ETHICAL AND LEGAL ISSUES IN CRITICAL CARE NURSING

• American Nurses Association

  • Code of Ethics for Nurses with Interpretive Statements

• American Association of Critical-Care Nurses

  • An Ethic of Care

Professional organizations that promote ethics and advocacy

• Emotionally charged

• ● Significant change in the patient’s condition

• ● Confusion about facts

• ● Hesitancy about the correct set of actions

• ● Deviation from customary practice

• ● Need for secrecy regarding proposed actions

Ethical Dilemma Warning Signs

• Assess

• Consider options

• Develop a plan with the patient, surrogate, family, and team

• Act on the plan

• Evaluate plan

Ethical Decision-Making Process

Autonomy

● Right to self-determination concerning medical care

Beneficence

● Duty to prevent harm, remove harm, and promote the good of another person

Nonmaleficence

● Not to intentionally inflict harm

Justice

● Fair distribution of health care resources

Veracity

● Truthfulness

Fidelity

● Faithfulness to commitment

Confidentiality

● Respect for the right to control information

Ethical Principles

Autonomy

Right to self-determination concerning medical care

Beneficence

Duty to prevent harm, remove harm, and promote the good of another person

Nonmaleficence

Not to intentionally inflict harm

Justice

Fair distribution of health care resources

Veracity

Truthfulness

Fidelity

Faithfulness to commitment

Confidentiality

Respect for the right to control information

Abandonment

Severing professional relationships when a patient needs care

Moral conflict

• A nurse is not required to practice if a situation violates hi her moral or religious beliefs

• ● Patient care must be transferred to another to avoid abandonment

Competence

Voluntariness

Disclosure

• Elements of Informed Consent

• Constitutional rights

● Quality of life

● Impact of advanced technology

● Medical futility

● Ordinary version, extraordinary care

Factors to consider in Life-Sustaining Treatment

Ordinary Care

• Common, noninvasive, and tested treatment

• ● Nutrition, hydration, antibiotics

Extraordinary Care

● Complex, invasive, experimental treatment

● Advanced Cardiac Life Support (ACLS), dialysis, and unproven therapies

Patient Self-Determination Act

● Patient’s right to initiate advance directive

● Right to consent to or refuse treatment

Advance Directive

● Communication about preferences for treatments if the patient is incapacitated

● Do not resuscitate (DNR)

● Natural death

Living will

Treatments desired and what should be withheld

Durable power of attorney for health care

● Determines who makes decisions

● Health care surrogate or proxy

• Advocacy

• Dilemmas can result in moral distress

• Formal mechanisms (The Joint Commission)

• Opportunities for critical care nurses

Nurse Involvement in Ethical Decision-Making

Competence

Ability to understand

Voluntariness

Consent without coercion

● Diagnosis

● Proposed treatment

● Probable outcome

● Benefits and risks

● Alterative treatments

● Prognoses if treatment is not provided

what do you disclose to a patient while providing informed consent?

not initiating

Withholding:

weaning or removing

Withdrawal:

● Communicate frequently

● Engage in consistent, honest communication

● Base decisions on the patient’s wishes

● Provide psychological support to the family

how Helping Families Make Decisions About Life Support