BIOETHICS
institution or hospital are
LEGAL ASPECTS AND THE NURSE
I. Introduction
● As nurses begin their professional
obligations, their legal
responsibilities begin as well.
Their license to practice attests
that they are qualified under the
law to practice their profession.
● The Philippine nursing act of
2002 is the best guide the nurse
can utilize as it defines the scope
of nursing practice.
● There are also standards of care
that may be used as criteria in
evaluating their work. Nurses are
enjoined to be familiar with the
Philippine nursing law, the
standards of nursing care, and
other loss which affect nursing
practice and their code of ethics
nurses need to be afraid of laws.
This should be understood so that
their scope and limitations may
be defined and identified. When
these are clarified, performance
of daily tasks are assumed with
more confidence and safety.
II. Responsibility and Accountability
for the Practice of Professional
Nursing
● When nurses undertake to
practice their profession, they are
held responsible and accountable
for the quality of performance of
their duties.
● Nurses employed in an agency,
directly responsible to their
immediate supervisors.
● Private duty nurses, being
independent practitioners are
held to a standard of conduct that
is expected of reasonably prudent
nurses.
● Standards serve as benchmark
against which to plan, implement
and assess quality of services and
to show that nursing is
accountable to society, to
consumers of nursing services
and two governments as well as
to the profession of nursing itself
and individual members.
III. Definition of Legal Terminologies
1. Nursing Jurisprudence
● Comprises all laws, rules,
doctrines, and principles, legal
opinions, and decisions of
competent authority regarding
governance and regulation of the
practice of nursing.
2. Nursing legislation
● Is the act or process of making
laws affecting the science, art,
and practice of nursing.
3. Due process of law
● Refers to the general law of the
land, a law which hears before it
condemns, which proceeds upon
inquiry and renders judgment
only after trial.
4. Defendant
● The accused person in a criminal
case.
 5. Plaintiff
● The party who institutes legal
proceedings.
6. Subpoena
● An order that requires a person
to be present at a specific time at
a specific place to testify as a
witness.
7. Subpoena Duces Tecum
● A subpoena that requires a
witness to bring
documents/papers in his/her
possession.
8. Summon
● A writ commanding an authorized
person to notify a party to appear
in court to answer a complaint
made against him/her.
IV. Legal Liabilities in Nursing Practice
A. Criminal Aspects
● Crimes - are acts contrary to law,
statute; wrongs committed
against the state, punishable by
the state and usually demonstrate
that intent was present.
● Criminal Actions - is one
instituted and prosecuted before
the courts for the punishment of
a crime. In the courts, offenders
will have to answer for any
criminal liability incurred.
V. Person in an Criminal Act
Criminal Conspiracy - occurs when 2 or
more persons agree to commit a crime.
Elements of Crime:
a.) Criminal Act- any crime, including an
act, omission, or possession under the
laws a state or unit of general local
government, which poses a substantial
threat of personal injury,
notwithstanding that by reason of age,
insanity, intoxication or otherwise the
person engaging in the act, omission or
possession was legally incapable of
committing a crime.
b.) Criminal intent - generally this
means that you acted in ‘’mens rea’’ or
guilty mind. The burden on proving
mens rea is placed on the prosecution to
show that you acted in a state which you
intended to do criminal activity.
(Planning, tools for criminal behavior,
past behavior, etc)
VI. Classification of persons who are
criminally liable
1. Principals
● Are those who take a direct
participation in the execution of
the act, or those who directly
force or induce others to commit
the act.
● A person who participates in a
crime through any of the
following actions:
a.) by direct participation in the
execution of the crime doer of the act.
b.) by inducement or by directly forcing
or paying another person to commit the
crime.
c.) By cooperation or participation in the
offense, by an act which the crime would
have not been accomplished.
2. Accomplices
● Are those who, not being
principals by direct participation,
inducement or cooperation
 through another act essential to
the consummation of the crime,
cooperate in the execution of the
offence by a previous or
simultaneous acts. They are also
known as the accessories before
the fact.
a.) Accessories - are those who
have knowledge of the
commission of the crime without
having participated therein either
as principals or accomplices, take
part subsequent to its
commission in any of the
following manner:
1.) By profiting themselves or
assisting the offenders to
profit by the effects of the
crime.
2.) By concealing or
destroying the body of the
crime, or the effects or
instruments thereof, in
order to prevent its
discovery.
3.) By harboring or assisting
the escape of the principal
of the crime, they are also
known as the accessories
after the fact.
VII. Negligence
● In a legal sense, it is typically
considered to be a failure to act in
accordance with or an action that
is in opposition to what a
reasonable person would do.
● Criminal Negligence - a flagrant
and reckless disregard for the
safety of others or wilful
indifference to the injury that
might result in personal injury or
death.
VIII. Crimes related to nursing practice
Misdemeanor
● Is a term used to express every
offence inferior to felony and
punishable by indictment.
● Is actually a term applied to all
those crimes and offenses for
which the law has not provided a
particular name.
● Felonies - are acts or omissions
punishable by law which may be
committed not only by means of
deceit (dolo) but also by means of
fault (culpa).
● There is deceit when the act is
performed with deliberate intent.
Deliberate intent includes 2
elements without which there
can be no crime arising from a
criminal act or omission.
a.) freedom - a person who acts without
freedom cannot act with deliberation.
b.) intelligence - without intelligence a
person is incapable of distinguishing
what act is good or bad and what is right
or wrong. That is why the law exempts
from criminal liability an imbecile, an
insane person, unless the latter acted
during lucid intervals and a child over 9
years of age but under 15, unless he has
acted with discernment, revealing
insight and understanding.
Felonies according to style of execution:
a.) Consummated - when all the
elements necessary for its
accomplishments are present.
b.) Frustrated - when the offender
performs all acts of execution which
would produce the felony as a
consequence but which would,
nevertheless, not produce it by reasons
not independent of the will of the
perpetrator.
c.) Attempted - where there is an
attempt to start the offense but it was
thwarted.
CIVIL ASPECT
1.) Torts
● Is a legal wrong, committed
against a person or property
independent of a contract which
renders the person who commits
it liable for damages in a civil
action.
● The person who has been
wronged seeks compensation for
the injury or wrong he has
suffered from the wrongdoer.
Examples:
a.) Assault and battery
b.) false imprisonment or illegal
detention
c.) invasion of right to privacy
d.) Defamation
Elements:
a.) There must be damage to the
offended party.
b.) there is a legal wrong or fault, or
negligence arising from an act or
omission for which the offender must
account.
c.) There is the nexus of cause and effect
between such fault or negligence and the
damage.
Damages done to an offended party
1.) Actual or compensatory damages
- the value of the actual loss and
the profits which were not
obtained.
2.) Moral damages - physical
suffering, mental anguish, serious
anxiety, besmirched reputation,
wounded feelings, social
humiliation, etc.
3.) Nominal damages - vindications
or recognition of the right of the
plaintiff which has been violated
by the defendant and not for the
purpose of indemnifying the loss
suffered by the plaintiff.
4.) Temperate or moderate damages
- more than the nominal but less
than compensatory damages.
Professional Negligence
● Refers to the failure of a nurse to
behave or act as a reasonable
prudent nurse who is charged
with a duty to use standard of due
care, and to foresee harm that
may result from failure to meet
such standard which may be
proximate cause of injury to
another person or his property.
The burden is on the patient to
prove negligence by the nurse.
 ● Negligence - refers to the
commission or omission of an act,
pursuant to a duty that a
reasonably prudent person in the
same or similar circumstances
would or would not do and acting
or the non-acting of which is the
proximate cause of injury to
another person or his property.
The elements of professional negligence
are:
1.) Existence of a duty on the part of
the person charged to use due to
care under circumstances.
2.) Failure to meet the standard of
due care.
3.) The foreseeability of harm
resulting from failure to meet the
standard.
4.) The fact that the breach of this
standard resulted in an injury to
the plaintiff.
● Failure to foresee harm to the
person injured, following from
ignorance of the admonition born
of the provisions, constitutes in
fact a negligence.
● Article 19 of the civil code states
that one shall act with justice,
give every man his due, observe
honesty and good faith.
Common acts of negligence for which a
nurse may be held liable:
a.) Injury to a delirious patient under the
care of a nurse.
b.) burns as a result of the negligent
administration of how water bags, heat
lamps, vaporizers, or sitz baths.c.) any
object left in a patient's abdomen in the
course of a surgical procedure.
d.) Careless execution of doctor’s orders
e.) Administering medicine without the
doctor’s order
f.) failing to report case history and
observations about the patient to the
attending physician
g.) carelessness in caring for clients
belongings. Ex: Dentures, clothing,
valuables, wallets, watches etc.
h.) Ignoring complaints of chest pains,
causing the death of the patient.
i.) mistaken identity
j.) failure to report observations to
attending physicians
k.) Failure to exercise the degree of
diligence which the circumstances of the
particular case demands.
l.) wrong medicine, wrong
concentration, wrong route, wrong dose
m.) defects in the equipment such as
stretchers and wheelchairs may lead to
falls thus injuring the patients.
n.) Errors due to family assistance
o.) Administration of medicine without a
doctor’s prescription
Doctrine of ‘’res ipsa loquitor’’
● The thing speaks for itself when a
thing which has caused an injury
is shown to be under the
management of the party charged
with negligence, and the accident
is such that in the ordinary
course of things it will not
happen if those who have such
arrangement use proper care
then the accident itself affords
reasonable evidence in the
 absence of explanation by the
parties charged that it arose from
lack of proper care.
3 conditions are required to establish a
defendant’s negligence without proving
specific conduct. These are:
1.) That the injury was of such
nature that it would not normally
occur unless there was a
negligence act on the part of
someone;
2.) That the injury was caused by an
agency within control of the
defendant and,
3.) That the plaintiff himself did not
engage in any manner that would
tend to bring about the injury.
Doctrine of respondeat superior
● ‘’Let the superior answer’’ for the
acts of his agent. This doctrine
applies only when the relation of
master and servant is shown to
exist between the wrongdoer and
the person sought to be charged
for the result of some neglect or
wrong at the time and in respect
to the very transaction out of
which the injury arose. It does
not apply when the injury occurs
while the servant is acting
outside the legitimate scope of
his authority.
Doctrine of Force Majeure
● Means ‘’irresistible or superior
force’’ this refers to facts or
accidents which human prudence
can neither foresee nor prevent.
● E.g: earthquakes, storms
Malpractice
● Refers to any professional
misconduct, or a bad, unskillful
practice or any practice contrary
to law or established rules and
regulations whereby the health of
a person is injured.
● Medical malpractice is
professional negligence by act or
omission by a healthcare provider
in which care provided deviates
from accepted standards of
practice in the medical
community and causes injury or
death to the patient, with most
cases involving medical error.
Common Acts of malpractice in Nursing
a.) neglect of a nurse to use the required
skill and knowledge in the treatment of
a patient.
b.) ignorance, negligence or
unskillfulness resulting in some injury
to the patient.
c.) omissions of duty to a patient which
makes the nurse either civilly or
criminally liable; and
d.) failure to perform properly the duty
which devolves upon his/her
professional relation to the patient and
which results in some injury to the
patient.
1.) Duty - the duty of a nurse to
employ his/her training and skill
in the care of the patient
commences at the time his/her
employment is engaged by the
patient.
2.) Breach - of these professional
duties, of skill and care, or their
 improper performance by the
nurse resulting to damage;
3.) Injury - to the body or health of
the patient constitutes an
actionable nursing malpractice.
4.) Proximate cause - in nursing can
be divided into 2 inquiries:
a.) whether the nurses action, in fact
causes harm to the patient and;
b.) whether these are proximate causes
of the patient’s injury.
Incompetence - is the lack of ability or
legal qualifications and being unfit to
discharge the required duty.
● Although a nurse is registered, if
in the performance over duty she
manifests incompetency, there is
ground for revocation or
suspension over certificate or
registration.
● Liability of nurses for the work of
nursing aides
● Nursing aides perform selected
nursing activities under the
direct supervision of nurses.
● Their responsibilities usually
pertain to the routine care of
chronically ill patients. They are
therefore responsible for their
own actions.
● Nurses should not delegate their
functions to nursing aids since
the Philippines nursing Act
specifies the scope of nursing
practice of the professional
nurses.
● Nurses are enjoined to supervise
their subordinates and see to it
that they perform only those
which they have been taught to
do and those which they are
capable of doing.
● Liability for the work of Nursing
Students
● Under the Philippine Nursing Act
of 2002 R.A 9173, nursing students
do not perform professional
nursing duties. They are to be
supervised by their clinical
instructors in order that errors
committed by nursing students
will be avoided and/or
minimized, the following
measures should be taken:
1.) Nursing students should
always be under the
supervision of their
clinical instructor.
2.) They should be given
assignments that are at
their level of training,
experience, and
competency.
3.) They should be advised to
seek guidance especially if
they are performing a
procedure for the first
time.
4.) They should be oriented to
the policies of the nursing
unit where they are
assigned.
5.) Their performance should
be assessed frequently to
determine their strengths
and weaknesses.
6.) Frequent conferences with
the students will reveal
 their problems which they
may want to bring to the
attention of their
instructors or vice versa.
Discussions of these
problems will iron out
doubts and possible
solutions may be provided.
● It must be emphasized that
although nursing students are
not employees of the hospital,
they are entrusted with the
responsibility of providing
supervised nursing care to the
patients.
● The patients can expect that the
care given by these students will
be in a manner consistent with
that which a reasonably prudent
person will give.
● Both the clinical instructor and
the staff nurse in the clinical area
where nursing students are
assigned should coordinate in
assessing the competence of
nursing students before they are
allowed to give care to patients so
that the risk of injury to the same
will be avoided.
injury; the patient cannot bring
suit against the nurse.
● On the other hand, the nurse has
expressly given advanced consent
in performing a duty that involves
risk, such as caring for a
psychiatric patient or a patient
with communicable disease, the
nurse cannot bring suit against
the patient if she gets hurt or
contracts the disease since upon
accepting the case, the nurse
agreed to assume the risk of harm
or infection thereby relieving the
patient or his relatives from legal
obligations. This is termed as
‘’assumption of risk’’.
● Nurses therefore shall exercise
their sound judgement and utilize
standards of care in order to
prevent lawsuits or harm to
themselves.

Legal defense in Negligence

● The most common defense in a
negligent action is when nurses
know and attain that standard of
care in giving service and that
they have documented the care
they give in a concise and
accurate manner.
● However, if the patient’s careless
conduct contributes to his own