Ethical and Legal Issues – Chapter 3 Study Notes

Learning Objectives

• The chapter equips learners to:

  • Compare values, rights, and ethics.

  • Explain the purpose and contents of the Patient Care Partnership.

  • Recall six steps for sound ethical decision-making.

  • Identify why practice acts are legally important.

  • Describe the procedure for involuntary psychiatric commitment.

  • List four key areas of potential legal liability in mental-health practice.

  • Distinguish negligence from malpractice in legal terms.

  • Discuss three nurse/legal responsibilities that relate to day-to-day practice.

Foundational Concepts: Attitudes, Beliefs, Values & Morals

• Attitudes

  • Ideas or feelings that help shape one’s outlook.

  • Influence perception and behavior.

• Beliefs

  • Intellectually accepted convictions regarded as true—may or may not be based on fact.

• Values

  • Things, ideas, or behaviors held dear; culturally learned in childhood.

  • Provide criteria for decision-making and prioritization.

• Morals

  • Personal, often culturally embedded, reflections of attitudes, beliefs, and values.

  • Relatively stable and resistant to change.

Rights

• A right = a power, privilege, or existence to which one has a just claim.

• Function to regulate social interaction using the principle of justice (fair, equal application).

• Each right implies a corollary obligation (e.g., right to privacy → obligation of others to respect confidentiality).

The Patient’s Bill of Rights → Patient Care Partnership

• 1st introduced $1972$; updated form “Patient Care Partnership: Understanding Expectations, Rights & Responsibilities” adopted $2003$.

• Guarantees to all clients:

  • Respectful care.

  • Privacy & confidentiality.

  • Continuity of care.

  • Relevant, understandable information about diagnosis, treatment, prognosis, and cost.

  • Involvement in planning and decision-making.

  • Review of records & explanation of the care bill.

• Emphasizes partnership—patients AND providers share responsibility for quality, safety, and effective outcomes.

Rights of Nurses & Other Care Providers

• Right to respect as unique individuals (e.g., names, credentials used correctly).

• Right to safe work environments—free of violence, harassment, avoidable occupational hazards.

• Right to competent assistance & teamwork—full, equal participation on the inter-professional team.

• Right to establish quality standards & policies influencing client care.

Ethics

• Defined as the set of rules, values, and principles that govern right behavior.

• Purpose: protect the rights and welfare of all people.

• Reflects:

  • Values (what is important),

  • Morals (personal convictions),

  • Principles of right & wrong.

Core Ethical Principles

• Autonomy – respect for individuals’ right to self-determination.

• Beneficence – actively promoting good; acting in the client’s best interest.

• Nonmaleficence – obligation to do no harm.

• Justice – fairness; equitable distribution of resources and care.

• Confidentiality – safeguarding private information.

• Fidelity – faithfulness; keeping promises and commitments.

• Veracity – telling the truth, fostering trust.

Codes of Ethics

• Developed by professional bodies:

  • International Council of Nurses (ICN).

  • American Nurses Association (ANA).

  • National Federation of Licensed Practical Nurses (NFLPN).

  • Canadian Nurses Association (CNA).

• Two overarching purposes:

  1. Offer guidelines & standards for professional practice.

  2. Inform the public of the conduct they may expect.

• General duties highlight:

  • Provide accurate info, maintain truthfulness, support clients.

  • Consult a supervisor whenever appropriateness is questionable.

Ethical Dilemmas & Decision-Making Process

• Ethical dilemma = conflict or uncertainty about which moral principles apply; cannot be solved solely through logic or empirical data.

• Six-Step Model (Slide visual):

  1. Identify all elements & stakeholders in the situation.

  2. Assume goodwill among all parties (no hidden malicious intent).

  3. Gather relevant information (facts, legal constraints, cultural factors, resources).

  4. List & order values involved (rank importance).

  5. Take action based on the prioritized values & data.

  6. Evaluate the plan’s effectiveness; revise as needed.

Law & Society

• Law = societal control mechanism; applies to every member.

• Built on the principles of:

  • Justice – fairness & equality.

  • Change – ability to evolve with societal needs.

  • Standards – baseline expectations.

  • Individual rights/responsibilities – balancing personal liberty with communal order.

Categories of Law

• Public (Criminal) Law

  • Regulates relationships between government & citizens.

  • Protects society as a whole.

  • Violations = misdemeanors (less serious) or felonies (serious crimes).

• Private (Civil) Law

  • Governs relationships among citizens &/or institutions.

  • Encompasses torts & contracts.

  • Objective is restitution/compensation rather than punishment.

Tort & Contract Breakdown (Key Terms)

• Intentional torts

  • Assault & Battery (threat/physical contact).

  • False Imprisonment (unauthorized restraint).

  • Invasion of Privacy.

  • Defamation (libel/slander).

  • Fraud.

• Unintentional torts

  • Negligence – failure to act as a reasonable, prudent person.

  • Malpractice – professional negligence leading to harm.

Legal Concepts in Health-Care Practice

• Governed by overlapping controls:

  • Nurse Practice Acts (state/provincial statutes).

  • Institutional Policies & Procedures.

  • Professional Standards of Practice set by boards & associations.

Mental Health Law

• Upon admission, clients retain all civil rights unless legally suspended.

Voluntary vs. Involuntary Admission

• Voluntary

  • Client actively requests care and may self-discharge at will (subject to standard notice period per jurisdiction).

• Involuntary (Civil Commitment)

  • Initiated by someone other than the client; aims to provide a protected therapeutic milieu and safeguard society.

  • Duration can range from days to years.

• Three-Stage Legal Flow (generic model):

  1. Petition (usually filed by caregiver, family, police).

  2. Examination (medical + judicial review).

  3. Determination leads to either:

  • Release, or

  • Hospitalization categorized as:

    • Emergency – controlling immediate threat.

    • Short-Term – diagnostics & brief therapy.

    • Long-Term – treatment until considered fit for discharge.

Provider Dilemma

• Must balance client autonomy & rights with duty to protect society.

• Common crimes within health-care settings: homicide, controlled-substance misuse, theft.

Negligence & Malpractice

• Both judged against the “reasonable & prudent person” standard.

• Negligence – omission or commission of an act a reasonable person would/wouldn’t do.

• Malpractice – failure to apply accepted professional skill resulting in injury, loss, or damage.

Four Legal Elements of Negligence (all must be proven)

1. Duty owed to the client.

2. Breach of that duty (action or inaction).

3. Injury suffered by the client.

4. Causation – injury directly linked to breach → actual loss.
   $Duty \rightarrow Breach \rightarrow Injury \rightarrow Causation$

Care-Provider Responsibilities

• Deliver dignified, humane treatment.

• Protect client rights (privacy, informed consent, least-restrictive environment).

• Adhere to reasonable & prudent caregiver principle—behave as an average professional with similar training & resources would in the same situation.

• Maintain documentation that is factual, timely, and complete (crucial in liability defense).

Practical Applications / Sample NCLEX-Style Questions

• Potential loss of rights during mental-health treatment: freedom from restraint or seclusion (correct answer to sample Q—client may temporarily lose this right if safety warrants; other rights remain intact).

• Provider rights focus on respect as individuals (sample Q answer $4$).

• Adding to the ANA Code of Ethics principles list → Nonmaleficence (sample Q answer $3$).

• Discussing a client in public violates invasion of privacy (sample Q answer $3$; defamation would require damaging untruths).

• Restraint guidelines: observe/monitor every $15$ minutes; remove one limb at a time & exercise each limb every $2$ hours (sample Q answer $2$).

Ethical-Legal Cross-Links & Real-World Significance

• Values ↔ Law: Personal values influence ethical codes, which in turn inform legislation (e.g., privacy → HIPAA).

• Ethical Principles in Action: Respecting autonomy drives informed-consent policies; nonmaleficence underlies medication-error reporting systems; justice guides triage and resource allocation.

• Malpractice climate: Rising litigation emphasizes robust risk-management (documentation, continuing education, inter-professional communication).

• Mental-health context: Emphasis on the least-restrictive alternative upholds autonomy yet may conflict with public safety obligations—providers need strong grounding in both ethical theory and commitment statutes.

Quick Reference Equations & Numbers

• Year Patient Bill of Rights → $1972$; Patient Care Partnership → $2003$.

• Restraint observation interval → $15 \text{ min}$.

• Restraint limb exercise interval → $2 \text{ h}$.

Study Tips

• Create flashcards pairing each ethical principle with a practice example.

• Map legal terms (tort, negligence, malpractice) onto real incidents from clinical practice or news articles.

• Use a decision-tree replica of the involuntary-commitment flow for quick recall.

• Rehearse the four elements of negligence; be able to supply a short, original example for each.