ETHICO-LEGAL CONCEPT c.

People have “inward autonomy”

if they have the ability to make
ETHICS
choices; they have “outward
● Study of conduct and character
autonomy” if their choices are
● Refers to a method of inquiry that helps
not limited or imposed by others
people to understand the morality of
d. Individual has the right to act as
human behavior
free agent
● The expected standard of moral
e. Inclosed link with consent
behavior of a particular group as
f. Human beings are free to decide
described in the group’s formal code of
how they live their lives as long as
professional ethics
their decisions do not negatively
● Concerned with determining what is
impact the lives of others
good or valuable for individuals
g. Nurse respects the client’s right to
● Refers to a method of inquiry that helps
make decisions even when those
people to understand the morality of
choices seem to the nurse not to
human behavior
be in the client’s best interest
MORAL
h. Exception
● Personal or private interpretation of
i. Mental capacity
what is good and bad
ii. Life threatening decisions
● Concerned with principles of right and
iii. Small children
wrong or conforming to standards of
2. NonMaleficence
behavior and character based on those
a. Do no harm
principles
b. Interactions with people should
ETHICAL/MORAL PRINCIPLES
not harm others
- Statements about broad, general,
c. Should not engage in any
philosophical concepts such as
activities that run the risk of
autonomy and justice
harming others
- They provide the foundation for moral
3. Beneficence
rules, which are specific prescriptions for
a. Taking positive actions to help
actions
others
1. Autonomy
b. Our actions should actively
a. Refers to the right to make one’s
promote the health and
decisions
well-being of others
b. Nurses who follow this principles
c. Taking positive actions to help
recognize that each client is
others
unique, has the right to be who
d. Our actions should actively
that individual is, and has the
promote the health and well
right to choose personal goals
being of others

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 e. best interests of the patient 2. The Principle of Totality
remain important than a. The whole is greater than its parts
self-interest b. States that all decisions in
4. Justice medical ethics must prioritize the
a. Being just/fair good of the entire person,
b. Rights of one individual or group including physical, psychological,
are balanced against another and spiritual factors
c. Assumes three standards: c. An individual may not dispose of
i. Impartiality his organs or destroy their
ii. Equality capacity to function, except to
iii. Reciprocity the extent that this is necessary
5. Fidelity for the general well-being of the
a. Being faithful whole body.
b. Involves loyalty, truthfulness, d. Destroying an organ or interfering
promise keeping, advocacy, and with its capacity to function
respect prevents the organ from
c. Unwillingness to abandon achieving its natural purpose
patients even when care 3. Epikia / Epikeia
becomes controversial or a. Reasonableness
complex b. Exception to the general rule
6. Veracity c. The principle in ethics that a law
a. Principle of truth telling can be broken to achieve a
b. Violation includes: greater good
i. Act of lying 4. One who acts through an agent is
ii. Deliberate exchange of himself responsible
erroneous information a. It is a maxim often stated in
iii. Deliberate withholding of discussing the liability of employer
all or portions of the truth for the act of employee in terms
iv. Deliberate cloaking of of vicarious liability
information in jargons or b. An action or present in the duty
language that fails to that has been represented by the
convey the information agent so the duty performed will
OTHER RELATED PRINCIPLES be seen as the performance of
1. Golden Rule the agent himself
a. Do unto others what you would c. Exception
like others do unto you i. Acts of personal nature
b. Treat kidney, with respect

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5. No one is obliged to betray himself/ of saving or prolonging a
herself patient’s life
a. No one can force any person to 11. The Two-fold Effect
answer a question if such will a. When a nurse is faced with a
incriminate him/her situation which may have both
6. The end does not justify the means good and bad effects, how
a. One cannot commit a series of should she choose which one to
knowingly fraudulent and illegal follow?
acts, even if purportedly done in b. Basis of action may be the
the same of a noble cause following:
i. assisting/fscilitating suicide i. The actions must be
/death to CS/HIV/ morally good
Chronically ill patient ii. The good effects must be
7. Defects of nature may be corrected willed and the bad effect
a. Congenital defects merely allowed
b. Corrected through artificial iii. The good effect must not
means life surgery and diet come from an evil action
certain non-beneficial mutations/ but from the initial action
traits can be corrected i.e. vision itself directly
problems with glasses iv. Good effect must be
8. If no one is willing to cooperate in the greater than the bad
act, no justice is done to him/her effect
a. Person subjects himself willingly to 12. The greatest good for the greatest
a clinical trial and has been told number
of possible effects, is of right age, a. Utilitarian principle
and is sane, there is no violation b. The greater majority of the
of human rights population shall be considered
9. A little more or less does not change the rather than the isolated few
substance of an act 13. The morality of cooperation
a. Taking without permission large or a. Formal cooperation in an evil act
small quantity, still be guilty of is never allowed
theft b. Abortion should not be
10. No one is held to the impossible participated by the nurse even if
a. To promise that a patient with a the doctor commands it
heart transplant will live may be BASIC TERMS IN HEALTH ETHICS
an impossibility. Yet, such 1. Advocacy
procedures are done in the hope a. Refers to the support of a
particular cause

3 | Varquez
 i. What is the cause? ● Standards of Care
ii. patient’s: ○ To protect the public
- Health ○ Skills and learning commonly
- Safety possessed by members of a
- Rights profession
2. Responsibility ○ Used to evaluate the quality of
a. Willingness to respect one’s care nurses provided and,
professional obligations and to therefore, become legal
follow through guidelines for nursing practice
b. Following policies and ● Nursing Liability is usually involved with
procedures tort law.
3. Accountability ● It is important for the nurse to know the
a. Ability to answer for one’s actions difference between professional
b. Ensuring professional actions are negligence (an unintentional tort) and
explainable to patient and international torts.
employer ● Nurses must also recognize those nursing
4. Liability situations in which negligent actions are
a. The quality or state of being most likely to occur and take measures
legally responsible for one’s to prevent them
obligations and actions for ● Crimes and Torts
making financial restitution for ○ Crime
wrongful acts ■ is an act committed in
5. Values violation of public
a. A personal belief about the worth (criminal) law and
of a given idea, attitude, custom, punishable by a fine or
or object that sets standards that imprisonment.
influence behavior ■ does not have to be
6. Social Networking intentional in order to be a
a. Presents ethical challenge for crime
nurses ■ Crimes are classified as
b. Risk to privacy is great either felonies or
c. Being friends online may interfere misdemeanors.
ability to maintain a therapeutic ○ A felony is a crime of serious
relationship (issue of trust) nature, such as murder,
AREAS OF POTENTIAL LIABILITY IN NURSING punishable by a term in prison
● Registered Nurses ○ Second-degree murder is called
○ Responsible and accountable for manslaughter
quality of performance

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 ○ Misdemeanors is an offense of a UNINTENTIONAL TORTS
less serious nature and is usually ● Negligence and professional
punishable by a fine or short-term negligence are examples of
jail sentence, or both unintentional torts that may occur in the
○ Tort health care setting
■ is a civil wrong committed ● Negligence is misconduct or practice
against a person or a that is below the standard expected of
person’s property. an ordinary, reasonable, and prudent
■ usually litigated in court by person
sued action between ● Such conduct places another person for
individuals harm
■ The person or persons ● Gross negligence involves extremely
claimed to be responsible lack of knowledge, skill, or decision
for the tort are sued for making that the person clearly should
damages have known would put others at risk for
■ Tort liability almost always harm
is based on fault, which is ● Malpractice is professional negligence,
something that was done that is, negligence that occurred while
incorrectly (an the person was performing as a
unreasonable act of professional
commission) or something ○ Applies to primary care providers,
that would have been dentists, lawyers, and generally
done but was not (an act includes nurses.
of omission) SIX ELEMENTS THAT MUST BE PRESENT FOR A
■ Torts are classified as CASE OF NURSING PROFESSIONAL NEGLIGENCE
unintentional or intentional TO BE PROVEN:
1. Duty
a. The nurse must have a
Crimes Torts
relationship with the client that
Felonies Unintentional involved providing care and
● Murder ● Negligence
following an acceptable
● Robbery ● Malpractice
● Rape ● Failing to do standard of care
● Kidnapping something b. Evident when the nurse has been
assigned to care for a client in
Misdemeanors Intentional
● Petty theft ● Assault & battery the home or hospital
● Minor in possession ● False imprisonment c. A nurse has general duty of care,
of alcohol ● Invasion of privacy
even if not specifically assigned
● Driving under the ● defamation
influence

5 | Varquez
 to a client, if the client needs for damages that may be
help compensated
2. Breach of Duty b. The goal of awarding damages is
a. There must be a standard of care to assist the injured party to his or
that is expected in the specific her original position as far as
situation but that the nurse did financially possible
not observe INTENTIONAL TORTS
b. Something was done that should ● The defendant executed the act on
not have been done or nothing purpose or with inter
was done when it should have ● No harm need be caused by intentional
been done torts for liability to exist
3. Foreseeability ● Since no standard is involved, no expert
a. A link must exist between the witnesses are needed
nurse’s act and the injury suffered 1. Assault and Battery
4. Causation a. Assault can be described as an
a. It must be provided that the harm attempt or threat to touch
occurred as a direct result of the another person unjustifiably
nurse’s failure to follow the i. Preceded battery
standard of care and that the ii. The act that causes the
nurse could have or should have person to believe a
known that failure to follow the battery is about to occur
standards of care could result in b. Battery is the willful touching of a
such harm person or the person’s clothe or
5. Harm or Injury even something the person is
a. The client of plaintiff must carrying that may or may not
demonstrate some type of harm cause harm
or injury (physical, financial, or 2. False Imprisonment
emotional) as a result of the a. Unjustifiable detention of a
breach of duty owed the client person without legal warrant to
b. The plaintiff will be asked to confine the person
document physical injury, b. Accompanied by forceful
medical costs, loss of wages, pain restraint or threat of restraint is
and suffering, and any other battery
damages c. The client can leave by signing
6. Damages an AWA (absence without
a. If professional negligence caused authority) or AMA (against
the injury, the nurse is held liable medical advice)

6 | Varquez
 3. Invasion of Privacy ● An act committed or omitted in
a. Direct wrong of a personal nature violation of the law
b. It injures the feelings of the person ● Criminal offenses are composed of two
and does not take into account elements
the effect of revealed ○ Criminal act
information on the reputation of ○ evil/ Criminal Intent
the person in the community CONSPIRACY TO COMMIT A CRIME
c. The right to privacy is the right of - When two or more persons agree to
individuals to withhold themselves commit a felony and decide to do it
and their lives from public security - Persons who commit felonies are either:
i. Described as the right to 1. Principals
be left alone a. Main perpetrator
4. Defamation b. Those who take a direct part of
a. Communicated that is false or the execution of the act
made with a careless disregard c. Who directly force or induce
for the truth and results in injury to others to commit or who
the reputation of a person cooperate in the commission of
b. Both libel and slander are the offense by another act w/o
wrongful actions that come which it would not have been
under the heading of accomplished
defamation 2. Accomplices
c. Libel – defamation by means of a. Those persons who, not being
print, writing or pictures. Writing in principals, cooperate in the
the nurse’s notes that a primary execution of the offense by
care provider is incompetent previous or simultaneous acts
because he did not respond 3. Accessories
immediately to a call us an a. Those who, having knowledge of
example of libel the commission of the crim, either
d. Slander – defamation by the as principals or accomplices,
spoken word, stating unprivileged take part subsequent to its
(not legally protected) of false commission by profiting
words by which a reputation is themselves or assisting the
damaged. An example of offender to profit from the effects
slander would be for the nurse to of the crime by concealing or
tell a client that another nurse is destroying the body of the crime
incompetent HOMICIDE
CRIME - Killing of one person by another

7 | Varquez
 - Is the death of a person that was ■ Intent to commit certain
caused by the improper actions of dangerous felonies such as
another armed robbery
- classification: ● Manslaughter
1. Justified Homicide ○ Charge is appropriate when a
a. Takes place in the reasonable homicide does not rise to the
belief that a serious crime is being level of murder
committed and in an attempt to ○ Voluntary Manslaughter
prevent the crime ■ One person kills another
b. Homicide with a good excuse after adequate
i. Self-defense, in defense of provocation, that is, there
others, on the line of duty has been action that was
2. Excusable Homicide sufficient to incite an
a. Homicide committed ordinary person to sudden
accidentally or with sufficient and intense passion such
provocation while lawful activity that he loses self-control
i. Self-defense but not killing ○ Involuntary Manslaughter
in cruel or unusual way ■ Unlawful killing of a human
3. Criminal Homicide being without malice
a. Homicide unlawful killing another aforethought
b. Divided into categories based on ■ Perpetrator had no intent
the intent of the person to kill at all, but acted in a
Categories may include in Criminal Homicide reckless or unreasonable
● Murder – intentional killing of one human manner
being by another with malice ● Criminally Negligent Homicide
aforethought. ○ Some laws categorize it as a form
● Malice aforethought: or type of involuntary
○ State of mind or intent manslaughter
○ A requirement that makes a ○ Addresses situations where a
homicide a murder defendant is aware of a situation,
○ 4 different states of mind should know it’s dangerous, but
considered to be evidence of ignores a risk that results in a
malice: death of another
■ An intent to kill ○ Aware of a substantial and
■ An intent to commit unjustifiable risk, and ignores or
grievous bodily injury fails to appreciate that risk
■ Reckless indifference to
value human life

8 | Varquez
 ■ Texting while driving ○ The purposes of the treatment
through a school zone full ○ What the client can expect to
of children feel or experience
INFORMED CONSENT ○ The intended benefits of the
● Informed consent is an agreement by a treatment
client to accept a course of treatment ○ Possible risks or negative
or a procedure after being provided outcomes of the treatment
complete information, including the ○ Advantages and disadvantages
benefits and risks of treatment, of possible alternatives to the
alternatives to the treatment, and treatment (including no
prognosis of not treated by a health treatment)
care provides ● Three Major Elements
● Mutual decision making between both ○ The consent must be given
professional and patient over the voluntarily
treatment option that the patient wishes ○ The consent must be given by a
to receive or not to receive client or individual with the
● Express capacity and competence to
○ May take the form of either an understand
oral or written agreement ○ The client or individual must be
○ Usually, the more invasive a given enough information to be
procedure or the greater the the ultimate decision maker
potential for risk to the client, the Exceptions
greater the need for written 1. Minors
permission a. A parent or guardian must give
● Implied consent before minors can
○ Exists when the individual’s obtain treatment.
nonverbal behavior indicates b. The same is true of an adult who
agreement has the mental capacity of a
● A reasonable amount of information child and who has an appointed
required for the client to make an guardian
informed decision is what any other 2. Individuals who are unconscious or
reasonable health care practitioner injured in such a way that they are
would disclose under similar unable to give consent
circumstances a. Consent is obtained from the
● General guidelines include the closest adult relative if existing
following: statutes permit
○ The diagnosis or condition that b. If no relative is around in an
requires treatment emergency situation, then the

9 | Varquez
 law generally agrees that their personal wishes
consent is implied to provide regarding treatment
necessary care decisions, inducing the
3. Mental illnesses right to refuse medical
a. Under the law as well as the rights treatment
of the staff caring for such clients c. Nurse need to assess if clients and
NURSE’S ROLE families have an accurate
● Nurses are often asked to obtain a understanding of life-sustaining
signed consent form measures
● The nurse is not responsible for d. Nurses need to incorporate
explaining the procedure but for teaching in this area and
witnessing the client’s signature on the continue to be supportive of
form client’s decisions
● The nurse’s signature confirms three e. Two types
things: i. Living will – it provides
○ The client gave consent specific instructions about
voluntarily what medical treatment
○ The signature is authentic the client chooses to omit
○ The client appears competent to or refuse in the event that
give consent the client is unable to
DEATH RELATED ISSUES make those decisions
1. Advance Health Care Directives ii. Health care proxy – also
a. A variety of legal and lay referred to as durable
documents that allow persons to power of attorney for
specify aspects of care the wish health care, is a notarized
to receive should they become or witnessed statement
unable to make or communicate appointing someone else
their preferences to manage health care
b. The patient Self-Determination treatment decisions when
Act (United States) implemented the client is unable to do
in 1991 so
i. Recognize advance 2. Autopsy
directives a. An autopsy or postmortem
ii. Ask clients whether they examination is an examination of
have advance directives the body after death
iii. Provide educational b. Performed only in certain cases
materials advising clients
of their rights to declare

10 | Varquez
 i. Death is sudden or occurs a. Is the act of painlessly putting to
within 48 hours of death people suffering from
admission to a hospital incurable or distressing diseases
c. The organs and tissues of the b. Referred to as mercy killing
body are examines to establish c. Euthanasia is legally wrong and
the exact cause of death, to can lead to criminal charges of
learn more about a disease, and homicide or to a civil lawsuit for
to assist in the accumulation of withholding treatment or
statistical data providing an unacceptable
3. Certification of Death standard of care
a. The formal determination of 6. Inquest
death, or pronouncement, must a. A legal inquiry into the cause or
be performed by a physician, a manner of a death
coroner, or a nurse. b. When a death is the result of an
b. Must be ,ade out when an accident, for example, an
individual die inquest is held into the
c. Signed by the attending primary circumstances of the accident to
care provider and filed with a determine any blame
local health or other government 7. Organ Donation
office a. Uniform Anatomical Gift Act and
4. Do-Not-Resuscitate Orders the National Organ Transplant
a. Physicians may order no code or Act (US)
do not resuscitate (DNR) for i. People 18 years old and of
clients who are in a stage of sound mind may make a
terminal, irreversible illness or gift of all or any part of
expected death. their own bodies for the
b. DNR is ordered generally written following purposes: for
when the client or proxy has medical or dental
expressed the wish for no education, research,
resuscitation in the event of a advancement of medical
respiratory or cardiac arrest or dental science, therapy,
c. DNR is written to indicates that or transplantation
the goals of treatment is a b. Philippine Organ Donation Act of
comfortable, dignified death and 1991
that further life-sustaining LEGAL RESPONSIBILITIES OF STUDENTS
measures are not indicated - Nursing students are responsible for their
5. Euthanasia own actions and liable for their own

11 | Varquez
 acts of negligence committed during ● Ask for additional help or
the course of clinical experiences supervision in situations for which
- When they perform duties that are they feel inadequately prepared
within the scope of professional nursing, ● Comply with the policies of the
such as administering an injection, they agency in which they obtains
are legally held to do the same their clinical experience
standard of skill and competence as a ● Comply with the policies and
registered professional nurse definitions of responsibility
- Lower standards are not applied to the supplied by the school of nursing
actions of nursing students
- Nursing students are not considered
employees of the agencies in which the
receive clinical experience because
therese nursing programs contract with
agencies to provide clinical experience
for students
- The education institutions will be held
potentially liable for negligent actions
by students
- Students in clinical situations must be
assigned learning experiences within
their capabilities and be given
reasonable guidance and supervision.
- Nursing instructors are responsible for
assigning students to the care of clients
and for providing reasonable
supervision
- Failure to provide reasonable
supervision or the assignment of a client
to a student who is not prepared and
competent can be a basis for liability
- To fulfill responsibilities to clients and to
minimize chances for liability, nursing
students need to:
● Make sure they are prepared to
carry out the necessary care for
assigned clients

12 | Varquez