LEGAL AND LEGAL AND ETHICAL ISSUES IN ETHICAL ISSUES IN

NURSINGNURSINGPresented by:Presented by:

Mrs. Anita Lopes, Mrs. Anita Lopes, M.Sc Nursing, RNM.Sc Nursing, RN

INTRODUCTIONINTRODUCTION Nursing has its own identity as a Nursing has its own identity as a

‘profession’, hence is governed by ‘profession’, hence is governed by many legal aspect.many legal aspect.

The need for nursing is universal and The need for nursing is universal and nurses are accountable for their nurses are accountable for their professional judgments and actions.professional judgments and actions.

Nurses render health services to the Nurses render health services to the individual, the family and the individual, the family and the community & co-ordinate their community & co-ordinate their services with inter related groups.services with inter related groups.

NEEDNEED Knowledge of the laws that regulate Knowledge of the laws that regulate

and affect nursing practice is needed and affect nursing practice is needed for two reasons:for two reasons:

* To ensure that that the nurse’s * To ensure that that the nurse’s decisions and actions are consistent decisions and actions are consistent with current legal principles.with current legal principles.

*To protect the nurse from liability. *To protect the nurse from liability.

AREAS OF CONCERNAREAS OF CONCERN Professional Nursing practiceProfessional Nursing practice

Legal issues Legal issues

Ethical principlesEthical principles

Labour managementLabour management

LAWLAWMeaning:Meaning: Law means a body of rules to guided Law means a body of rules to guided

human actionhuman action

Definition:Definition:

The law is the body of principles recognized The law is the body of principles recognized and applied by the state and the and applied by the state and the administration of justiceadministration of justice

-Salmaind-Salmaind

FUNCTIONS OF LAW IN FUNCTIONS OF LAW IN NURSINGNURSING

Provides a framework for establishing Provides a framework for establishing which nursing actions in the care of which nursing actions in the care of clients are legal.clients are legal.

It differentiates the nurses responsibilities It differentiates the nurses responsibilities from those of other health professionals.from those of other health professionals.

It helps establish the boundaries of It helps establish the boundaries of independent nursing action.independent nursing action.

It assists in maintaining a standard of It assists in maintaining a standard of nursing practice by making sure nurses nursing practice by making sure nurses are accountable under the laware accountable under the law

NURSING ETHICSNURSING ETHICS It involves rules and principles to guide It involves rules and principles to guide

right conduct in terms of moral duties and right conduct in terms of moral duties and obligations to protect the rights of human obligations to protect the rights of human being.being.

In nursing, ethical code provides In nursing, ethical code provides professional standards and formal professional standards and formal guidelines for nursing activities to protect guidelines for nursing activities to protect both the nurse and the patient. both the nurse and the patient.

PURPOSES OF ETHICS IN NURSINGPURPOSES OF ETHICS IN NURSING To provide a basis for regulating To provide a basis for regulating

relationships between nurse, patient, co-relationships between nurse, patient, co-workers, society and profession.workers, society and profession.

To provide a standard for excluding To provide a standard for excluding unscrupulous nursing practitioners and unscrupulous nursing practitioners and for defending nurses unjustly accused.for defending nurses unjustly accused.

To serve as a basis for nursing To serve as a basis for nursing curriculum.curriculum.

To orient new nurses and the public to To orient new nurses and the public to ethical professional conduct. ethical professional conduct.

TYPES OF LAWTYPES OF LAW

Public law: Public law: refers to the body of law that refers to the body of law that

deals with relationship between deals with relationship between individuals and the government individuals and the government and governmental agencies.and governmental agencies.

TYPES OF LAWTYPES OF LAW Civil law:Civil law: Includes rules and regulations that Includes rules and regulations that

specify the required course of action to specify the required course of action to be followed by an individual in social be followed by an individual in social relationships with others………concerned relationships with others………concerned with protection of person’s rights & with protection of person’s rights & relationship….usually no threat to the relationship….usually no threat to the society is perceived. society is perceived.

TYPES OF LAWTYPES OF LAW Contract law: Contract law: involves the involves the

enforcement of agreement among enforcement of agreement among private individuals or the payment of private individuals or the payment of compensation for failure to fulfill the compensation for failure to fulfill the agreement. agreement.

E.g. Nurse & client, Nurse & employerE.g. Nurse & client, Nurse & employer

Tort law:Tort law: defines and enforces duties defines and enforces duties and rights among private individuals and rights among private individuals that are not based on contractual that are not based on contractual agreement. E.g. Negligence, Invasion agreement. E.g. Negligence, Invasion of privacy. of privacy.

TYPES OF LAWTYPES OF LAW

Criminal Law:Criminal Law: Defines offences that affect public Defines offences that affect public

welfare and security and impose welfare and security and impose penalties….includes forbidding penalties….includes forbidding conduct….concerned with relationship conduct….concerned with relationship between individuals and the government between individuals and the government that threatens the society.that threatens the society.

SOURCES OF LAWSOURCES OF LAW1)1) Statutory Law/ statute:Statutory Law/ statute: Documented rules for living in your own Documented rules for living in your own

state.state. *State law*State law *Federal Law (Central Government)*Federal Law (Central Government) -These laws are prepared by state -These laws are prepared by state

legislature & congresslegislature & congress -Covers the rules of relationship we -Covers the rules of relationship we

share with each other and can be share with each other and can be viewed as ethic of society and conduct. viewed as ethic of society and conduct.

SOURCES OF LAW…SOURCES OF LAW…

3) Constitutional law3) Constitutional law

4) Common law4) Common law

5) Administrative law5) Administrative law

CRIME & LEGAL ACTIONCRIME & LEGAL ACTION Crime is an offence against the society Crime is an offence against the society

that violates a law.that violates a law.

Types of crime & Legal action:Types of crime & Legal action: AA Felony Felony is a crime of serious nature is a crime of serious nature

that carries a penalty of imprisonment for that carries a penalty of imprisonment for greater than a year or death.greater than a year or death.

A A misdemeanour misdemeanour is a crime of less is a crime of less serious nature and the penalty is usually serious nature and the penalty is usually a fine or imprisonment less than a year.a fine or imprisonment less than a year.

TORTTORT Tort is a civil wrong committed against a Tort is a civil wrong committed against a

person or a person's propertyperson or a person's property Fraud, negligence and malpractice are Fraud, negligence and malpractice are

torts.torts. Tort can be intentional or unintentional Tort can be intentional or unintentional

tort. tort.

INTENTIONAL TORTSINTENTIONAL TORTS

Fraud:Fraud: Misinterpretation of fact with Misinterpretation of fact with intentions for it to be acted on by another intentions for it to be acted on by another person ( e.g. false certificates/ reports).person ( e.g. false certificates/ reports).

Assault:Assault: an attempt or threat to touch an attempt or threat to touch another person unjustifiably.another person unjustifiably.

INTENTIONAL TORTS….INTENTIONAL TORTS…. Battery:Battery: the willful or negligent touching the willful or negligent touching

of a person (or the person's clothes or of a person (or the person's clothes or even something the person is carrying), even something the person is carrying), which may or may not cause harmwhich may or may not cause harm

False imprisonment: False imprisonment: the unlawful the unlawful restraint or detention of another person restraint or detention of another person against his or her wishes.against his or her wishes.

INTENTIONAL TORTS….INTENTIONAL TORTS…. Invasion of privacy:Invasion of privacy: a direct wrong a direct wrong

of a personal nature, it injures the of a personal nature, it injures the feelings of the person and does not take feelings of the person and does not take into account the effect of reveled into account the effect of reveled information on the standing of the person information on the standing of the person in the communityin the community

A CLIENT MUST BE PROTECTED A CLIENT MUST BE PROTECTED FROM: FROM:

Use of clients name or likeness for profit, Use of clients name or likeness for profit, without consent.without consent.

Unreasonable intrusionUnreasonable intrusion Public disclosure of private factsPublic disclosure of private facts Putting a person in a false light. Putting a person in a false light.

Defamation:Defamation: (legal) a communication (legal) a communication that is false, or made with careless that is false, or made with careless disregard for the truth, and results in disregard for the truth, and results in injury to the reputation of anotherinjury to the reputation of another

Libel:Libel: defamation by means of print, defamation by means of print, writing, or pictureswriting, or pictures

Slander:Slander: defamation by the spoken defamation by the spoken word, stating unprivileged (not legally word, stating unprivileged (not legally protected) or false words by which a protected) or false words by which a reputation is damagedreputation is damaged

UNINTENTIONAL TORTSUNINTENTIONAL TORTS Negligence: Negligence: Failure to behave in a Failure to behave in a

reasonable and prudent manner; an reasonable and prudent manner; an unintentional tortunintentional tort

Or Carelessness on the part of the Or Carelessness on the part of the nurses which leads to a court action nurses which leads to a court action against the nurse and heavy damage can against the nurse and heavy damage can be sued to the hospital and nursebe sued to the hospital and nurse

Types of negligenceTypes of negligence Failure to follow standards of careFailure to follow standards of care Sponge countSponge count BurnsBurns FallsFalls Failure to observe and take appropriate Failure to observe and take appropriate

actionsactions Wrong medicine, dose, routeWrong medicine, dose, route Mistaken identityMistaken identity Failure to communicateFailure to communicate Loss of or damage to patient’s property. Loss of or damage to patient’s property.

MALPRACTICEMALPRACTICE

Malpractice:Malpractice: the negligent acts of the negligent acts of persons engaged in professions or persons engaged in professions or occupations in which highly technical or occupations in which highly technical or professional skills are employedprofessional skills are employed

ELEMENTS OF ELEMENTS OF MALPRACTICEMALPRACTICE

DutyDuty Breach of dutyBreach of duty ForeseeabilityForeseeability CausationCausation Possible harm to patientPossible harm to patient DamagesDamages

NURSE AS AN EMPLOYEENURSE AS AN EMPLOYEE License:License: a legal permits granted to a legal permits granted to

individuals to engage in the practice of a individuals to engage in the practice of a profession and to use a particular titleprofession and to use a particular title

A nurse must know how to obtain a license A nurse must know how to obtain a license & practice legally in a state.& practice legally in a state.

Must be aware of formalities when Must be aware of formalities when transferred to another state.transferred to another state.

Must possess a valid and current license Must possess a valid and current license from the state council.from the state council.

Follow the renewal of license protocol: time Follow the renewal of license protocol: time and educational requirement.and educational requirement.

NURSE AS AN EMPLOYEENURSE AS AN EMPLOYEE

Must know the disciplinary actions which Must know the disciplinary actions which can be taken to revoke the license.can be taken to revoke the license.

Must know the outline of an appeal legal Must know the outline of an appeal legal process.process.

Must know her job description (legal Must know her job description (legal protection).protection).

Must know and practice the acceptable Must know and practice the acceptable standards of care set by ICN. standards of care set by ICN.

Greeting of accuse & Greeting of accuse & accused in the courtaccused in the court

Criminal cases: Criminal cases: State Vs Defendant.State Vs Defendant.

Civil cases: Civil cases: Plaintiff Vs DefendantPlaintiff Vs Defendant

Plaintiff:Plaintiff: A plaintiff also known as A plaintiff also known as claimant/ complainant, is the party claimant/ complainant, is the party who initiates a lawsuit (also known as who initiates a lawsuit (also known as action before court)action before court)

Defendant : Defendant : A defendant/ a defender A defendant/ a defender is any party who is required to answer is any party who is required to answer the complaint of a plaintiff in a civil the complaint of a plaintiff in a civil law suit before the court or any other law suit before the court or any other party who has been formally charged party who has been formally charged or accused of violating a criminal or accused of violating a criminal statute. statute.

CIVIL JUDICIAL PROCESSCIVIL JUDICIAL PROCESS FIVE STEPSFIVE STEPS

1) A document, called a 1) A document, called a complaintcomplaint, is filed , is filed by a person referred to as by a person referred to as plaintiffplaintiff, who , who claims that his/her legal rights have been claims that his/her legal rights have been infringed on by the one or more persons, infringed on by the one or more persons, referred as referred as defendantdefendant. .

2) A written response, called as an 2) A written response, called as an answeranswer, , is made by the defendant.is made by the defendant.

3) Both parties engage in pretrial 3) Both parties engage in pretrial activities, referred to as activities, referred to as discoverydiscovery, in , in an effort to obtain facts about the an effort to obtain facts about the situation. situation.

4) In the 4) In the trial trial of the case, all the relevant of the case, all the relevant facts are presented to a jury or only to facts are presented to a jury or only to a judge.a judge.

5) The judge renders a 5) The judge renders a decision,decision, or the or the jury renders a jury renders a verdict.verdict. If the outcome If the outcome is not acceptable to one of the parties, is not acceptable to one of the parties, an appeal can be made for another an appeal can be made for another trial. trial.

LEGAL IMPLICATIONS IN LEGAL IMPLICATIONS IN NURSINGNURSING (A) Legal role of a nurse: (A) Legal role of a nurse: 1)1) Safe & competent careSafe & competent care (standards of (standards of

care): detailed guidelines describing the care): detailed guidelines describing the minimal nursing care that can reasonably minimal nursing care that can reasonably be expected to ensure high quality care be expected to ensure high quality care in a defined situation in a defined situation

2)2) Liability:Liability: is the quality or state of being is the quality or state of being legally responsible for one’s obligations legally responsible for one’s obligations and actions. and actions.

3)3) Contractual Obligations:Contractual Obligations: refers to refers to a nurse’s duty of care, that is, duty to a nurse’s duty of care, that is, duty to render care, established by the presence render care, established by the presence of an implied contract. of an implied contract.

LEGAL IMPLICATIONS IN LEGAL IMPLICATIONS IN NURSING….NURSING….

(B) Informed consent: (B) Informed consent: It is an agreement by a client to accept a It is an agreement by a client to accept a

course of treatment or a procedure after course of treatment or a procedure after being provided complete information, being provided complete information, including the benefits and risks of including the benefits and risks of treatments, alternatives to treatment and treatments, alternatives to treatment and prognosis if not treated by a health care prognosis if not treated by a health care provider. provider.

Implied Consent:Implied Consent: It exists when the It exists when the individual’s nonverbal behaviour individual’s nonverbal behaviour indicates agreement. indicates agreement.

E.g. Before administering IM injections. E.g. Before administering IM injections. Major Elements:Major Elements: VoluntarilyVoluntarily Within capacity or competence of Within capacity or competence of

individual individual Client is the ultimate decision maker. Client is the ultimate decision maker.

(C) Incident Report: (C) Incident Report: It is a written document about an incident It is a written document about an incident

which has lead to a harm or possibly which has lead to a harm or possibly could have a caused a harm to a person could have a caused a harm to a person within hospital premises.within hospital premises.

Objective dataObjective data No assumptions & judgments.No assumptions & judgments.

(D) Death and Related (D) Death and Related issues: issues:

Advance directives:Advance directives: Legal, written or Legal, written or oral statements made by a mentally oral statements made by a mentally competent person about treatment competent person about treatment preferences. In the event the person is preferences. In the event the person is unable to make these determinations, a unable to make these determinations, a designated surrogate decision maker can designated surrogate decision maker can do so. do so.

Living will:Living will: legal document stating legal document stating person des not wish to have extraordinary person des not wish to have extraordinary lifesaving measures when not able to lifesaving measures when not able to make decisions about own care.make decisions about own care.

Durable power of attorney: Durable power of attorney: Legal document giving a person a Legal document giving a person a

authority to make health care decisions authority to make health care decisions on client’s behalf when client is unable to on client’s behalf when client is unable to do so. do so.

Autopsy:Autopsy: An autopsy or postmortem An autopsy or postmortem examination is an examination of the examination is an examination of the body after death…..Consent is needed…body after death…..Consent is needed…Hospital cannot retain any tissue or Hospital cannot retain any tissue or organ. organ.

Certification of death: Certification of death: Must be proclaimed & certified by Must be proclaimed & certified by

physician.physician. Original certificate must be handed over Original certificate must be handed over

directly in the relatives hands, a directly in the relatives hands, a photocopy is retained in the hospital.photocopy is retained in the hospital.

All reports, medications & personal All reports, medications & personal belonging must be handed over.belonging must be handed over.

Outside state: 3 copies. Outside state: 3 copies. Coroner’s office: NOC & death certificate, Coroner’s office: NOC & death certificate,

arrange transportation. arrange transportation.

Medico legal cases: Medico legal cases: No death certificate is issued.No death certificate is issued. Summary of arrival is documented.Summary of arrival is documented. No cause of death is mentioned.No cause of death is mentioned. The client’s body is directly sent to The client’s body is directly sent to

coroner’s office.coroner’s office. A decision for post mortem is made. A decision for post mortem is made.

Do-Not-Resuscitate Orders:Do-Not-Resuscitate Orders: A DNR order is generally written when a A DNR order is generally written when a

the client or proxy has expressed the the client or proxy has expressed the wish for no resuscitation in the event of a wish for no resuscitation in the event of a respiratory or cardiac arrest. respiratory or cardiac arrest.

Euthanasia:Euthanasia: It is the act of painlessly putting to death It is the act of painlessly putting to death

persons suffering from incurable or persons suffering from incurable or distressing disease.distressing disease.

Inquest:Inquest: An Inquest is a legal inquiry into the An Inquest is a legal inquiry into the

cause or manner of a death. cause or manner of a death.

Organ donation: Organ donation: People 18 years or older and of sound People 18 years or older and of sound

mind may make a gift of all or any part of mind may make a gift of all or any part of their own bodies for medical or dental their own bodies for medical or dental education, research, advancement of education, research, advancement of medical science, therapy, or medical science, therapy, or transplantation. transplantation.

E) Abortions: Ethical issues….E) Abortions: Ethical issues…. F) Sexual harassment.F) Sexual harassment. G) Violence, Abuse and Neglect.G) Violence, Abuse and Neglect. H) The Impaired nurse.H) The Impaired nurse. I) Controlled substances.I) Controlled substances. J) Delegation. J) Delegation.

NURSING CODE OF ETHICSNURSING CODE OF ETHICS a formal statement of a group's ideals a formal statement of a group's ideals

and values; and values; a set of ethical principles shared by a set of ethical principles shared by

members of a group, members of a group, reflects their moral judgments over time reflects their moral judgments over time serves as a standard for professional serves as a standard for professional

actions.actions.

THE ICN CODE OF ETHICSTHE ICN CODE OF ETHICSThe elements of code are: The elements of code are: The nurses and the PeopleThe nurses and the People The nurses and PracticeThe nurses and Practice The nurses and the ProfessionThe nurses and the Profession The nurses and the Co-workersThe nurses and the Co-workers

ANA code of ethicsANA code of ethics Respect for human dignity and uniquenessRespect for human dignity and uniqueness Right to privacy and confidentiality.Right to privacy and confidentiality. Protect patient from incompetent, unethical, Protect patient from incompetent, unethical,

or illegal behaviour.or illegal behaviour. Accept responsibilityAccept responsibility Maintain competenceMaintain competence Maintain responsibility when delegatingMaintain responsibility when delegating Maintain and improve nursing standardsMaintain and improve nursing standards Protect consumer from misinformation. Protect consumer from misinformation.

BIOETHICSBIOETHICS A philosophical field that applies ethical A philosophical field that applies ethical

reasoning process for achieving clear reasoning process for achieving clear and convincing reasons to issues and and convincing reasons to issues and dilemmas (conflicts between two dilemmas (conflicts between two obligations) in health careobligations) in health care

Or it is the ethical rules or principles that Or it is the ethical rules or principles that govern right conduct concerning lifegovern right conduct concerning life

Purpose of applying Purpose of applying Bioethics Bioethics

Improve quality of professional nursing Improve quality of professional nursing decisionsdecisions

Increase sensitivity to othersIncrease sensitivity to others Offer a sense of moral clarity and Offer a sense of moral clarity and

enlightment.enlightment.

MODELS OF ETHICAL MODELS OF ETHICAL REASONING/DECISION REASONING/DECISION

MAKINGMAKING DeontologicalDeontological

Teleological Teleological

Situational Situational

Framework for analyzing Framework for analyzing an ethical issuean ethical issue

1)1) Who are the relevant participants in the Who are the relevant participants in the situation?situation?

2)2) What is the action required?What is the action required?3)3) What are the probable and possible What are the probable and possible

benefits and consequences of the action ?benefits and consequences of the action ?4)4) What is the range of alternative actions or What is the range of alternative actions or

choices?choices?5)5) What is the intent or purpose of the What is the intent or purpose of the

action?action?6)6) What is the context of the action?What is the context of the action?

ETHICAL PRINCIPLESETHICAL PRINCIPLES AutonomyAutonomy BeneficenceBeneficence JusticeJustice Fidelity/ConfidentialityFidelity/Confidentiality VeracityVeracity Non- malfeasanceNon- malfeasance

AUTONOMYAUTONOMY Upholds the exercise of Upholds the exercise of personal choicepersonal choice Respects the right of a person to make their Respects the right of a person to make their

own decision, free of external control.own decision, free of external control. Privacy: Privacy: right to be free from intrusion in one’s right to be free from intrusion in one’s

own personal affairs.own personal affairs. Confidentiality:Confidentiality: It is the ethical principle of It is the ethical principle of

upholding the practices of safeguarding upholding the practices of safeguarding personal information.personal information.

Parentalism:Parentalism: It is the deliberate restriction of It is the deliberate restriction of person’s autonomy by health care person’s autonomy by health care professionals based on the ideas that they professionals based on the ideas that they know what is best for the client. know what is best for the client.

BENEFICIANCEBENEFICIANCE

Doing goodDoing good Removing harmRemoving harm Preventing harmPreventing harm The essence of nursing.The essence of nursing.

JUSTICEJUSTICE

Giving people their dueGiving people their due

All persons should be treated All persons should be treated equally and fairlyequally and fairly

FIDELITYFIDELITY

Keeping one’s promises or Keeping one’s promises or commitmentscommitments

Faithfully fulfilling the duties and Faithfully fulfilling the duties and obligations. obligations.

VERACITYVERACITY Concerns telling the truth.Concerns telling the truth. Care-givers should provide the Care-givers should provide the

client with accurate, reality based client with accurate, reality based information about the health information about the health status and care or treatment.status and care or treatment.

Telling truth helps to build trustTelling truth helps to build trust Nurse manager: should practice Nurse manager: should practice

this principle when dealing with this principle when dealing with their sub ordinatestheir sub ordinates

NON-MALEFICENCENON-MALEFICENCE

One should do no harm whether One should do no harm whether intentional or non-intentional.intentional or non-intentional.

Harm refers to ‘physical’, ‘social’ Harm refers to ‘physical’, ‘social’ or ‘emotional’ harm. or ‘emotional’ harm.

PATIENT’S BILL OF PATIENT’S BILL OF RIGHTSRIGHTS

Information/disclosureInformation/disclosure Choice of provider and plans.Choice of provider and plans. Access to emergency services.Access to emergency services. Participation in treatment decisions.Participation in treatment decisions. Respect and non-discrimination.Respect and non-discrimination. Confidentiality.Confidentiality. Complaints and appealComplaints and appeal Consumer responsibilitiesConsumer responsibilities

ETHICAL DILEMMASETHICAL DILEMMAS AIDSAIDS AbortionAbortion Organ transplantationOrgan transplantation Blood transfusionBlood transfusion End of life issuesEnd of life issues Personal values versus professional dutyPersonal values versus professional duty Nurses versus agencyNurses versus agency Nurse versus colleaguesNurse versus colleagues Nurses versus patient/familyNurses versus patient/family Conflicting responsibilityConflicting responsibility

Nurse as an effective advocate Nurse as an effective advocate involves:involves:

Being assertiveBeing assertive Recognizing the rights and values of client and Recognizing the rights and values of client and

families must take precedence when they families must take precedence when they conflict with those of health care provider.conflict with those of health care provider.

Being aware that conflicts may arise over Being aware that conflicts may arise over issues that require consultation, confrontation issues that require consultation, confrontation or negotiation between the nurse and or negotiation between the nurse and administrative personnel or between the nurse administrative personnel or between the nurse and primary care provider.and primary care provider.

Working with community agencies and lay Working with community agencies and lay practitioners.practitioners.

Knowing that advocacy may require political Knowing that advocacy may require political action: communicating a client’s health care action: communicating a client’s health care needs to the government and other officials. needs to the government and other officials.

THANK YOUTHANK YOU