Translated from Indonesian to English - www.onlinedoctranslator.

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PRAYER LEARNING

"We are pleased with Allah SWT as my Lord, Islam

as my religion, and the Prophet Muhammad as a
Prophet and Messenger, O Allah, add to me
knowledge and give me understanding."
Ethical and legal aspects of maternity
nursing
Dwi Sri Handayani, M.Kep
Ethical Aspects of Maternity Nursing

The Code of Ethics for Nursing (American Nurses Association (ANA): is

Responsibilities of every nurse
Non-discussable standards of professional ethics
Understanding nursing & its commitment to society
Nurse Code of Conduct (ANA)
Code of ethics for nursing according to the American Nurses Association (ANA)
1. Nurses provide services with respect for human dignity and the uniqueness of
clients who are not limited by considerations of social or economic status, personal
attributes, or the nature of their health problems.
2. The nurse protects the client's right to privacy by upholding confidential
information.
3.Nurses protect clients and the public when their health and safety are threatened by
someone else's incompetent, unethical or illegal practices.
4.Nurses assume responsibility for the consideration and treatment actions carried
out by each individual.
5.Nurses maintain nursing competence.
6. Nurses exercise reasonable judgment and use individual competencies and
qualifications as criteria in seeking consultation, accepting responsibility, and
delegating nursing activities to others.

7. Nurses participate in activities in helping the development of professional knowledge.

8. Nurses participate in professional efforts to implement and improve
nursing standards.
9. Nurses participate in professional efforts to implement and foster working
conditions that support quality nursing services. 10. nurses participate in the
profession's efforts to protect the public against misinformation and
misrepresentation and maintain the integrity of nurses. 11. Nurses cooperate with
members of the health profession or other members of the community in enhancing
community and national efforts to meet public health needs.
Obstetrics and neonatal nurse ethical standards (AWHONN)
Obstetrics and neonatal nurse ethical standards (AWHONN)
• Use the ANA Nursing Code of Conduct to guide practice
• Seek available resources needed to help formulate ethical decisions

• Maintain confidentiality and protect the privacy of patient information consistent within legal
and regulatory parameters
• Act as a patient advocate in an appropriate manner and assist patients in developing
skills for self-advocacy
• Provide care in a non-judgmental and non-discriminatory manner that is sensitive to
patient diversity and patient baseline whenever possible

• Provide care in a compassionate manner that preserves the patient's independence,

dignity. safety and rights
• Report and seek to protect women and their infants from incompetent, flawed,
unethical or illegal health care practices
• Contribute to the resolution of ethical issues for women and fetuses or newborns or
family members, and in health care services or systems appropriate to their role
through participation in activities such as the AWHONN Resources ethics committee
(2009CA05).
SOURCE DR STATEMENT FLORENCE NIGHTINGALE
= PROFESSION Pledge

1. Help the sick 2.Help healthy

To achieve Maintain
good health his health

4. Help someone
Those facing 3. Help those who are
Death to live incurable
as optimal as possible To realize
Until near its potential
death
 Definition of Ethical Principles

• Ethical principles are defined as the basis for

nurses in making decisions about consideration
of consequences and general moral principles
when making clinical judgments.
• Ethical decisions made by nurses are based on
ethical principles of nursing which are supported by
ethical principles. However sometimes depending
on one's personal beliefs, values & experiences in
a particular situation, different choices can be made
involving the same dilemma.
 Continuation of Ethical Principles.....

• Some of the ethics related to patient

care include:
– The right to make their own choices.
– Respect for others: the principle that everyone is
equally important
– Duty to do well
– Duty not to make mistakes
– Justice in treating everyone
– The obligation to keep promises
– The obligation to tell the truth
– Do the best for each individual
 Moral and ethical principles in nursing
• Respect for autonomy: agreement to respect the right of others
to determine their own course of action; support for independent
decision making
• Non-maleficence: avoid harm or get hurt; core of medical
vows & nursing ethics
• Beneficence: good active promotion; best consideration for the
patient
• Justice: the promotion of justice in every situation; equitable allocation of
resources & treatment according to emergency, ethical principles, in making
clinical decisions
• Veracity: true or tell the truth
• Confidentiality: regarding patient information, the care of which can
be disclosed with the patient's consent, except when required by law
and duty
• Fidelity : This principle requires loyalty, fairness, honesty, advocacy &
dedication to patients. Fidelity refers to the concept of keeping
commitments and is based on caring neglect
 Ethical dilemma
• An ethical dilemma is a situation in which a
person needs to make a choice between two or
more choices where the choice is morally
acceptable and morally justifiable even though
there is a problem without a satisfactory
resolution (Beauchamp &
childress 2001; McConnell 2002)
• Most ethical dilemmas in nursing can be identified
according to the classification of moral ethical
principles that constitute the dilemma.
 Continuing the ethical dilemma...
• An ethical dilemma is a choice that has the potential to undermine
ethical principles (Lagana & Duderstadt, 2004)
• In nursing, ethical dilemmas are based on the
nurse's commitment to advocacy
• Actions taken for ethical dilemmas with full
responsibility and are part of the nurse's
concern are patient advocacy
• Advocacy is the responsibility of nurses in
meeting patient needs (Lagana, 2000)
• The advocacy role of maternity nurses is more focused on
pregnant women than fetuses but the needs of mother and
fetus are interdependent (Lagana & Duderstadt, 2004)
 Ethical approach
• Ethical considerations can assist nurses in resolving
ethical dilemmas. The following are the keys to an
ethical approach:
– Rights approach, focuses on the individual's right
to choose, the right to privacy, knowing the truth
& being free from injury
– Benefit approach, based on this approach,
ethical action is
give more good than bad
 An example of a clinical case of a perinatal ethical dilemma
• Bespoke treatment example: cesarean section ordered without indication
• Withdrawal of life support equipment, for example: removal of the ventilator in an emergency
patient at the request of the family
• Taking fetal organs or tissues for certain purposes or abortion
• In vitro fertilization and decision to dispose of the remaining fertilized eggs e.g. eggs
stored in the ovum bank, the owner of the egg wants to be discarded
• Allocate resources in prenatal care before the period of fetal life

• Fetal surgery
• Treatment of genetic disorders or fetal abnormalities found on prenatal screening
• Equal access to prenatal care
• Maternal rights versus fetal rights

• Excellent medical care for pregnancy complications

• Using the organs of the baby's anencephalic
• Genetical manipulation
• Clone
• Surrogacy mother (surrogate mother)
• Drug test in pregnancy
• Sanctity of life versus quality of life for very premature or severely disabled infants
• Substance abuse in pregnancy
• survival line: for resuscitation or not
• termination of the fetus
• Preconception Selection by Gender
Legal Definition
Ethics

- The legal aspect can be defined as a feasibility

study that questions the validity of an action in
terms of applicable law in Indonesia.

- Legal is something that is considered legal by

law and law
 Legal concept

- Good judgment and sound decision making ensure

safe and appropriate nursing care.

- Legal guidelines to be followed: Laws, Laws (civil,

criminal, regulatory/administrative, and customary law
etc.)
 Legal Meaning

- CONSIDERATIONS IN MAKING THE

TRUTH OF A DECISION

-THE EXPECTED MODEL OF BEHAVIOR

& STANDARDS
 Legal dimension

Nurses should know about the laws that govern

nursing practice such as:

1. Provide certainty that decisions and

actions taken are in accordance with
legal principles.

2. Protect nurses from liability.

 What is a legal issue
...
- Public awareness of their rights in humane
health services is increasing

- Professional care providers, which are safe,

effective and patient-friendly.

- If this expectation is not fulfilled, then the

community will take legal action to defend
their rights.
 Advanced....

- Clients have a legally recognized legal

right to obtain safe and competent
services.

- The legal and ethical concerns raised by

consumers have changed the health care
system.
 Advanced...

• Policies that exist within the institution

establish appropriate procedures for
obtaining client consent for the
treatment carried out.

• Establish various ethics committees to

review professional practice and provide
guidance when client rights are threatened
 Advanced...

-More attention is also paid to advocacy

clients so that health care providers are
more serious about continuing to provide
information the client and his family are
responsible for the actions taken.
 Nursing Ethics Legal Issues
• Malpractice • Pregnancy and abortion

• Action approval contracts.

• Incident and risk • Abortion problem.

management • Controlled substance.
• Command not resuscitated. • AIDS mother.
• Surrogate Mother
 Malpractice

Malpractice refers to an act of negligence

committed in a profession or occupation
that requires professional technical skills.
 Elements of malpractice

• The nurse's duty to the client to

provide care must follow standard
standards.

• Violation of the nurse's duties when there is an injury

to the client

• Causal relationship between infringement of duties

Example of malpractice article “traditional culture in”
Action approval

Consent to action is an
agreement made by the client to
accept a course of therapy or
procedures after complete information
including the risks of therapy and the facts
associated with the therapy have been
given by doctor
Nurse's responsibilities

In completing the approval of action:

1. Witness the agreement between the client and the
doctor.
2. Ensure that the client really
understands.
3. Witness the client sign the
action agreement.
4. The nurse writes witness.tt on
the form
 The main elements of the agreement

•.
- Consent must be given voluntarily.

- Consent must be given by an individual who has

the capacity and competence to understand the
action.

- The client must be sufficiently informed to

be the primary decision maker
 Basic Informed consent

- Basics of Informed consent Law No.

23/1992 on health
- Article 53 paragraph (2) and Regulation of the Minister of

Health of the Republic of Indonesia NO 585, concerning

approval of medical action.

Pregnancy and abortion contracts

- Some states have statutes preventing

parental guardianship agreements from
being enforced.
- Indonesia - has not been regulated in detail.
- Other countries - baby sales statutes.
- Prohibition of selling babies.
- The adoption statutes prohibit a mother from
giving consent to the adoption of a child
before birth.
 Abortion problem

•- .Abortion is a fundamental right to privacy, free

to terminate the pregnancy in the first trimester
as long as the maternal risk is less.

- In the second trimester, it becomes a threat to the

protection of maternal health.

- In the third trimester abortion is prohibited,

except for the protection of maternal health
 Controlled substance

- Includes the use of substances such as

narcotics, depressants, stimulants, and
hallucinogens.

- Nurses can administer controlled

substances under the direction of a
certified doctor or nurse who has the
authority to prescribe.

- Substances must be controlled and maintained

safely.
 AIDS

- AIDS client care has legal implications for

nurses, for blood and fluid precautions.

- Standard precautions as protection.

- Infected individuals, protected under the

law people with disabilities, reduce
discrimination against affected nurses
 Euthanasia

- A painless act that causes the death

of a person suffering from an
incurable disease

- Euthanasia is called mercy killing

- Euthanasia in terms of law is a

wrong act
.
Command not to resuscitate

Physicians may order not to

resuscitate a patient who is in a
terminal illness or expecting death.
The importance of case law. public

1. Public health protection.

2. Advocacy for human rights.
3. Regulate health and financial
services.
4. Ensure professional
responsibility for services.
Nurses as risk managers

- Minimize risk in providing care to

clients.
- Nurses reduce the possibility of clients being
harmed financially and emotionally due to
inappropriate care.
- Ensure a safe environment for clients, and
help clients avoid lawsuits
 Risk Management

A system to ensure proper nursing care,

the steps involved in risk management
including identifying risks that may occur.

For example: influencing the client to

fall, analyze, act to reduce, evaluate
the steps taken.
 Professional engagement

- Nurses are involved in professional organizations.

- There is a nursing committee that can
directly see nursing practice.
- Nurses must be able to represent client
care and perspectives on the board.
- Nurses' views will become stronger and more
effective if managed cohesively
 Legal basis for practice legislation
nursing

Some of the laws that protect practitioners and

recipients of nursing practice in Indonesia are as
follows:
1. Law No.23 of 1992 concerning health, ninth part article 32 (healing of
disease and recovery)
2. Law No. 8 of 1999 concerning consumer protection
3. Minister of Health Regulation No.159b/Men.Kes/II/1998 concerning
Hospitals
 Advanced...

- Minister of Health Regulation No.660/MenKes/SK/IX/1987 which

is accompanied by a circular letter from the Director General of
Medical Services No.105/Yan.Med/RS.Umdik/Raw/I/88
concerning the application of standard nursing practice for
health nurses in hospitals.
 Carry on........

- Kepmenkes No.647/SK/IV/2000 on
registration and practice of nurses and
revised by Decree of Kepmenkes
No.1239/Menkes/SK/XI/2001 concerning the
registration and practice of nurses.
 ETHICAL AND LEGAL PROBLEMS

- LIGHT
Talking about client secrets
Screaming at clients
Not maintaining privacy
- COMPLEX
Giving the wrong medicine
Refuse to take action
 Treatment Refusal

a. The client's right to refuse treatment is

based on the principle of autonomy.

b. the client's right to refuse

treatment and the right to die
challenge the values of some
health care providers.
 Examples of ethical dilemma cases

• Case Example 1:
A certain woman has been married for 4 years and
really want to get pregnant. She is finally pregnant and
happy & looking forward to the birth of her baby. At 29
weeks gestation, she developed severe preeclampsia &
termination of pregnancy can not be avoided. It was a
difficult decision for the woman and her husband who had
been waiting for this pregnancy. Termination of pregnancy
according to the woman & her husband is not an option
because it is against their faith. After much counseling, the
woman & her partner received consent for termination of
pregnancy but this bothered them for a long time
 Case Example 2
• A pregnant woman being followed up at the heart clinic for management of
congestive heart disease
class II was treated with difficulty breathing. She is Para 0 + 2 gravida 3.
Gestational age is 12 weeks
via ultrasound. Echocardiogram showing pulmonary hypertension in pregnancy. After a
comprehensive assessment by cardiologists and obstetricians, the medical team
concludedtermination of pregnancy would save the woman's life. The woman refused
to consent to the termination after being given a detailed report of her physiological
changes and life's fate.
• She was subjected to several counseling sessions but her final decision was to have
a baby. She is saved in
counteract drugs (digoxin, lasix, and ceftriaxone), close monitoring of vital signs
paying attention to
dyspnoea. He was advised to maintain complete rest and be treated in a sitting
position. Daily leg exercises are performed to prevent deep vein thrombosis.

• At 28 weeks pregnant she started to get worse but still she couldn't agree to the
termination. Tim's health is stuck, relatives are involved but he can't accept for
approval. Family counseling was carried out progressively but all in vain. Family
members are also expecting a baby from this woman. Then she succumbed to death
while still pregnant.
Ethical dilemmas on ethical principles and problem solving examples
case 1 and 2

• Dilemma: In scenarios 1 and 2 above the dilemma faced is:

Autonomy and respect for people and kindness. In Kenya, the Criminal Code, as amended in 2010
(article 26), generally prohibits termination of pregnancy. Termination of pregnancy is legally
allowed to save a woman's life, to maintain physical health and maintain mental health. Termination
of pregnancy must be carried out by a certified physician, with the consent of the woman and her
partner. Two medical opinions, one of which must be from a doctor who has treated the woman and
the other from a psychiatrist, are required before termination of pregnancy is carried out.
Termination of pregnancy must also be done in a hospital.
• The ethical need for autonomy need not conflict with the physician's overall ethical
obligation to the principle of generosity; that is, every effort should be made to include a
commitment to informed consent in a commitment to provide medical benefits to patients
and their respect for them as whole and tangible persons.
 How nurses participate
in making ethical decisions
• The ethical decision-making model is the same as the nursing process such as
assessment, diagnosis, goals/interventions, implementation & evaluation
• The steps:
1. First, examine whether the ethical dilemma is related to a health-focused decision or one that
requires a response. Does it require moral sensitivity (monitor ethical situations that occur)
& moral character (action professionally & ethically)
2. Second, it is very important to collect basic data including identifying stakeholders,
their agreement decision capacity and sociocultural considerations
3. Third, explore the potential options. is a real situation in a dilemma between "good &
bad" or between both "good" or both "bad". So we have to identify who is the
decision maker? Can the anticipated outcome of each action be carried out? For
example, the chosen choice is the best choice for all parties

4. Fourth, focus on the most appropriate implementation of the choice

5. Fifth, evaluate the outcome and determine if any additional actions are
indicated

Basically, in making ethical decisions, it must be based on the appropriate professional code of ethics
ANA(ANA, 2001)
 Strategies for making decisions
ethical
• Ethical decision-making process:
Ethical decision making is a step to step process
analytical and intellectual reasoning used in making choices in
ethical problem situations. So, ethically responsible reasons are
rational and systematic. It is the application of a problem solving
process guided by ethical principles and codes. The best ethical
decisions are those that protect the best interests of the client
and also preserve the integrity of all involved. An ethical
dilemma is a difficult moral problem involving two or more
mutually exclusive, morally right causes of action. A nurse may
not be sure what action to take when in a dilemma.

The following steps can help guide a nurse's decision-

making:
 Steps in decision making
ethics in nursing
• Process identification or ethical clarification
Dilemma: This is described as identifying the problem. The questions asked may include:

whose problem is it? what is the purpose? who should make the decisions? affected by the decision? what are
the ethical and moral principles associated with the problem?
• Collect additional data:
To analyze the causes and consequences of the problem, get as much detailed information about
the situation as possible to enable you to make informed
decision. [Describe the situation that gave rise to the problem, the main people involved, their views and interests,
the client's overall nursing, medical and social situation, the legal and administrative relevance of staff
considerations.
• Explore optional solutions to this problem:
Identify options. Identify all possible courses of action open to you and weigh the results of each when
considering the immediate consequences to the people involved as well as the long-term consequences
for institutions and society.
• Make a decision: Think about the options identified.
Some will be more worthy than others. Determine which option is most acceptable to you. The best
decisions are confirmed as one, which is consistent with one's values and does not involve risking one's
life or breaking the law. In terms of professional ethics, a good decision is one that is in the best interests
of the client and at the same time maintains the integrity of all involved. These decisions should be guided
by ethical principles and professional codes. Rely on their principles, which you think are most important

and the one you feel most certain.

 Further steps...
• Act:
Apply the selected solution. Bring the decision. You
can collaborate with other people
apply the decision as you did to identify
choice.
• Evaluate the results: After acting on a decision,
evaluating its impact, compare the
actually with the anticipated results. Is your choice
of action the best or would there be a better
alternative. Through feedback mechanisms, ethical
decision-making is primarily an educational
process. Responsible ethical review is rational and
systematic, based on ethical principles

and code of ethics

 Strategies that help in
make ethical choices
• Know your professional values and values and don't compromise
either.
• Know your accountability. Your role as a client advocate
will help you to prioritize your responsibilities and
accountability.
• Recognize the accountability of others, collaborate and
negotiate by being able to prioritize what nursing actions are
the most important
• Ethical judgment relies on rational thinking rather than emotion,
from sound basic knowledge,
• Don't be disappointed that not everyone lives up to your
standards, don't force yourself into other people's
values.
 Nurse's role in decision making
ethical
• Identification of ethical problems in practice
• Advocacy on behalf of patients and families.
• Inform and involve patients in ethical decisions
• Participate in formal and informal processes that address ethical issues
• Evaluate the process The nurse's role in clinical ethical decision-making
• Recognizing that nurses have dual responsibilities and rights to care for
all people, we believe that nurses have a responsibility to:
– Be aware of personal values and how they relate to professional practice.

– Develop basic knowledge of ethical principles and

concepts.
– Understand the processes and resources available to assist them in
ethical decision making.
– Be aware of legal and health changes and should take this into
account during ethical decision making.

• By fulfilling these roles and responsibilities, nurses

integrate ethics into their practice.
 Conclusion

• In caring for pregnant women, practitioners must

recognize that in most cases, the interests of the pregnant
woman and her fetus converge rather than diverge. There
is a need to promote the health of pregnant women
through advocating for healthy behavior. Policymakers,
legislators, doctors and nurses/midwives must work
together to find constructive and evidence-based ways to
meet needs. Ethical dilemmas that arise must be handled
in a way that the safety of the mother's life is the top
priority. This should include the development of safe,
available and efficacious services for women at risk and
their families.
 reference list
• Chelagat D., et al. (2016).Ethical Dilemmas in Reproductive Health: Experiences of 10 Midwives.
International Journal of Humanities and Social Science, vol.6(2)
• Callister, LC & Robinson, TS (2011). An Overview of ethics in maternal –child nursing)Lippincott
Williams & Wilkins, vol.36(3)
• Aderemi. (2016).Ethical Issues in Maternal and Child Health Nursing: Challenges Faced By
Maternal and Child Health Nurses and Strategies for Decision Making. International Journal of
Medicine and Biomedical Research, Vol. 5(2)
• Amir & Hanafiah, (1999). Medical Ethics and Health Law, third edition: Jakarta: EGC.
• Craven & Hirnle. (2000).Fundamentals of nursing. Philadelphia. Lippincott
• Huston, CJ, (2000). Leadership Roles and Management Functions in Nursing; Theory and Application; third
edition: Philadelphia: Lippincott.
• Kozier. (2000).Fundamentals of Nursing : concept theory and practice. Philadelphia. Addison
Wesley.
• Decree of the Minister of Health of the Republic of Indonesia Number 1239/Menkes/SK/XI/2001, Concerning the Registration of Nurse Practices.

• Slide from Ni ketut Mendri. TRENDS & LEGAL ISSUES IN NURSING SERVICES.
Gadjah Mada University
 Reference list
• Leah Curtin & M. Josephine Flaherty (1992). Nursing Ethics; Theories and
Pragmatics:Maryland: Robert J. Brady CO.
• Priharjo, R (1995). Introduction to nursing ethics; Yogyakarta: Kanisius.
• Redjeki, S. (2005). Nursing ethics in terms of law. Seminar materials are not
published.
• Supriadi, (2001). Medical Law : Bandung: CV Mandar Maju.
• Staunton, P and Whyburn, B. (1997). Nursing and the law. 4th ed. Sydney: Harcourt.
- Sampurno, B. (2005). Malpractice in medical services. Seminar materials are
not published.
- Soenarto Soerodibroto, (2001). KUHP & KUHAP are equipped with the jurisprudence
of the Supreme Court and Hoge Road: Jakarta : PT.RajaGrafindo Persada.
- Tonia, Aiken. (1994).Legal, Ethical & Political Issues in Nursing. 2ndEd.
Philadelphia. FA Davis.
- Consumer Protection Act number 8 of 1999. Jakarta: Sinar Graphic.
 Case 3
• A 40-year-old woman, G5P4A0 presented to the delivery unit
complaining of lower abdominal pain and liquor drainage four hours
earlier. She is a single mother who works as an ordinary laborer in a
flower plantation referred from a pharmacy and has never attended an
antenatal clinic. On examination, fundal height was 24 weeks, cervix was
dilated 7cm, presentation was cephalic, with strong contractions lasting
45 seconds. The diagnosis of preterm labor at 24 weeks was made. The
woman was accepted for monitoring. After 1 hour, she gave birth to a
600 gram baby boy withanencephaly. As soon as the woman saw the
baby, she breathed a sigh of relief and asked “will this baby survive?
“APGAR score is 4 in 1 minute. I replied, "The baby is alive and we will do
our best." But first we have to admit your baby to nursery for further
treatment. "He touched the baby and asked me to leave him with him. "I
have 4 children, God wants to take this one, so please let it go," he said
 Case Question 4
• An 18-year-old woman had a premature birth of
twins. No. 1 weighed 750 grams and died; the
no.2 weighed 650grams and survived but
required continued neonatal care. After delivery
the parents are advised to be referred to a facility
that can offer advanced neonatal care. They
refused to be transferred as they believed the
baby would not survive and they also had limited
financial resources for any anticipated costs
associated with the transfer. One day they
wanted to be allowed to go home and leave the
baby dead.
 Case Question 5
• A patient X is a 26 year old primigravida, who came at 36 weeks gestation for the
antenatal clinic at the hospital, she explained that she wanted to be induced the next
day because her mother was seriously ill scheduled for surgery in the next three
days and the prognosis was poor. The patient reported that he would have liked his
mother to see her baby before the operation. He and his immediate family were
concerned that his mother might not survive the operation. She had started her
antenatal clinic at 24 weeks, and all parameters were within normal range.
Supportive family members include the most basic husband, aunt and mother.

The client was worried especially when talking about the woman's condition and waiting for the
operation.

• the client insists that she wants a baby born before her mother's surgery,
given that her client is the only child of the ailing mother. After consulting
the medical officer in charge we were forced to do it, at the request of the
client and the team decided to persuade him the next day.
 Case Question 6

• Mother, age 26, P3A0, suffered a second

degree perineal tear during delivery.
She refused to have perineal stitches, the
mother claimed that in all her previous
pregnancies, she had never had stitches.
Despite explanations about the
importance of repairing the perineum,
she still decided not to have stitches.
 Case Question 7

• A 22-year-old patient G2P1A0 was admitted to

the maternity ward as a referral from a
hospital in a rural district. On examination the
patient had vaginal bleeding, was very pale
and no fetal heartbeat was heard on
auscultation. Fetal parts can be felt on
abdominal palpation. The patient has a
history that two years ago she had a cesarean
section due to uterine rupture and the baby
was born extracted
 Case 9
• During my practice, I met a childless couple
despite being in a relationship of twelve years.
The woman has been treated for primary
infertility for five years during which she did
several examinations
without identified problems can be found. The
husband also had an examination at the same clinic
and was diagnosed with severe azoospermia. They
were then informed and counseled about the
possibility of them not having children of their own
unless adopted.
 Case Question 10
• A mother is diagnosed to lose her first born child
because she is diagnosed with fetal distress in the
first stage of labour. There are two options for

management which includes an ethical dilemma. She

was transferred to another hospital 150 kilometers away
or had a caesarean section performed by her husband
who was the only doctor at the hospital. The husband
finally decided to do a C-section and save the life of the
mother (his wife) and their baby instead of moving them
and possibly losing the baby on the way.
 STUDENT TASKS
• Sound “explanation of ethical dilemma case
study analysis” ETHICAL DILEMMA CASE STUDY
EXPLANATION.mp3
• Determine what ethical principles the patient
maintains and the nurse must respect in case of
• What ethical dilemma did the nurse experience in this case?
• Data on cases that raise ethical principles or
dilemmas
• Action solutions for good and bad plans of
decisions
• Implementation and evaluation