Module It provides an overview of ethical decision making and the legal system to help nurses manage common

ethical and legal dilemmas in nursing.

ETHICAL ASPECTS IN NURSING

ETHICS
 Greek word “ethicos”
 French word “ethos”
 Custom
 Good and bad
 Societal norms
 “Science of right and wrong, good and bad,
 governs our relationships with others and
 based on personal beliefs and values.” (Sullivan & Decker, 2010)

o Ethics is a concept that deals with moral issues of good and bad based societal norms
o It is the code written and unwritten that guides the behavior of human beings in the context of different
cultures and situations. This moral code may vary from society to society. However there are certain aspects
that hold good in every situation. The application of this principles would be dependent on the person and
the situation. In short, it is a judgment quote.

o As we talk abt ethics to guide our behavior in the practice of our profession, we have the code of ethics
CODE OF ETHICS – a specific set of professional behaviors and values the professional must know and abide
by including integrity, accuracy, privacy and confidentiality.
CODE OF ETHICS for Nurses

1. Provide services with dignity and uniqueness of individuals.

The nurse in all professional relationships, practices with compassion and respect for the dignity,
worth and uniqueness of every individual.
2. Are committed to the patient.
The nurses’ primary commitment is to the patient whether an individual, family, group or
community.
3. Advocate for the patient.
The nurse promotes and advocates for the pt. and strive to protect the health, safety and rights of
the patient.
4. Accountability and responsibility for nursing judgments and actions.
The nurse is responsible and accountable for individual nursing practice and determines the
appropriate delegation of tasks consistent with the nurse obligation to provide optimum pt care.
5. Competence in nursing skills and practice.
Nurses are responsible to maintain competence in nursing skills and practice
6. Positive environments for care.
Nurse participates in improving the healthcare environments and conditions conducive to the
provision of quality healthcare.
7. Participation to ongoing professional development.
The nurse participates in the advancement of the profession
8. Collaborative practice.
The nurse collaborates with other health professionals to meet the health needs of our pt.

ETHICAL THEORIES – could guide us, what could be good behaviors

 UTILITARIANISM
“The greatest good for the greatest number of people”
 We have policies, we have rules that would benefit the majority. Greatest good means the highest good the
life of the righteous. Greatest number means the highest common factor. The only moral framework that can
justify an action. Action is morally right if it serves the greatest happiness for the greatest number of people.
Ex. Mass Vaccination – The greatest good for the greatest number of people. Do what produces the best
consequences. In healthcare, utilitarianism is society centered, what is good for the society.

 DEONTOLOGY
“An act is good only if it springs from goodwill”
It is patient centered, an act is good only if it springs from goodwill.
Ex: Decision based on the duties and obligations of a doctor to the best interest of the pt.
Deontology means duty, actions that obey rules are ethical. Morally obligatory regardless of their
consequences for human welfare

 TELEOLOGY
“All’s well that ends well”
Moral obligation from what is good or desirable as an edge to be achieved.
Ex: Stealing could be right or wrong depending on the consequences. Why do we take care of people? So we
come up with teleological explanation to help them achieve optimal health

 CARING
“Promote the common good or the welfare of the group”

Ethics is the philosophical study of morality

MORALITY – application of ethics, the guide to good or right conduct. To do what are the best reasons for doing
good.
“Behavior in accordance with custom or tradition and usually reflects personal or religious beliefs”
A person who is moral has the willingness to do the right thing is what morality is all about.
Morality protects the life and is respectful of others

VIRTUE
 Moral goodness
 Person rather than action base. It’s a moral character of the person caring out an action
- A good person is someone who lives virtuously, who possesses and lives the virtues
 It is a behavior that shows higher moral standards behaving in the right manner
Characteristics
 Compassion
 Discernment
 Trustworthiness
 Integrity

ETHICAL PRINCIPLES – that would play a role in solving ethical dilemmas that nurses may experience in their practice
 Autonomy
respect for individual’s liberty, it could mean independence, respect for an individual’s right to self-
determination, self-reliance. The recognition that people have the right to make their own choices, hold
their own values and take actions based on their personal values and belief systems, respecting patient’s
wishes even when you do not agree with them. Autonomy is not an absolute right, under certain
circumstances, the individuals rights do not prevail over the rights of others. Idiv autonomy that does not
prevail Ex. When it interferes with the rights, the health, and well-being of another. Ex. A nurse has the right
to refute to render care to a pt, bec of religious beliefs. However, if the safety of the pt is jeopardized bec of
that lack of care, the nurse may suffer legal consequences if care is not provided. In addition, the nurse has
an ethical obligation to be sure that pt has adequate care.
 Beneficence
to do good to others- It is the duty of nurses to help others by doing what is best for them.
 It means the duty to do good to others, it is an ethical principle with the idea that the nurse action
should promote good.

 Nonmaleficence
doing no harm
 An ethical principle that requires an intention to avoid harm or injury that can arise through acts of
commission or omission which is called negligence. One has the duty not only to do good, but also
not to inflict harm or to risk harm to others. A beneficent nurse acts with empathy for the pts and
staff and without resentment. A nurse who acts in bad faith or who makes false accusations
concerning a pt or colleague violates the principle of beneficence. In many instances, when an
individual does not desire what others determine to be in that persons best interest such as in a
parent or pt refuses treatment, the principles of beneficence and autonomy conflicts. Generally
speaking, in conflict situation involving pt care decisions, the principle of autonomy over right the
principle of beneficence.

 Justice
principle of fairness
 Justice is giving the person that which he or she deserves. Justice means right to fair treatment,
equitable distribution of healthcare benefits for instance, treating others equitably and with fairness
regardless of gender, religion or socio economic status so every pt has the right to be given equally
and fairly. Now allocation and rationing of resources are the most important ethical issues facing
nurses today. Allocation, is a decision society makes regarding how many of its health resources will
be devoted to a particular case. Rationing is a decision regarding who gets the healthcare resources
and who does not. Ex. Mass vaccination – they come up with a list of priorities who would be first
vaccinated .. so there is equal allocation and rationing of the vaccines.

 Fidelity
principle of keeping one’s word or promise
 The duty to do what one has promised. It is honoring commitments to clients to be faithful to
agreement and promises. Nurses make promises such as, I will find out for you about you pain
medication and nurses should take these promises seriously
2 TYPES
 Implicit Promise – promises that are implied, not verbally communicated. Ex. When pt comes in the
hospital they expect to be cared for
 Explicit Promise – those that we verbally communicate. Ex. Telling them that you’d be back with pain
meds.

 Respect for others

right of people to make decisions. Related to the principle of autonomy

 Confidentiality
protect patient privacy
 It is adherence to the standards of confidentiality that would help us in promoting a trusting
relationship with clients. Breaking confidentiality is both an ethical and legal issue. The ethical
consideration in confidentiality is that confidentiality is right of all pts . The code of ethics for nurses
asserts duty of the nurse to protect confidentiality of pts.
 However, there is also a legal consideration of confidentiality. Under the requirements of health
insurance portability and accountability act (HiPAA) health info may not be released without pt
consent except to those people for whom it is necessary in order to implement the treatment plan.
  Veracity
obligation to tell the truth
 Ex. Patient asking do I have cancer.

 Accountability
acceptance of responsibility

PATIENT’S RIGHTS
1. Participate in treatment decisions
2. Provide informed consent to treatment.
3. Receive considerate and respectful care.
4. Review records.
5. Be informed of hospital policies.
6. Expect reasonable and appropriate continuity of care after hospitalization.

LEGAL ASPECTS OF NURSING (nursing juries prudence )

Nurse’s legal responsibilities is to do no harm pt since a nurse is responsible for a pt care. The legal aspects
of nursing associated with helping and caring people in the healthcare industry have beome an important
pre requisite to be aware of. Cases of negligence had increased resulting to less people wanting to get into
the healthcare industry with fear of legal aspects and law suits. Thus, we have the nursing law, the nurse
practice act to regulate our practice. The legal aspects need to be applied by nurses in their roles and ensure
that necessary care is present in maintaining the health and safety of pts

ACCOUNTABILITY AND RESPONSIBILITY

Accountability
 Acceptance of responsibility,
 Being answerable for one’s nursing practice or actions.
client – you hold yourself out to the client as someone having the special knowledge, training and skills
associated with nursing
employer – As an employee you have the responsibility to work within the scope of employment as
defined by the employer. You are responsible to know your terms of employment and to work within
those terms
profession – as a nurse, you are accountable to meet the standards of your profession. These standards
may be contain in the nurse practice act
Responsibility
 Obligation to perform
duties
tasks
roles

LAW
Rule of conduct prescribed by the supreme power in a state commanding what is right and prohibiting what
is wrong.

TYPES OF LAW according to source of authority

 Divine law

 Human law

TYPES OF HUMAN LAW

 Private or civil law
Deals with relationship among private individuals.
  Public law
Deals with relationship between individuals and the government.
e.g. Criminal law, Administrative law
 International law
Regulates the intercourse of nations.

SOURCES OF LAW
 Constitutional Law - Supreme law of the land.
 Legislation (Statutory) Law - Laws enacted by any legislative body
 Common Law - Laws evolving from court decisions.

LEGAL PROTECTION IN NURSING PRACTICE

Good Samaritan Acts

A nurse who renders first aid or treatment at the scene of an emergency , acting in good faith, is relieved of
the consequences of the act.

LEGAL CONCEPTS & ISSUES IN NURSING

 Liability
An obligation or debt enforced by law.
e.g. Malpractice – A person who is liable of malpractice is usually required to pay for damages
 Damages
Compensation in money.
 Negligence
-Failure to do something which a reasonable and prudent person should have done.
- Neglect or failure
 Types of Negligence
 Commission - Wrong doing
 Omission - Total neglect of care – didn’t do anything.
 Examples of Negligence
 Burns. - comission
 Objects left in the patient’s body.
 Falls of elderly, children.
 Failure to observe & take appropriate action as needed.
 Failure to report observations to attending physicians. Omission
 Mistaken identity.
 Wrong medicine, wrong concentration, wrong route, and wrong dose.

 Res ipsa loquitor

 “the thing speaks for itself”
 Doctrine that infers negligence from the very nature of an accident or injury in the absence
of direct evidence on how any defendant behave
 Respondeat superior
 “let the master answer”
 Doctrine that a party is responsible for acts of their agents. A legal principle that allows the
court to hold an employer responsible for the actions of an employee when performing services for the
organization
 Force majeure
 “superior force”
 Frees both parties from liability or obligation when an extraordinary event beyond their
control, prevents them from fulfilling their obligations under contract.
 Malpractice
 Acts or conduct not licensed to perform resulting to injuries.
  Professional negligence. It evolves from negligence and the premise that all individuals are
responsible for the consequences of their actions
 Refers to any misconduct, lack of skill in caring out professional responsibilities.
 For malpractice to exist, 4 elements must be present
 Duty
 Breach of duty
 Causation
 Injury
 Examples of Malpractice
 Misdiagnosis of an illness.
 Birth injuries.
 Surgical complications.
 Prescription errors.
 Failure to provide treatment.
 Incompetence
 Lack of ability, legal qualifications or fitness to discharge the required duty.
 A nurse who performs a task for which she is not qualified can be sued and nurses are expected to
refuse an assignment for which they are not qualified.
 Five Rights of DELEGATION
 Right task.
 Right circumstances.
 Right person.
 Right direction/communication.
 Right supervision.

MEDICAL RECORDS
■ A means of communication
– To provide legal documentation
– To obtain third party payments (health insurance)
■ “If information was not charted, it was not done or observed”
■ CHARTING DONE BY STUDENT NURSES
When a nurse or clinical instructor counter signs the charting of the nursing student, he/she has personal
knowledge of information and that such is accurate and authentic.
■ INCIDENT REPORT
It is an administrative report required of nurses if there are violations of standards and policies whether or
not injury occurs.

CONSENT TO MEDICAL AND SURGICAL PROCEDURE

CONSENT
“free and rational act that presupposes knowledge of the thing – given by a person who is legally capable to
give consent
INFORMED CONSENT – written consent, and it should be signed to show that the procedure is the one consented to
and that “the person understands the nature of the procedure”
 3 requirements for informed consent
1. Voluntary
2. Informed
3. Indiv is capable of giving consent

Who must consent?

 Patient of legal age (21 y/o above)
 Parents give consent of minors (below 21 y/o)
 Mentally & physically competent
 Parental consent is not needed if the patient is married or emancipated
Refusal to consent
 Patient who is mentally and legally competent has the right to refuse. Ex. The touching of her body

TORT Law
 A ‘private or civil wrong or injury”
 Involves malpractice and negligence cases which many take time to learn
 TORT- wrongful act, committed against a person or property. It could be intentional or unintentional that
causes harm.
A Tort can be:
a. Denial of person’s legal rights.
b. Failure to comply with public duty.
c. Failure to perform private duty that harms another person.

Unintentional Tort
 Malpractice.
 Neglect.

Intentional Tort
 Assault.
 Battery.
 Defamation of character

Tort Charges
 Assault.- threatened but not touched. Ex. Punching a pt face.
 Battery. – unwanted physical contact upon another person.
 False imprisonment. -
 Invasion of privacy.
 Defamation of character. (Slander or Libel )
o Libel – written defamation. Ex. Article, photo caption
o Slander – spoken defamation
o How to handle? Handle it with sensitivity and maturity. You explain you issues and concerns and
explain your stand. As Abraham Lincoln said, “truth is the best vindication against slander, do
not hold back, take the necessary actions”
 Fraud.

False Imprisonment
 Unjustifiable detention of a person without a legal warrant.
 Unjustified or illegal confinement of a person, preventing the person from moving or not allowed to
leave. It is making someone wrongfully feel that she cannot leave the place
 Ex. Confining the pt because the fam cannot pay the hospital bills
Use of Restraints
• Behavior is out of control
 • To prevent patient and others from injury
• Risk to the physical safety of patient and others
Use of Restraints
 In emergency situations
 Requires a physician’s order
 Nurses responsibility in the use of restraints: have to use constraints with caution and discretion. Need to
monitor and check the circulation such as skin redness around the restraints. Need to document the
observation and the behaviordisplayed
Types of Restraints
1. Mechanical – use of equipment like special mittens, belt, bedrails etc
2. Physical –holding pt to restrict the pts movement
3. Chemical - use of medications to calm the pt
4. Technological Surveillance – use of CCTV to monitor pts movement, door alarms etc.
5. Psychological – giving instruction just like taking away a persons lifestyle. Ex. You are not allowed to…

INVASION TO RIGHT OF PRIVACY AND BREACH OF CONFIDENTIALITY

■ RIGHT to PRIVACY
 Right to be left alone
 Right to be free from unwarranted publicity and exposure to public view
 Right to live one’s life without having anyone’s name, picture or private affairs made public against one’s will

ETHICAL and LEGAL ASPECTS of NURSING

SPECIFIC ETHICAL ISSUES RELATED TO THE NURSING PROFESSION

 Commitment to the patient

 Commitment to your employer
 Commitment to your colleagues
 Commitment to your personal excellence
 Commitment to the nursing profession
ETHICS is a concept that deals with moral issues of good and bad, based on societal norms.
 ETHICAL PRINCIPLES:
 AUTONOMY Respect patient’s wishes, even when you do not agree with them
 BENEFICENCE Actively seeking to do good,
 NONMALEFICENCE Actively seeking to do no harm.
 FIDELITY Honoring commitment to clients, colleagues and students, being faithful to one’s
commitments
 JUSTICE Right to fair treatment; fairness or equity
 VERACITY telling the truth
 Patient CONFIDENTIALITY
Ethical considerations: Confidentiality is right of all patients.
                                        Code of Ethics for Nurses asserts duty of nurse to
                                                   protect patient confidentiality.
          Legal considerations: Health Insurance Portability and Accountability Act (HIPAA) 2003, Health
information may not be released without patient’s consent, except to those for whom it is necessary in
order to implement the treatment plan.

DEFAMATION
Libel and Slander

ELEMENTS OF DEFAMATION
1. Defamatory Language - Anything that really harm a person’s reputation
2. Of and Concerning the Plaintiff – Defamatory statement must relate to the plaintiff
3. Publication to 3rd Party – Any kind of communication by any method when its communicated to one or more
people who understand it. Publication can be:
Intentional – where the defendants intent was to defame the person. Intentionally spoke or wrote something
about the plaintiff
Negligent – occurs when a person types up a defamatory email intending just to say that on their computer
4. Damage to Plaintiff’s Reputation – where slander and liable comes in .
Slander – Spoken – must prove special damages unless defamation falls in to slander groups
Libel – Written – no need for plaintiff to prove special damages general damages preassumed

Matter of public concerns

 5. Falsity
6. Fault

FALSE IMPRISONMENT
■ A crime that involves a person holding a victim against his or her will
■ The victim is simply not allowed to leave
■ The captor can face a civil lawsuit due to injuries the victim sustained, in addition to facing criminal
charges
■ Confinement of a person to a limited area. Robbery – preventing people from moving and leaving
the area

BATTERY – Harmful or Offensive contact

PROTECTION OF PTS CONFIDENTIALITY

■ Revealing the identity is a violation to the patients’ rights
■ Confidentiality of records that could identify subjects should be protected, respecting the privacy and
confidentiality rules in accordance with the applicable regulatory requirements