Ethics And Legal Issues

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Ethics

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Systematic study of moral conduct and provides the framework for studying and examining moral dilemmas.

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Bioethics

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Also called biomedical ethics or medical ethics, is the study of moral conductwithin te context of health care.

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Morality

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Refers to norms about right and wrong human conduct that form a social consensus

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Moral virtues

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Socially valued character traits

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Five moral virtues for health care

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Compassion, Discernment, Trustworthiness, Integrity, and Conscientiousness

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Benefience

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To do good.
Promote the well being of the patient.
Prevent harm.

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Nonmaleficence

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To refrain from harm.
Obligates the clinician to avoid inflicting harm directly or intentionally.
Balanced with beneficence - maximize benefits while minimizing harm.

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Autonomy

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Refers o the human right to make ones own decision.

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Show Autonomy by:

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Tell Truth
Repsect the privacy of others
Protect confidential information
Obtain consent for interventions with patients
When asked, help others make important decisions
Justice is the principle of fairness
To treat equals equally
To refrain from discrimination

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Code of Ethics for Nurses: One

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The nurse, in all profesional relationships, practices with compassion and response for the inherent dignity, worth and uniqueness of every individual, unrestricted by the consideration of social or economic status, personal attributes, or the nature of the health problem.

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Codet with t of Ethics for Nurse: Two

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The nurse's primary commitment is to the patient, whether an individual, family group or community.

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Code of Ethics for Nurses: Three

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The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.

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Code of Ethics for Nurses: Four

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The nurse is responsible and accountable or individual nursing practice and determines the appropriate delegation of tasks consistent with the nurses obligation to provide optimum patient care.

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Code of Ethics for Nurses: Five

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The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain coompetence, and to continue personal and professional growth.

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Code of Ethics for Nurses: Six

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The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.

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Code of Ethic for Nurses: Seven

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The nurse participated in the advancement of the profession through contributions to practice, education, administration and knowledge development.

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Code of Ethics for Nurses: Eight

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The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.

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Code of Ethics for Nurses: Nine

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The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining in the integrity of the profession and its practice, and for shaping social policy.

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Informed Consent

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Based on respect for autonomy. Five elements: Decisional capacity, Disclosure, Understanding, Voluntariness, and Consent.

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Decisional Capacity

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Specific and not global; vary over time due to physiological and situational factors; if it cannot be determined initially, assess over time adn consult with expert when necessary; surrogate decision makers are authorized

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Surrogate decision makers

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Required to make the decision that the incompetent patient would have made or substituted judgement stanadard. If surrogate has no way of knowing what choice a person would have made then best interest standard should be used

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Order of surrogate authority

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1 Court appointed guardian
2 Durable power of attorney
3 Spouse
4 Adult children
5 Parents
6 Adult siblings

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Disclosure

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Includes a core set of infomation about the treatment or research procedure:
Facts or descriptions of procedure
Information the clinician believes to be relevant
The clinicians recommendations
The purpose of seeking consent
The nature and limits of consent
The right to refuse to be informed regarding their health care decisions

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Understanding

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Difficult to assess; understand what the clinician or researcher needs to understand to authorize the procedure.

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Voluntariness

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Patient agrees to the intervention without undue influence

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Consent

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Acceptance or refusal of the treatment or research study after the patient is adequately informed.
Can be withdrawn at any time
Written form is required
Written consent is not required for noninvasive activities.

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Advance Directives

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A person while competent, can complete a directive documentating his or her health care wishes or values, or selecting a surrogate to make decisions during periods of incapacity.

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Living Wills

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Directives that specify preferred treatment during periods of incapcity.

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Durable power of attorney for health care (DPAHC)

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A legal document in which one person assigns authority to another to act as his or her surrogate if he or she is unable to make health care decisions

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Patient Self-Determination Act of 1990

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Requires health care facilities to develop programs to inform patients and staff about advance directives

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Access to Care

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Major ethical and political issue confronting the US and is based on the priniciple of justice. Access is limited and dilemma confronting US is how to fund and distribute health care.

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Principle of Justice

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Fair distribution of resource; equals are treated equally - implies a right to health care.

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Four Moral Virtues for Nurse/Health Care Team/Patient Relationships

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Veracity
Privacy
Confidentiality
Fidelity

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Veracity

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Obligates the nurse to be truthful with patients and members of the health care team.

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Privacy

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Obligates the nurse to appropriately restrict access to the patient and to the health care record.

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Confidentiality

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Requires the nurse to share information about the patient only with the patient and those health care professionals involved in caring for the patient.

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Fidelity

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Refers to faithfulness in keeping promise.

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Withholding and withdrawing treatment

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derives from the priniciples of benefience and nonmalefience

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Medical Futility

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Controversial
Quantitative medical furility: less than 1% chance treatment will have intended effect.
Qualitative furility: Treatment will have desired effect but will not achieve a desired benefit.

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Ordinary versus extraordinary treatments

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Rule: Extraordinary treatment can be withheld but ordinary cannot but distinction is not clear.

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Double effect

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A single act may have two effects, on beneficial and one harmful. Is there alternative treatments without unintended effect? Does the intended effect outweigh the unintended effect?

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Systematic Ethical Reasoning

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Review facts and assumption about the case or situation.
Define ethical dilemma in specific terms.
List possible course of action.
Choose a course of action, considering: patient preference, professional standards, relevant law, and personal values and principles.
Evaluate choices.

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Ethical Decision-Making Resources

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Ethical committee are multidisciplinary group
Ethics consultation are on call
Formal educational programs for clinican
Policies from institute (DNAR)

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Patient's Rights

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Right to be considerate and respectful care.
Right to information about diagnosis, treatment, and prognosis.
Right to make decisions about the plan of care.
Right to have an advance directive.
Right to privacy.
Right to confidentiality.
Right to review clinical records.
Right to responsible care and services.
Right to information about business relationships among the hospital, educational institutions and payers that might influence care and treatment.
Right to reasonable continunity of care.
Righth to be informed of hospital policies and procedures that regulate patient care, treatment, and responsibilties.

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Professional Practice Standards

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Standard of care and standard of professional performance

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Standard of care

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Describe a competent level of nursing care as demonstrated by the nursing process.

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Standards of professional performance

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Describe a competent level of behavior in the professional role.

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1980 Social Policy Statement

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The diagnosis and treatment of human reponses to actual or potential health problems.

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Definition of nursing - Four essential features

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Attention to the full range of human experiences and responses to health and illness.
Integration of objective data with understanding of the patient's subjective experience.
Use of scientfiic knowledge in the process of diagnosis and treatment.
Provision of caring relationships that facilitate healing.

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Basic Nursing Practice

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Promoting, supporting, and restoring health; preventing illness; and assisting with activities that contribute to a peaceful death.

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Professional Certification

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Private agencies sponsor programs to certifiy that individuals meet certain criteria and are prepared to practice in that discipline or clinical area.
Recognizes specialized knowledge and skills beyond that which is required for safe, basic care.

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Legal Regulation of Nursing Practice

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Protects the public health, safety, and welfare.

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Nurse Practice Acts

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State Laws that grant the right to practice nursing to individuals who meet predetermined standards; regulatory boards are created under the nurse practice acts and govern nursing practice in the state.

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BON

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Determines eligibilty for licensing and relicensing.
Approving and supervising educational programs.
Enforcing the statues.
Writing rules and regulations governing the practice of nursing.

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Basic ground rules for disiplinary action.

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Fraud in obtaining license
Unprofessional, illegal, dishonorable, or immoral conduct.
Performance of specific actions prohibitied by the acts.
Convictions of felony or crime of moral turpitude.
Drugs or alcohol addiction rendering the individual incapable of performing duties.

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Nurses individual accountability

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Personally responsible for his or her actions.
Person who causes harm has the primary responsibility.
Duty to communicate may be the most important duty of the nurse.

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Duty to communicate

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Change in patient's condition.
Concern about impaired practice to supervisor.
Concern about short staffing to the appropriate person when situation occurs.

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Employer and Supervisor Accountability

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Liable for the actions of its employees within their scope of employment.
Liable for harm caused by incompetent nurse due to drugs.
Health care facility is obligated to carefully monitor the credentials and competence of employees and independent contractors.

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Independent Contractor Accountability

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Reponsible for his or her actions.
Health care facility may be liable if it had reason to know that the independent contractor was incompetent and failed to act.

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Define Tort

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Tort is a civil action for financial damages for injury to a person, property or reputation.

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Describe tort

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Intentional vs unintentional
Negligence is most common for nurses (unintentional) and includes failing to adhere to the standard of nursing care and results in harm to the patient.
Good Samaritan Laws protect in emergency situations.
Generally result in financial settlement.

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Four elements to establish claim for negligence

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1. Duty: Nurse had a duty for patient and scope or limits of that duty must be proven.
2. Breach of duty: Deviated in standard of care.
3. Injury or harm must result.
4. Causation: breach of duty must be proved to be the proximated cause of injury.

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Protect against negligence

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Know:
practice area and remain current.
abilities and limitations
standard of care
facility's policies and procedures.
patients and their family members

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Intentional tort

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Assault and battery
Defamation is wrongful injury to a persons reputation.
Invasion of privacy.
Fraud and misreputation
False imprisionment