Ethical & Legal Issues in Canadian Nursing

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Chapter 1 Introduction to Nursing Law and Ethics

Learning Objectives
The purpose of this chapter is to enable you to understand:

•Why nurses must be familiar with the law and ethics

•The knowledge nurses require to practise according to ethical and legal standards
•The role of professionals in serving the public interest
•How and why the field of ethics has grown over recent years
•The challenges nurses face when dealing with complex legal and ethical issues
•Key ethical and legal issues that arise in the practice of nursing

Introduction
A century ago, before the nursing profession was regulated and before the technology available today
was in place, nurses had no need to concern themselves with the legalities of their practice. Although
there probably existed issues of negligence and malpractice, they were rarely considered because there
was absolute faith in the medical system. However, even in early nursing schools, the study of ethics
was deemed fundamental to the training of nurses. The major challenges faced at that time related
primarily to:

•Behaving appropriately in the new health care environment (primarily hospitals at that time)
•Recognizing one's own faults, biases, and personality traits (e.g., tendency toward anger,
impatience, ambition)
•Understanding the repercussions of misconduct, disloyalty, insubordination, and so on

Consider the following ethical issues identified in a textbook on nursing ethics first published in 1916
(Aikens, 1926):

Loyalty to the physician is one of the duties demanded of every nurse, not only because the
physician is her superior officer, but chiefly because the confidence of the patient in his
physician is one of the important elements in the management of his illness, and nothing should
be said or done that would weaken this faith or create doubts as to the character or ability or
methods of the physician on whom he is depending. (p. 25)

Aikens continues:

To learn to do the thing ordered punctually, when she is busy, when her own judgment opposes it
or when she feels it to be unnecessary; to refrain from arguing the case when she feels she has a
strong side to present; to make no grumbling comments about the order; to grasp the thought that
the thing ordered is to be done even if it be inconvenient and so difficult as to be well-nigh

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impossible—these are qualities to be coveted and cultivated in every nurse. To make for herself a
reputation for being faithful and dependable is possible for every nurse. (p. 66)

Much has changed over the past century. Today, nurses are expected to think critically, to offer
evidence-informed solutions, and to respectfully challenge physicians or other health care professionals
when they have concerns about the treatment plans of patients. Nursing has evolved into an
autonomous profession, distinct from medicine, resulting in increasingly complex ethical challenges
for nurses within the context of a more sophisticated and collaborative health care team.

Like other professionals, nurses operate within a set of professional standards as well as a framework of
legal and ethical rules and guidelines. These are aimed at ensuring the consistency, quality,
competence, and safety of health services, while preserving respect for individual rights and human
dignity. As part of their professional role, nurses make and act on decisions that relate to both
independent practice and collaborative relationships with other professionals; patients, clients, and their
families; government agencies; and others. For all of these decisions and actions, the nursing
professional must answer to individual clients or patients, their families, fellow health care team
members, regulatory bodies, employers, their communities, the profession, and society in general.
These multiple accountabilities may often be in conflict, posing challenges for nurses. Nurses,
therefore, require a sound knowledge base, including familiarity with the law, ethics, ethical theory, and
the workings of Canada's legal system; practical skills and reasoning skills; and a willingness both to
take risks and to be accountable.

Nursing, the Law, and Ethics

Introduction
Members of professional groups have an obligation to serve the public interest and the common good
because their roles, missions, and ethical foundations focus not only on the individuals they serve but
on society as a whole. Professionals have this authority, and they accept this responsibility, because of
their unique body of knowledge, skills, and expertise. Society has traditionally depended on
professionals as custodians of such fields of knowledge as health, law, and education. They are placed
in a position of respect and are accordingly given the power to engage in decisions that influence and
shape public policy, law, and societal norms. As technology advances and the issues society faces
become more complex, existing professions are becoming more specialized and new professions are
emerging (Jennings, Callahan, & Wolf, 1987).

In recent years, the field of ethics in health care has gained greater prominence because of the
increasing complexity and volume of ethical dilemmas, a result of the growing sophistication of science
and technology. Consider the rapidly evolving field of genetics. We are capable of predicting
congenital abnormalities and future illnesses at the embryonic stage of life. In this climate, questions
arise: Is it right to do this? What precisely are we capable of doing? And if we proceed, what are we to
do with the knowledge and information we gain? Advances in technology, too, have made it possible
for us to affect various life processes in ways that pose moral and legal questions for health
professionals,

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patients, and society alike. A growing awareness of patients' rights and a greater emphasis on respect
for individual autonomy have consequently led to the establishment of advocacy groups
representing the interests of various patient constituencies.

Nurses, in particular, have been challenged by an increasing number of ethical and legal concerns. As
they confront each new issue, it is easy for them to be confused by the often conflicting interplay of
ethics and law. Moreover, nurses must deal with these conflicts while providing quality, ethical care to
patients within the context of a health care system strained by limited funds and resources. More than
any other health professional, they are in sustained contact with patients in the home, in the community,
and in the institutional setting. Nurses fulfill the important task of supporting patients and their
families, as well as intervening or advocating on behalf of those patients when necessary. Their role
involves building professional and trusting relationships with people throughout the life continuum. All
of this must be achieved within the requirements of ethical rules and the law.

To aid them in the difficult decisions they make, nurses must have knowledge of ethics. Chapter 2
explores theories, principles, and decisional frameworks that guide nurses' ethical choices. This
material is not exhaustive but is intended only to provide nurses with a foundation in ethics. In Chapter
3, these theories will be applied to the Canadian Nurses Association's Code of Ethics for Registered
Nurses. This will begin the process of lifelong professional learning in ethics and provide a framework
for the specific ethical themes discussed in later chapters.

The Need to Know the Law

The situations nurses face as health professionals may involve clear institutional rules and procedures
or straightforward legal rules and statutes. Yet, many situations are more complicated and require
nurses to decide, from many possible alternative courses of action, the morally correct thing to do. At
times, nurses may face situations in which what they believe to be the most ethically and legally
correct course of action may not be supported by law, or in which they are clear on the right action but
are unable to act upon it. An example of an ethical solution that is opposed by law can be found in the
challenging and emotional debate surrounding euthanasia. One might believe that the most
compassionate approach is desirable when death is inevitable; however, the Criminal Code of Canada
clearly makes it an offence for a person to assist another person in taking his or her own life (Criminal
Code, 1985).

Society holds nurses to high standards of professional, moral, and ethical competence, but it also
affords them certain rights and privileges. The law strives to keep these competing interests in constant
balance. It regulates the education and licensing of nurses; the conditions of their employment; their
collective bargaining rights; their rights, duties, and responsibilities toward patients, physicians, other
health care professionals, the public, and each other; and a host of other matters. Furthermore, the legal
system provides a forum for resolving disputes and conflicts, which inevitably arise when these
divergent interests clash.

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Thus, for example, under occupational health and safety legislation in force in some provinces, a nurse
who is being made to work in conditions that are unsafe or even dangerous has recourse against his or
her employer. Likewise, a patient who has suffered injury or harm as a result of the negligence of a
nurse may commence a civil suit in the courts for damages against that nurse and the health care
facility.

In recent years, more attention has been paid to patient safety. There is a growing focus on the role of
systems versus the individual when harm occurs. The culture is evolving into one of blamelessness and
understanding in which nurses are obliged to disclose any harm that may have occurred to patients and
their families. There is also more recognition that nurses' work environments must be healthy and that
health care employers must ensure a work culture that is ethical, safe, and supportive. The ultimate aim
is to provide an environment with a low tolerance for disrespect, especially between nurses and within
the health care team.

As Canadian society becomes culturally more diverse, there is correspondingly more diversity among
patients as well as within the interprofessional team. Diversity in other forms (e.g., same-sex parents,
people with physical or psychological challenges) is becoming increasingly evident and understood as
well. Nurses therefore need a greater understanding, empathy, and respect for these differences and for
differences in values and beliefs.

There are many other reasons why nurses should familiarize themselves with the law and have a basic
understanding of Canada's legal system. First, the Canadian Nurses Association's Code of Ethics for
Registered Nurses1 (Canadian Nurses Association [CNA], 2008), which is discussed in Chapter 3, and
each provincial regulatory body have certain requirements with respect to nurses' level of professional
knowledge and skill. Failure to meet these requirements, or undertaking the practice of nursing without
adequate education, leaves the nurse open to disciplinary action from his or her provincial professional
governing body and, if the conduct is serious enough, the courts, by way of either criminal prosecution
(in cases in which the conduct involves a breach of criminal law), or a lawsuit (in which the nurse is
sued for negligence due to the breach of an accepted standard of nursing care). Chapter 4 outlines the
principles of Canada's legal system in order to provide nurses with a basic understanding of what often
seems an obscure and confusing institution. The roles of legislatures and executive branches of
government are briefly discussed, as are some of the legal concepts and principles applicable to nursing
law. These provide a framework for the chapters that follow. Chapter 5 describes the structure, role, and
workings of various provincial professional regulatory bodies and institutions. Against this
background, nurses can begin to appreciate how their profession is regulated and, in particular, how the
concept of self-government is integrated into this regulatory structure and into professional codes of
ethics.

Second, nurses have access to drugs that are heavily regulated by legislation and hospital procedures
governing their use, prescription, dispensation, and handling (see, for example, the Drug and
Pharmacies Regulation Act, 1990). In addition, in some provinces, nurse practitioners (NPs) have the
authority to prescribe medication in certain situations (see, for example, Nova Scotia's Registered
nurses' Regulations, N.S. Reg. 155/2001, section 28(1), and Nova Scotia College of nurses' Authorized

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Practice Schedule, Schedule of Drugs and Drug Interventions for Primary Health Care Nurse
Practitioners, available on the college's Web site). An understanding of the legal system, and of the law
and rules surrounding negligence, underscores the importance of following such procedures and
regulations when administering any medication. Not only civil, but also criminal, consequences can
flow from a breach of such laws. Chapter 7 deals with issues of negligence and standards of care in the
nursing profession. It describes how nurses' conduct and professionalism in carrying out their duties are
measured in relation to the law and current ethical standards. Chapter 7 also explores the legal, ethical,
and practical aspects of proper documentation. Ensuring a high standard of documentation is important
in maintaining effective communication, which is key to professional nursing practice. The nurse's
assessment and progress notes monitor, on a continuing basis, the course of a patient's treatment and
the effect of interventions. Inadequate documentation or the failure to review client information and
history has a negative influence on the quality of care. Given that multiple caregivers may be involved,
it is impossible to achieve effective communication and continuity of care without accurate
documentation.

Third, the rights of patients influence the everyday actions and decisions made by nurses. These actions
and decisions may involve going beyond the usual consensual barriers. For instance, a patient who
needs an injection may readily consent by holding out an arm to the nurse who administers it. However,
if a patient is unable to consent to a procedure owing to physical or mental incapacity, including
impairment by illness or the effects of medication, the nurse bears the onus of ensuring that any action
taken or treatment administered is in the patient's best interests and is consistent with that patient's
wishes. It is often difficult to determine whether the patient is truly capable of giving consent.
However, failure to do so leaves the nurse open to the risk of a civil suit for damages from the
nonconsenting patient or the next of kin. There are also challenges with respect to the consent of
children and the sincerity of substitute decision makers. Most provinces and territories have enacted
legislation that clearly defines the parameters of consent, the patient's capacity, the manner of giving
consent, express versus implied consent, and so forth. This legislation is discussed in detail in Chapter
6. Furthermore, health professionals are legally obligated to ensure that the patient understands the
nature of the illness, the need for treatment, and all the attendant risks and benefits of such treatment if
that patient is to give as fully informed a consent as the law requires. Issues of consent to treatment and
the many subissues arising from this area are also addressed in Chapter 6.

Chapter 8 discusses the challenging legal and ethical issues associated with the end of life. Current
subjects such as euthanasia, assisted suicide, and organ donation will be explored. These topics have
gained public prominence in recent years and hold profound implications for nurses. The fear of death
has led to an emphasis on finding ways to extend life at all costs. Yet, there is a heavy price when
extending someone's life also diminishes the quality and dignity that give life its meaning. As means of
dealing with death and the dying process change, nurses are challenged to find new ways to preserve
patients' human values, autonomy, and dignity.

Recent, extraordinary advances in medical technology have made it possible both to manipulate the
reproductive process at one end of the life continuum and, at the other, to extend life in cases in which
death would once have been certain. Chapter 9 explores complex technologies such as those related to

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reproductive and genetic science. Technologies now exist that not only attempt to overcome infertility
but have the capacity to identify genetic anomalies much earlier and to control the characteristics of the
children produced. This overwhelming power to manipulate the creation of life has the potential to
reshape our society and to redefine future generations.

Often, these situations arise before laws can be made to deal with them. The law, therefore, is not an
exhaustive source of guidance and direction in such matters and is sometimes slow to adapt legal
solutions for them. Through knowledge of our legal system, the nurse will see that the law is also, not
infrequently, out of step with current societal values. Law is usually perceived as a “black and white”
proposition, while ethical situations—such as euthanasia and physician-assisted suicide, as mentioned
earlier—are vastly more complicated by shades of grey. Today, the single biggest challenge facing
lawmakers and the legal system is the attempt to come to terms with the grey areas and to provide more
realistic and practical guidelines for dealing with ethical problems. Law often evolves from ethical
principles and common sense. For example, the law now recognizes that a person's consent is essential
before a health care professional initiates any physical contact. This stems from the principle of
autonomy in that a person has the ethical right to ultimately control what will be done to his or her body
and person. There is also now an increasing awareness that the law must respect individual privacy and
the security of health records.

A further reason for understanding the law as it applies to nursing is that nurses have access to
confidential information about individual patients. They have both legal and ethical obligations to keep
all such information confidential and not to divulge it without the patient's consent. When that consent
cannot be obtained, they may reveal only as much as is absolutely necessary in the interests of the
patient and only to persons whose participation in the patient's treatment is necessary (i.e., the “circle
of care”). There may be cases in which nurses are required to disclose such information in court in the
form of testimony, or in which it is essential to prevent harm to the patient or others. Most provinces
have enacted privacy legislation governing health records that clearly delineates the responsibilities of
the custodians of such records, the use that may be made of confidential patient information, who may
consent to its release, and to whom such information can be disclosed. This legislation is discussed in
Chapters 4 and 7. Knowledge of the workings of the law, the rules of evidence, ethics, and the judicial
system provides a framework when determining whether to disclose sensitive and confidential
information about a particular patient. Ill or injured patients are in a vulnerable state and are not always
able to protect their rights as citizens. To ensure that the interests of their patients or clients are
represented, nurses must understand the rights of their clients as well as their own professional
obligations to protect or respect these rights. These issues are explored in Chapter 10.

If nurses have obligations to their clients, they also have rights regarding what they can expect as
professionals. Like all other Canadians, under the Charter of Rights and Freedoms, nurses have the
right to privacy and respect, and to freedom of expression—the right to think, say, write, or otherwise
act in accordance with their beliefs. However, these rights must be considered in the context of nurses'
responsibilities as professionals and of their obligations to patients and clients. Chapter 11 focuses on
the balance between these rights and obligations.

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Visit http://www.cna-aiic.ca/CNA/practice/ethics/code/default_e.aspx to obtain a copy of the Code.

Why Should Nurses Study Ethics?

Nurses function within a health care team and collaborate with many other health care professionals.
Today, nurses practise in many different contexts beyond the traditional health care settings: in the
community or the home; in continuing care or rehabilitation; in business or industry; in adult and
pediatric long-term care facilities; and in many other areas such as government. In some situations,
nurses may interact with other professionals who do not share the same perspective about or
understanding of nursing or health care in general. Each member of the team may have a different
perspective on an ethical issue, or some may share a similar position. However, similarities—as well as
differences—must be clarified. Without discussion and clarification, on occasion others may interpret
decisions made and actions taken by members of the team as wrong. If the reasons, values, and
perspectives behind these decisions and actions are explained, however, they may more readily be
understood and respected, if not accepted, by others. There is a growing focus on the nurse within the
context of interprofessional practice, and this will be discussed in Chapter 12.

Most importantly, nurses must study ethics because morality (i.e., doing good) is at the heart of
traditional theoretical perspectives of nursing practice. Many nursing theorists consider “care” not only
a key dimension of nursing practice but the very core of it (Benner, 1990; see also Leininger, 1988a;
Leininger, 1988b; and Watson, 1988). Recent ethical theorists view care as both a therapeutic
interaction and a moral imperative (Roach, 1992). To that end, nurses are viewed as “moral agents”
charged with nurturing the humanity of those for whom they care (Cloyes, 2002).

Within health care, choices are often not easy: it may be difficult to determine, from among many
alternatives, which is best. Consider, for example, a situation in which the medical team is aggressively
treating a terminally ill patient in an Intensive Care Unit. Some nurses involved with the person's care
may consider this approach wrong because they believe that it will only diminish the quality of the
patient's remaining life and result in a painful death. If the medical team involved were to clarify its
position'say, at a team conference—the nurses and other team members might discover that the
physicians' decisions were based on a belief in the sanctity of life and the view that their collective role
is to preserve life at all costs. Possibly, on an earlier occasion, the patient asked a doctor to try anything
that might save his life. Or, perhaps, the physician has other knowledge about the patient's story, such as
a particular religious or cultural perspective he observes that requires every effort be taken to sustain
life. Perhaps there was an advance directive stating this, or perhaps the family was awaiting a beloved
relative's arrival from out of town so that final goodbyes could be said. Though the views of some
nurses or team members may not change, they may come to a better understanding of the reasons
behind the physicians' actions. Such discussion would reduce the moral conflict and distress
experienced by some nurses and ensure better relationships among those on the interprofessional team.

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It is imperative that patients or clients, families, physicians, nurses, and other team members discuss
such issues together and attempt to reach consensus on a course of action. Since many ethical
quandaries do not have clear-cut answers, collaboration and effective communication, as well as a
respect for one another's values and beliefs, can enhance the resolution process. The communication
that is necessary to clarify and justify our moral actions and choices to our professional colleagues is
improved through a shared language grounded in a solid foundation of ethical theory. This shared
language also involves the interplay of law relative to such difficult dilemmas as withdrawal of
treatment and the use of advance directives in making treatment decisions for incapacitated patients.

The study of ethics provides nurses with some tools to be better able to manage and contribute to such
discussions. Knowledge of abstract philosophical theories and terminologies does not always provide
solutions to ethical problems; however, such knowledge can serve to help us better understand the
moral context and the values and beliefs of ourselves and others.

Nurses face ethical choices every day in practice. These may deal with the areas of pain control,
patient comfort, restraints, patient choice, and family involvement in care. The issues do not always
make headlines. Ethics is involved when nurses decide how to allocate time and nursing care to
patients; whose needs are to be met first; and how to show respect to patients, families, each other, and
the interprofessional team.

Nurses are involved not only in the ethical context of the individual nurse-patient or nurse—client
relationship; they are also affected by—and are in a position to influence—policy, the wider context of
health care, and the health care system.

For example, advances in the areas of organ transplantation and reproductive technology force
questions about how we allocate these scarce resources and, indeed, whether we should be using this
technology at all. The growth of the consumer movement, the proliferation of special interest groups,
and the occupational issues that arise from collective bargaining and unionization all influence the
context of health care and hence nurses' ethical choices. The effect of financial restraints on the nurse-
client ratio poses additional challenges relative to how nurses allocate their time and services. Further,
the role of the nurse is expanding: nurses are being given more autonomy and, with that, more
authority and responsibility.

Moral Justification
Persons involved in the field of ethics draw upon ethical theories and principles not only to select an
ethical approach to an issue but also to justify and defend their positions to others. Points of view,
especially in controversial areas, are open to criticism and debate and require justification, an argued
defence of one's perspective. Theories and principles of ethics can clarify relationships between reasons
and conclusions. Points of view are justified through reasoned arguments and evidence, and are subject
to criticism and counterexamples. Arguments can be disguised by rhetoric, irrelevancies, redundancies,
and connections with other arguments, and can mislead those not comfortable with ethical language and

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theory (Beauchamp & Walters, 2003). As moral problems in the health care environment increase in
frequency and intensity, it becomes increasingly important for nurses to have knowledge of ethical
theory and some skill in justifying and defending their positions to others.

Everyday Ethical Issues Faced by Nurses

Nurses have the opportunity to defend and protect patient rights, to promote compassionate care, and to
enhance the dignity and autonomy of their patients or clients. They are often required to choose from
among a number of good or “least wrong” alternatives and to assess and defend the choices made or
actions taken; however, they may not even be aware of the ethical nature of their choices. Since
options are not always clear, how does one decide what the right thing to do is? In order to address
ethical challenges, nurses first need to be aware that these challenges exist and be able to identify them
as ethical in nature.

Within the context of a health care system strained by limited funds and resources, every day, nurses
face a challenge in providing high-quality and ethical care to patients. The following scenarios are not
uncommon.

An infant in a pediatric centre has been diagnosed with a malignant cerebral tumour. The infant is
comatose, nonresponsive, and on life-support systems. There is nothing the team can do to halt the
progress of this terminal disease. They believe it would be in the child's best interest to discontinue life
support and to allow the child to die a natural death. The parents disagree and want all measures taken
to save their child's life.

Who decides the best interests of this child? Do patients or families have the right to expensive, futile
health care? How do the nurses support the parents through this crisis and the loss of their child?
How do they ensure quality care for this child throughout the dying process?

Joe, a 20-year-old man diagnosed with schizophrenia at the age of 16, is admitted to the psychiatric unit
of a community hospital. He is agitated and expresses a wish to “end all this pain.” He refuses all
medications to deal with his symptoms. He wants to go home.

What rights does Joe have in this situation? Is there meaning behind Joe's wish to “end all this pain,” or
is this merely a symptom of his disease process?

A man with end-stage cancer of the liver is receiving palliative care at home. His wife and children,
with some support from home care and community nurses, are his primary caregivers. As his condition
deteriorates, his symptoms become more difficult to manage. Drained, the family questions whether he
might be better off in a hospital. The patient, however, has always stated his preference is to die at
home.

How does the community nurse manage the conflicting interests of this patient and his family? What is
society's role in ensuring adequate resources to address the needs of a dying patient at home?

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A 40-year-old single man is recovering from surgery to his lower back. Though he is still in pain and
continues to have difficulty with mobility, the hospital needs the bed, and he has reached his expected
length of stay. The hospital nurse discusses his transition to the community with the home care case
managers, who determine that he does not qualify for homemaker support, even though he does not
have family or friends at home to help him.

How do these nurses ensure this man a safe transition to his home? How do they deal with the rules that
limit needed resources in the community?

An occupational health nurse in an industrial setting is managing the case of a worker who was injured
at work. He has recovered and is functionally able to return to his former work. Management is eager to
have him return as soon as possible. However, the worker confides to the nurse that his front-line
manager constantly harasses him and his co-workers; he believes that it was this stressful environment
that led to his accident in the first place. He asks the nurse to keep this information confidential, as he
fears repercussions.

How does the nurse balance the responsibility to ensure this worker's safe return to work—and concern
for the safety of other workers in this hostile environment—with the obligation to honour the worker's
request for confidentiality?

An older adult in a geriatric unit is confused and agitated. The use of physical restraints is considered.

How do nurses caring for this patient balance the risks and benefits of this option while respecting the
patient's wishes?

It is the middle of an evening shift on a busy medical unit. A patient is dying; family and friends are
not around.

Should nurses let this patient die alone?

A child is dying. The parents, clearly distressed, have been with the child for weeks and are seriously
sleep deprived. The father, who has grown increasingly agitated, goes to the nursing station to request
additional pain medication for his child. When 10 minutes pass with no response, he becomes
enraged and yells at the team, using profanity, aggressive language, and other threatening behaviours.

How does the nursing team balance the needs of the parents and the child with the rights of the nurses
and staff to a safe work environment? How could the situation have been prevented?

John has recently begun working as a nurse in a small hospital in a rural community. He moved there
with his partner, who was recently appointed as a manager in a nearby mine. Since he started a few
months earlier, John has found it difficult to engage with other staff members. They routinely fail to
help him if he is busy and have never invited him to join them on a break. Already feeling
marginalized, he overhears three of the nurses discussing his personal relationship and speculating on
why a man would ever become a nurse.

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What is happening here? What options does John have to address this uncomfortable situation?

These are only a few examples of the types of complex and challenging situations faced by nurses on a
daily basis. It is not uncommon for nurses to be confronted with a number of these ethical issues and
questions simultaneously. A better understanding of ethical theory, greater awareness of the ethical
issues, increased knowledge and skill to address them, and appropriate system supports may limit or
better address these challenges.

Now, take some time to reflect on the above scenarios. What choices would you make? What are your
reasons for making them? Is your rationale consistent from one scenario to the next, or does your
approach vary depending on the situation or your past experience? Are you able to defend your
approach to your colleagues?

After you review the theoretical perspectives discussed in Chapter 2, return to these scenarios. Was
your approach to these problems consistent with any of Chapter 2's theories? Did your views change as
you read through the chapter? Did these perspectives provide you with arguments to assist in
defending your position? Are you better able to identify the ethical issues in these scenarios? Do the
theories help you decide on a course of action?

Summary
Clearly, the impact of the law and ethics on the nursing profession is widespread and significant. An
understanding of the law's structures, terminology, and mechanisms is essential to the nurse's ability to
operate within society's expectations and standards; similarly, a familiarity with and a willingness to be
guided by the values and ethical standards of the nursing profession is essential to practising within a
system with high standards of patient care. The authors have tried to lay the basis for such an
understanding in the chapters that follow.

This chapter conveyed the reasons nurses must be familiar with the law and ethics and have the
knowledge to practise according to these standards. Professionals have a significant role in serving the
interests of the public and must be sure they have their trust. As we have seen from the scenarios above,
the complexity of ethical issues has grown alongside the increasing reliance upon ethics in guiding and
supporting decisions. It is clear that ethics and law intersect on many levels, and a strong understanding
of both is essential to exemplary nursing practice.

Critical Thinking
Discussion Points
These questions are intended to encourage self-reflection.

1. Why did you decide to enter the nursing profession?

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2.What personal values do you share with the nursing profession?

3.Have you or a family member had a memorable experience with the health care system?
What did you most appreciate about this experience? What did you least like about it?
4.In your opinion, what are the most significant legal issues that nurses may face?
What significant ethical issues might a nurse face?
5.If you were a patient or client today, what would you expect from the nurses caring for you?
If a member of your family were a patient or client today, what would you expect? As a nurse
or a nursing student, do you meet these expectations with your own patients or clients?

References
Statutes
Criminal Code, R.S.C. 1985, c. C-46 (Canada), s. 241; R.S., 1985, c. 27 (1st Supp.), s. 7.
Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H.4 (Ontario).

Regulations
Nova Scotia's Registered nurses' regulations, N.S. Reg. 155/2001 (Nova Scotia).

Regulatory Body Policies

Nova Scotia College of Nurses: Authorized practice schedule, schedule of drugs and drug
interventions for primary health care nurse practitioners Retrieved July, 2008 from
http://www.crnns.ca/documents
/AuthorizedPracticesScheduleofDrugsPHCNPsJuly2008.pdf, 2008.

Texts and Articles

C.A. Aikens: In Studies in ethics for nurses. 2nd ed., 1926, W.B. Saunders Company, Philadelphia, PA.
T.L. Beauchamp, L. Walters: In Contemporary issues in bioethics. 6th ed., 2003, Wadsworth Publishing
Company, Belmont, CA.
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