ETHICO –LEGAL NURSING(Topic Outline)

• ETHICS , NURSING ETHICS AND JURISPRUDENCE

• ETHICO- MORAL PRINCIPLES -Beneficence-Nonmaleficence-Autonomy-Justice-Veracity-Fidelity-Confidentiality

• MORAL AND SPIRITUAL RESPONSIBILITIES OF NURSES

• PATIENT’S BILL OF RIGHTS

• CODE OF ETHICS FOR NURSES IN THE PHILIPPINES(Board Resolution No. 220, s. 2004)

• LEGAL ASPECT OF NURSING PRACTICE

• RA 9173 – PHILIPPINE NURSING ACT OF 2002

• LEGAL LIABILITIES OF NURSES -Negligence-Malpractice-Assault-Battery

• CRIMES

• LEGAL PROBLEMS and ETHICAL ISSUES IN NURSING PRACTICE-Fraud-Telephone Orders-Do Not Resuscitate orders etc.. 

X. OTHER LAWS AFFECTING THE PRACTICE OF NURSING IN THE PHILS.References: Nursing Law, Jurisprudence & Professional Ethics 1st editionAtty. Rustico T. De Belen; Donna Vivian V. De Belen, 2007 Fundamentals of Nursing , Standards and Practice 3rd editionSue C. Delaune; patricia K. Ladner, 2006 Bioethics and Moral DecisionsFlorentino T. Timbreza, 2003 Values and Work EthicsArchimedes C. Articulo; Gloria G. Florendo, Ph.D., 2003 ETHICS AND ISSUES IN CONTEMPORARY NURSING 2nd editionby: Margaret A. Burkhardt, Alvita K. Nathaniel, 2002PHILS.

nurses work with people nurses make decisions nurses work interact with other members of the health team Professional commitment

Ethical Principles AUTONOMY:“ I DECIDE FOR MYSELF” Ethical Principles

1.) BENEFICENCE:“ DO GOOD”

3 major components: (PPR)

– Promote good

– Prevent harm

– Remove evil or harm2.) NONMALEFICENCE:“DO NO HARM”

Schizophrenic patient who has intent of killing someone who is falsely seen as an evil in society should be restrained.

Epileptic who has daytime attacks should be prevented from driving. Removing a child from his home in cases of child abuse. Preventing a pregnant nurse from handling radiation and chemotherapy patients

3.) JUSTICE: “BE FAIR”4.) VERACITY: “TELL THE TRUTH”5.) FIDELITY: “ BE FAITHFUL”6.) CONFIDENTIALITY: “TELL NO ONE”

MORAL PRINCIPLES-THE GOLDEN RULE-THE TWO-FOLD EFFECT.

That the action must be morally good; That the good effect must be willed and the bad effect merely allowed; That the good effect must not come from an evil action but from the initial action itself

directly; and That the good effect must be greater than the bad effect.

example:A patient who has cancer of the uterus submits to hysterectomy she will not be able to bear a child.

If she does not have the operation, she will die. It is the gynecologist’s intention to help the mother and not to harm her. The surgeon’s action is morally good since saving the mother’s life is of primary importance.

THE PRINCIPLE OF TOTALITY. EPIKIA ONE WHO ACTS THROUGH AN AGENT IS HIMSELF RESPONSIBLE. NO ONE IS OBLIGED TO BETRAY HIMSELF/HERSELF. THE END DOES NOT JUSTIFY THE MEANS. DEFECTS OF NATURE MAY BE CORRECTED. IF ONE IS WILLING TO COOPERATE IN THE ACT, NO INJUSTICE IS DONE TO HIM/HER. A LITTLE MORE OR LESS DOES NOT CHANGE THE SUBSTANCE OF AN ACT. THE GREATEST GOOD FOR THE GREATEST NUMBER. NO ONE IS HELD TO THE IMPOSSIBLE. THE MORALITY OF COOPERATION. PRINCIPLE RELATING TO THE ORIGIN AND DESTRUCTION OF LIFE.

-ETHICAL DECISION-MAKING-Who owns the problem?-Gather relevant facts

-Clarify values and beliefs and conflicts-Identify the ethical issues-Apply ethical principles-Consider possible sources of action-Evaluate outcomes

NON-COMPLIANCE VS AUTONOMY

Dionisia is a forty-five year-old woman who looks years older than her stated age. She has very limited monthly income and no health insurance. Dionisia smokes two and one-half packs of cigarettes per day. She has a severe COPD with constant dyspnea and frequent exacerbations.

The nurse who sees her at a local free clinic is interested in at least preventing further problems, and speaks to Dionisia often about the importance of quitting smoking. The situation becomes very frustrating for all involved when Dionisia returns repeatedly for increasing severe problems, having failed to quit smoking. Parting, of course, becomes labeled as non-compliant.

During a particularly severe exacerbation, the nurse says to Dionisa, “ you know you are committing suicide by continuing to smoke.” Dionisa reply is, “You don’t understand. I live alone. I have no money, no friends, no family, and never will be able to work. I know the damage I’m doing, but smoking is the only pleasure I have in life.

ETHICAL DECISION-MAKINGI- Who owns the problem?

NurseII- Gather relevant facts Patring - a 45 yo woman

- w/ limited monthly income - no health insurance. - smokes 2&1/2 packs of cigarettes per day - has a severe COPD with

constant dyspnea and frequent exacerbations

III Clarify values and beliefs and conflicts Nurse intends to prevent further harm - sees Patring at clinic - health teachings on quitting

End of life issues Advance directives Ethical nurse recruitment Patient-physician-nurse relationship Working conditions (cost, resources) Withdrawal of food and fluids Destructive lifestyles (drug abuse, prostitution)Telephone Orders

Right to Good Quality Health Care and Humane Treatment Right to Dignity. Right to be Informed of His Rights and Obligations as a Patient Right to Choose His Physician / Health Institution Right to Informed Consent Right to Refuse Diagnostic and Medical Treatment Right to Religious Belief and Assistance Right To Privacy and Confidentiality Right to Disclosure of, and Access to, Information Right to Correspondence and to Receive Visitors

Right to Medical Records Right to Health Education Right to Leave Against Medical Advise Right to Express Grievances. Right to Health Right to Access to Quality Public Health Care Right to a Healthy and Safe Workplace Right to Medical Information and Education Programs Right to Participate in Policy Decisions Right to Access to Health Facilities Right to an Equitable and Economical Use of Resources Right to Continuing Health Care Right to Be Provided Quality Health Care In Times of Insolvency Know Rights Provide Adequate, Accurate and Complete Information Report Unexpected Health Changes Understand the Purpose and Cost of Treatment Accept the Consequences of Own Informed Consent Settle Financial Obligations. Respect the Rights of Health Care Providers, Health Care Institutions and Other Obligation to Self Provide Adequate Health Information and Actively Participate in His/Her Treatment. Respect the Right to Privacy of Health Care Providers and Institutions. Exercise Fidelity on Privileged Communication Respect a Physician’s Refusal to Treat Him Respect the Physician’s Decision on Medical Reasons based on His/Her Religious Beliefs Ensure Integrity and Authenticity of Medical Records Participate in the Training of Competent Future Physicians Report Infractions and Exhaust Grievance Mechanism.

S.B. NO. 2371“Magna Carta of Patient’s Rights and Obligations of 2008.

An act Proclaiming the rights and obligations of patients, providing a grievance mechanism thereof and for other purposes

Author: SEN PIA CAYETANO

Nurses have the right to:

practice in a manner that fulfills their obligations to society and to those who receive nursing care.

practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice

work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurses

freely and openly advocate for themselves and their patients, without fear of retribution. fair compensation for their work. Consistent with their knowledge, experience, and

professional responsibilities. a work environment that is safe for themselves and their patients. negotiate the conditions of their employment, either as individuals or collectively, in all

practice settings.