declaration of the Rights
of Children” proclaimed by UNICEF in 1959 and approved by the
44th General Assembly of the United Nations in 1989.

2/9/20
UNITED NATIONS’ DECLARATION OF THE
RIGHT OF THE CHILD
 To be free from discrimination
 To develop physically and mentally in freedom and dignity
 To have a name and nationality
 To have adequate nutrition, housing, recreation and medical
services
 To receive special treatment if handicapped
 To receive an education and develop his/her abilities
 To be the first to receive protection in disaster
 To be protected from neglect, cruelty and exploitation
 To be brought up in a spirit of friendship among people
2/9/20
HISTORY

o In 1989, general assembly of the United Nations adopted a

special human rights conservation for children “the
convention on the rights of the child”.

o More than 180 countries have signed the “convention”.

10/29/2020
 CHILDREN’S BILL OF RIGHTS
SECTION I: ARTICLES THAT ARE IMPLEMENTED
IMMEDIATELY
1. Children's universal rights
Right to receive care and protection no matter what country they
were born in or are living in, what their race is or what religion is.
2. Right to inherit a better world
Parents have a responsibility to think about know they will leave a
better world to their children.
3. Right to influence the future
Have the right to participate in discussions related to political and
social issues so that they can help create the kind of world they will
grow up in.
10/29/2020
 CONT.

4. Right to freedom of thought, opinion, expression, conscience and

religion
5. Right to media access
6. Right to participate in decisions affecting children
7. Right to privacy
8. Right of respect and courtesy
9. Right to an identity
Have the right to know their name, their biological parents and
when and where they were born.
10. Right to freedom of association
Have the right to meet with others and to join or form association
equivalent to that held by adults.

10/29/2020
 CONT.

11. Right to care nurturing

12. Right to leisure and play
13. Right to safe work
14. Right to an adequate standard of living
15. Right to live physical, integrity and protection from
maltreatment
16. Right to education
17. Right to access appropriate information

10/29/2020
 CONT.

SECTION II: ARTICLES THAT REQUIRES SOCIAL OR

NATIONAL POLICIES
20. Right to a clean environment
22. Right to vote
23. Right to medical care
24. Legal right
Children accused of crimes have at least the same legal right as
adult.
25. Right not to participate in war
Young people under 21 have the right not to go to war.

10/29/2020
 PATIENT’S BILL OF RIGHTS

o Has the right to refuse a recommended treatment or plan of care to

the extent permitted by law and hospital policy and to be informed
of the medical consequences of this action.
o Has the right to have an advance directive such as a living will,
health care proxy, or double power of attorney for health care
concerning treatment or designating surrogate decision-maker.
o Has the right to make decisions about the plan of care prior to and
during the course of treatment, and to be informed of the medical
consequences of this action.
o Has the right to considerate and respectful care.

10/29/2020
 INFORMED CONSENT

Informed consent is a process for getting permission before

conducting a healthcare intervention on a person.

Elements of informed consent includes:

• Nature of procedure
• Risk and hazards
• Benefits
• Alternative procedures

10/29/2020
 WHEN INFORMED CONSENT IS NOT
REQUIRED IN MINOR
o In case of emergency situation
o Many places allow the evaluation and treatment of a child
for suspected physical or sexual abuse without the informed
consent of a parent or guardian
o Photographing and taking an x-ray
o In case of forensic examination (do not force or restrain the
child to perform genital or rectal examination)

WHEN A MINOR CAN CONSENT FOR CARE

A minor can consent to care as long as the individual
demonstrates the maturity to understand the risks and benefits
of the treatment.
10/29/2020
  Children are continuously developing physically, emotionally,
and cognitively. At some points of their development they are
more capable to make decisions about their health care.

 They must be determined as a competent and voluntary agent.

They must have information about their condition and
prognosis, understand the intervention, and be able to
understand the risks, benefits, and side effects. For minors, this
consent is given by parents because minors are considered
incompetent.

 Assent is the agreement of someone not able to give consent to

participate in the activity.

10/29/2020
 PARENTAL CONSENT AFTER DIVORCE

After divorce, the ability to consent for medical care rests with the
parent who has been granted legal custody by the divorce decree.

The legal document approved by the court that grant divorce,

divides marital property and specifies child custody.

10/29/2020
WHEN PARENT OR CHILD REFUSE MEDICAL CARE

o Religious beliefs

o Government can make legal decision for the child

10/29/2020
WHAT HAPPENS WHEN THE MEDICAL TEAM
DISAGREE WITH PARENTS DECISION

In the overwhelming majority of cases, parents and those with

parental responsibility have the child’s interests at heart and are
best placed to make decisions for them. Occasionally, the health
team may have concerns that a particular decision might not be in a
child’s interests.

If such a disagreement arises, further discussion should take place

and a second opinion offered, but it may be necessary to seek legal
advice. In the interim, only emergency treatment that is essential to
preserve life or prevent serious deterioration should be provided.

10/29/2020
OBTAINING INFORMED CONSENT UNDER
SPECIAL CIRCUMSTANCES

1- Consent for donation of tissues or organs

o If a child is too young, the parent or legal guardian may consent

for the child
o Three requirement for the minor to be a donor:
• The parent who is consenting must be aware of the risks and
benefits
• The child primary caregiver must be able to provide emotional
support for the child
• There must be a close relationship between the donor and the
recipient
10/29/2020
 CONT.

2- Consent for genetic testing

o The benefits and the risks should be discussed with a child if

appropriate
o Parents or guardian can consent for the testing
o Genetic testing should not be performed on a child unless
the results of the test will serve the best interests of the child

10/29/2020
 CONT.

3- Consent for medical experimentation with children

All research facilities that receive funds must comply with

government regulations that require review of all
experimental protocols by an ethical committee in the
institution whose regulations require the consent of one or
both parents and the assent of the child, depending on the
amount of the potential risk and benefit associated with the
treatment or procedure.

10/29/2020
Collaborative decision making
Nurses must prepare themselves systematically for
collaborative ethical decision making. They can
accomplish this through formal course work, continuing
education, contemporary literature, and work to
establish an environment conducive to ethical discourse.

10/29/2020
 REFERENCES

Berman, A.T, Snyder, S.J. & Frandsen, G. (2016). Kozier &

Erb’s Fundamentals of Nursing: Concepts, Process, and
Practice (10th ed.). Pearson Education: Boston. ISBN:
9780133974362.
Hockenberry, M.J. & Wilson, D. (2014). Wong's Nursing
Care of Infants and Children (10th ed.). St. Louis: Elsevier.
ISBN: 0323222412.(chapter 1)
Polts, N. L. & Mandteo, B.L. (2011). Pediatric Nursing
Caring for Children and Their Families (3rd ed). Delmar
Cengage Learning: Australia.
10/29/2020