Nurse 1001- Ethical and Legal Issues

Goals for this Lecture

1. Define and describe the concepts
2. Discuss ethical principles and theories
3. Identify ways that ethical and legal issues impact nursing and healthcare

Definition

Ethics- the study or examination of morality through a variety of different approaches.

• The study of the philosophical ideals of right and wrong
• Also refers to the values & standards of individuals & professions
• How you respond to an ethical situation is a reflection of the core values, beliefs, and character that make you the person you are and, ultimately, the professional you will become.

Ethics requires that you “be critically reflective, exploring your values, behaviours, actions, judgments, and justifications.”

Complexity of Ethics

• Ethics encompasses many different dimensions of a person's life

Scope of Ethics

Ethics

• Societal ethics
• Organizational ethics -come from mission vision and value
• bioethics/clinical ethics/research ethics -About specific circumstances like Assisted suicide or abortion, decisions we make in clinical practice, ethics from a research prospective quantitative and qualitative
• Professional ethics -expectations that we as professional healthcare providers must follow
• Personal ethics - our own personal beliefs

College of Nurses Ethics- Code of Conduct

• The code consists of six principles:
• 1. Nurses respect clients’ dignity.
• 2. Nurses provide inclusive and culturally safe care by practicing cultural humility
• 3. Nurses provide safe and competent care.
• 4. Nurses work respectfully with the health care team to best meet client’s needs
• 5. Nurses act with integrity in clients’ best interest
• 6. Nurses maintain public confidence in the nursing profession.

Entry-To-Practice Competencies

• Registered Nurses are clinicians who provide safe, competent, ethical, compassionate, and evidence-informed care across the lifespan in response to client needs. Registered Nurses integrate knowledge, skills, judgement and professional values from nursing and other diverse sources into their practice (p.5)

CNA Code of Ethics

• Providing safe, compassionate, competent and ethical care
• Promoting health and well-being
• Promoting and respecting informed decision-making
• Honouring dignity
• Maintaining privacy and confidentiality
• Promoting justice
• Being accountable

Ethical Theory

• Ethics of duty
  • Is the right thing to do
• Ethics of consequence
  • Is the greatest good for the greatest number
• Ethics of character
  • Is based on life experiences and a willingness to reflect on our actions
• Ethics of relationships
  • Is the nature and obligation inherent in human relationships

Ethical Principles

• An ethical principle is similar to a camera lens. Camera lenses can have various magnifications or filters; likewise, situations can be viewed differently, depending on the lens

Principles of Ethics

• Values are the heart of ethics
• Numerous theories of ethics
  • I.e. deontology, utilitarianism, bioethics, feminists, relational
• Four basic principles common to all
  • Autonomy
  • Beneficence
  • Non-maleficence
  • Justice
  • fidelity/veracity

Autonomy

• “Asserts that a capable and competent individual is free to determine, and to act in accordance with, a self-chosen plan”
• Granting the right to privacy and confidentiality
• All human beings should be respected.
• Patients are assumed to be competent
• Patient choice supported
• Voluntariness-free from undo external influence
• Sometimes come into conflict with other moral principles (ie. sanctity of life)

Veracity

• Derived from the principle of autonomy
• Duty to tell the truth
• Central to developing trust in nurse-patient relationships
• Can cause conflicts in nursing care

Non-maleficence Beneficence

Not inflict evil or harm → prevent evil or harm→ remove evil or harm → to do or promote good

Fidelity

• “About nurses being loyal, keeping promises and telling the truth (veracity) to those in their care
• Conflicts arise when being loyal to patient compromises own ethical principles and laws

Identify ways that ethical issues impact Nursing and Healthcare

• Responsibility
• Accountability
• Answerability
• Advocacy

Your actions

• Taking appropriate actions in response to ethically challenging situations requires three virtues of health professionals.

1. Courage
2. Compassion
3. Commitment

Your Actions (Cont.)

• Failure to act or respond in an ethically appropriate way has been linked to:
  • Serious and potentially dangerous errors
  • Personal stress
  • Professional burnout

Confronted with Difficult Choices

• How we act ethically in practice

OR

• Why we falter ethically when confronted with difficult choices
• The nurse has to make certain decisions that are critical to an ethical practice

Everyday Ethics?

Ethical Dilemma

• “A conflict between two sets of human values, both of which are judged to be “good” but neither of which can be fully served.”

Ethical Issues in Nursing

• Protecting patients’ rights and human dignity
• Not respecting informed consent treatment
• Providing care with risk to the health of the nurse
• Using or not using chemical or physical restraints
• Understaffing
• Inadequate resources
• Prolonging the living and dying process with inappropriate measures
• Policies that could threaten the quality of care
• Working with unethical or impaired colleagues

LAW

• Define rights and obligations
• Rules and penalties
• Reflect popular beliefs about “right” and “wrong”
• Congruency between ethics and legalities can be argued

Sources of Law

• Civil
• Statue
• Tort: willful acts (assault & battery)
  • Invasion of privacy
  • False imprisonment
  • Unintentional acts (negligence)

Nursing and the Law

Why do nurses need to understand about legal issues?

• Scope of practice
• Autonomy
• Legal rights of patients
• Professional status and self-regulation
• Increasing propensity for seeking damages
• Process for investigation and disciple
• Process for quality assurance

The Nursing Act 1991

Scope of practice statement

Provisions and regulations specific to the nursing profession

Title protection regulations

Definitions of the classes of nurse registration

Entry-to-practice

Regulations on controlled acts authorized to nursing

Determining Scope of Practice

• Entry to Practice Standards
• CNO practice standards
• Controlled Acts
• Standards of Care

What are the Nursing Classes in Ontario?

• RN
• RPN
• Nurse Practitioner