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 Objectives
2
 At the end of the lesson, the students will be able to:
 Principles and concepts
 Describe ANA Code of ethics
 List types of ethical principles
 Describe Ethical dilemma steps
 Definitions as applied to ethical decisions nurses
make during care of clients
 Describe sources of law that affect nursing practice
 Avoiding Malpractice claims
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3
Introduction

WHAT IS
ETHICS?
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 Cont.
4
Ethics – philosophical ideals of right and wrong
behavior
 A set of moral principles or values.
 The principle of conduct governing an individual or
group
 Ethics is not religion or law
 Nurses have a duty to practice ethically and
morally.

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5 Cont.
 Tells us how human beings should behave, not
necessarily what they do.
 Not a religion, not law, but both of these can be
the basis of ethical decisions that you make.
 The word duty is a legal term…

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 Types of Ethics
6
 Descriptive: It is the description of the values and beliefs of
various cultural, religious or social groups about health and
illness
 Analytical: analyzes the meaning of moral terms.
 It seeks the reasons why these action or attitudes are either
wrong or right
 Normative: a study of human activities in a broad sense in an
attempt to identify human actions that are right or wrong and
good and bad qualities.
 In nursing normative ethics addresses: scope of practice of
different categories of nurses and, level of competence
expected
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7
Ethical Issues #1
 Moral uncertainty/conflict:
 When the nurse is unsure which moral principle to
apply, or even what the problem is
 Common with new nurses, they’re not sure what
they are supposed to be doing.
 Moral Distress
 When the individual knows the right thing to do
but organizational constraints keep them from
doing it

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8
Ethical Issues #2
 Moral outrage
 An individual witnesses an immoral act by another
but feels powerless to stop it
 Moral/ethical dilemma
 Occurs when two or more clear principles apply
but they support inconsistent courses of action
 Self-awareness
 Not an ethical issue, but is absolutely vital in
ethical decision making
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 Ethical Theories
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 Deontology
 Is also called Duty Based or Rule Based Theory
 This theory proposes that the rightness or
wrongness of an action depends on the nature of
the act rather than its consequences.
 This theory holds that you are acting rightly when
you act according to duties and rights

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 Cont.
10

2.Teleology ( End Based Theory)

 This theory looks to the consequences of an action
in judging whether that action is right or wrong
 According to the utilitarian school of thought right
action is that which has greatest utility or
usefulness
 Utilitarian hold that no action in itself is good or
bad, the only factors that make actions good or bad
are the outcomes, or end results that are derived
from them
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 Cont.
11
3. Intuitions
 The notion that people inherently know what is
right or wrong; determining what is not a matter of
rational thought or learning
 E.g. Nurse inherently known it is wrong to strike a
client, this does not need to be reasoned out
 Caring is a force for protecting and enhancing
client dignity

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12
Cont.
4.The Ethic of Caring
 Also called Case Based Theory
 Unlike the preceding theories which are based on
the concept of fairness (justice) an ethical caring is
based on relationships
 It stresses courage, generosity, commitment, and
responsibility

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 Ethical Frameworks #1
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 Utilitarian – Most good, Least harm
 Most common approach, “First do no harm” is
related to this
 Attempts to produce the greatest good with the
least harm
Ethical Frameworks #2
Rights Based:– Best protects the rights and respects
the moral rights of those affected
 Begins with idea of human dignity and freedom of
choice
 The pt has the right to make the decision 02/13/20
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 Ethical Frameworks #3
14Common good – Best for community/society
 Decisions should be made on what is good for the
community as a whole, not necessarily for the
individual
 Where many of our nations laws are base
Ethical Frameworks #4
 Virtue : Actions consistent with certain ideal virtues
 Decisions should be directed at maintaining virtues
(honesty, courage, compassion, etc.)
 A person using this approach may ask themselves, “If
I carry out these actions, what kind of person will I
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15
Principles Ethical Reasoning
Autonomy
Beneficence
Non-maleficence
Justice
Paternalism
Confidentiality
Fidelity
Respect for Persons
Sanctity of Life
Veracity 02/13/20
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Major Ethical principles
16

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 Autonomy
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 Definition: “autos” = self, “nomos” = rule

Individual rights
Privacy
Freedom of choice
 May see this come up with consent for treatment
issues, informed consent
 Pt has right to know procedure, procedure
complications, other options, that they can to not
have the procedure/treatment
 Framework is rights based 02/13/20
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 Beneficence
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Duty to do good: Goodness, Kindness, Charity
 Includes non-maleficence
 Centerpiece for caring
Non-Maleficence
Duty: NOT TO CAUSE harm
Duty: PREVENT harm
Duty: REMOVE harm
 More binding than beneficence
 Because you are going beyond just trying to do
good to that patient, you’re trying to prevent harm
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 Confidentiality
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 Keep privileged information private

 Exceptions
 Protecting one person’s privacy harms another or
threatens social good (direct threat to another
person)
 Drug abuse in employees, elder and child abuse

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20
Fidelity
Duty to be faithful to one’s commitments
–Includes implicit and explicit promises
–Make a promise, follow through
Implicit – Those promises that are implied, not
verbally communicated
–Like when pt comes into the hospital, they expect to
be cared for
Explicit – Those that we verbally communicate
–Like if you tell them you will be back with pain
medications, you had better come back 02/13/20
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21
Justice
 Seeks fairness
 Mores Specifically
 Distributive justice refers to distribution of benefits
and burdens
 Distributive Justice Concepts
 Equally disbursed according to:
 Need
 Effort
 Societal contribution
 Legal entitlement 02/13/20
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22
Paternalism
 When one individual assumes the right to make
decisions for another
 Limits freedom of choice
 Think about parents making decisions for children
 Ex. Withholding pertinent information from a pt
 Like elderly dx with terminal cancer, and family
asks to not tell them that it’s terminal so they will
still be motivated to fight

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23
Respect for Persons
 Closely tied to autonomy
 Promotes ability of individuals to make
autonomous choices and should be treated
accordingly
 Autonomy is preserved thru advanced directives

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24
Sanctity of Life

 Life is the highest good

 All forms of life, including mere biologic
existence, should take precedence over external
criteria for judging quality of life
 If life is the highest good, is it ethical to keep a
brain dead person alive?
Veracity
 The obligation to tell the truth and not to lie or
deceive others
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Ethics
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and Professional Practice

ICN Code of ethics

Informed consent
Durable power of
Euthanasia
Assisted suicide
Durable power of attorney for healthcare
guardian
Death
Disasters 02/13/20
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26
ICN Code of Ethics

 International Council of Nurses Code of Ethics

 Four fundamental responsibilities of Nurses
Promote health
Prevent illness
Restore health
Alleviate suffering

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27
Nurses Rights in Ethical Situations

 Nurse has the right to refuse to participate in giving

care to a client if they disagree with care on ethical
grounds
– Assure client is not abandoned for care
– The Joint Commission (TJC) requires employers to
establish policies and mechanisms to address staff
requests not to participate in aspects of care that
conflict with cultural values or religious beliefs

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28
Informed Consent
 Core underlying value is patient autonomy
 Physician / practitioner obtains consent
 Nurses role: witness / monitor
 Emergency consent is presumed when patient
unable to provide
 Informed consent is a process that people go thru,
not just a paper
 Nurses role is to make sure pt understands
everything and that the person that signs is the
person who needs to be signing!
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 Capacity to Form Consent
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 Decision-making capacity (not competency) determined by:
–Appreciation of right to make the choice
–Understanding of risks/benefits of procedure
– Understanding of risks/benefits of opting out of procedure
– Ability to communicate decision
• Communication may not always be verbal, can be written or
whatever
 Needs to have interpreter avail! Can’t just use the family or
whatever
 Use layman jargon. Normal words… Don’t say layman jargon

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 Withholding/Withdrawing Care
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 Can withhold “inhumane” treatment if it is
“virtually futile” in extending life
– usually DNR
 Allowing to die vs making die

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 Euthanasia
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 Definition – intentional termination of life (at the
request of that person who wishes to die) Active vs.
Passive
–Generally illegal –May be legal under certain
circumstances
–Active – involves purposefully causing the persons
death (doc or nurse)
–Usually involved with law problems
–Passive – involves hastening of death by altering
some form of support, taking a pt off a ventilation,
generally accepted by medical community 02/13/20
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 Assisted Suicide
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 Patient actively seeks physician/nurse to “help”

them commit suicide
 Criminal offense in all states but Oregon,
Washington, and Montana
 Usually pt is given prescriptions in amts that are
legal and the pt decides if they want to use it.

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 Ethical Dilemmas
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 An ethical dilemma takes place in a decision-
making context where any of the available
options requires the agent to violate or
compromise on their ethical standards.
 The action or situation involves actual or
potential harm to someone or some thing
 A possibility of a violation of what we generally
consider right or good
 Is this issue about more than what is legal or
what is most efficient?
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 What are the 4 ethical dilemmas?
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 According to Kidder, there are four dilemmas:
 Good for the unit versus good for the whole.
 Good for the short term versus good for the long
term.
 Truth versus loyalty.
 Justice versus mercy.

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 How to Process an Ethical Dilemma
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1. Determine whether or not a dilemma exists
2. Gather all relevant information
3. Reflect on your values on the issues
4. Verbalize problem
5. Consider all possible courses of action – including
referral to ethics committee
6. Negotiate outcome
7. Evaluate action, not the outcome

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36 NURSING LEGALITIES

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es
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ur
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37

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Distinction between Law and Ethics
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Concepts Law Ethics

Source External Internal

Concerns Conduct and Action Motive, attitude,

culture

Interests Society Individual

Enforcements Courts, BON Ethics Committee

and professional
organizations
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39

What is
law?

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 Law
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 Rules of conduct
– Authored & enforced by formal authorities
– Hold people Accountable for compliance
_ Body of rules to guide human action
 Purpose of Nursing Law
– Protect – patient and nurse
–Scope of practice (define it)

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41

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42

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 Sources of Law
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 Constitution: establishes a basis for a governing

system (highest law that gives authority to the
other branches)
 Statutes: laws that govern
 law that is passed by a legislative body such as the state's
legislature
 Administrative agencies : given authority to
create rules and regulations to enforce statutes
 Court decisions: interpret statutes and determine
consequences
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 Types of Court Cases & Laws #1
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 Criminal law:
 covers acts that are illegal and against the law
 includes felony and misdemeanor infractions of the
law
 crimes committed against an individual or society,
innocent until proven guilty beyond a reasonable
doubt
 Consequences range from fine to jail to death
penalty

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45
Types of Court Cases & Laws #2
 Civil law: one individual sues another for money
b/c of a perceived loss
 Guilty verdict is based on the belief that the
accused is more likely than not to have caused the
injuries.
 part of public law, covers torts and contract law

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 Professional Negligence
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Negligence:
 The omission to do something that a reasonable
and prudent person in a reasonable situation would
or would not do
Malpractice:
 Failure of a person with professional training to act
in a reasonable and prudent manner

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 Five components necessary for
47 professional negligence to occur:
1. Standard of care
2. Failure to meet standard
3. Foresee ability of harm
4. Correlation b/t care and harm must be proven
5. Actual patient injury must occur

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 Professional Negligence
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 Reducing the Risk:
 Know the law
 Document everything
 Refrain from negative comments
 Question authority
 Stay educated
 Manage risks
 Don’t hurry through discharge
 Be discreet
 Use restraints wisely
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 Be kind 25
 Liability
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 Liability: Liability is vulnerability and legal responsibility,
simply stated. E.g., nurses are liable when they fail to carry
out doctor's orders.
 Liable: to be legally responsible by law
 Personal liability: every person is liable for
his/her own conduct
 Joint liability: nurse, physician, and employing
organization are liable
 Respondent superior liability: “the master is
responsible for the acts of his servants”
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 Claims Against Nurses
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 Inadequate charting.
 Inadequate communication with HCP or
supervisors about changes in pt condition
 Leaving potentially harmful items within patient
reach

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 Intentional Torts
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 Assault & Battery –
 Assault is the behavior that makes a person fearful of
harm
 is threatening to touch a person without their consent.
 Battery is an intentional physical contact with a
person that causes injury
 False Imprisonment
 Any unlawful confinement within fixed boundaries,
can be physical, emotional, or chemical

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 Cont.
52
 Defamation of character (slander)
 Communicating to a 3rd party information that can
hurt character, self esteem, esteem, etc.
 Being truthful reduces risks of being charged with
this
 Invasion of privacy- is the intrusion into the personal
life of another, without just cause, which can give the
person whose privacy has been invaded a right to bring a
lawsuit for damages against the person or entity that
intruded

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 Types of Consent
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 Informed consent
 Implied consent
 Pt unable to consent
 Treatment is in patients best interest
 Express consent
 Witness pt signature
 Assure pt received information
 Informed Consent
 Language patient understands
 Patient competency
 Requires full disclosure (procedure process, risks and benefits)
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54
Credentialing
 Credentialing is the process of determining and
maintaining competence-nursing practice
 Credentials includes:
o Licensure
o Registration
o Certification
o Accreditation

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 Licensure
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 It is legal permit a government agency grants to
individuals to engage in the practice of a profession
and to use particular title
 It generally meets three criteria:
 There is a need to protect the public's safety or
welfare
 The occupation is clearly delineated with a
separate, distinct area of work
 There is a proper authority to assume the obligation
of the licensing process
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 Registration
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 Is listing of an individual's name and other
information on the official roster of a governmental
agency
 Nurses who are registered are permitted to use the
title “Registered Nurses“
Certification
 It is the voluntary practice of validating that an
individual nurses met minimum standards of
nursing competence in specialty areas such as
pediatrics, mental health, gerontology and school
health 02/13/20
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 Accreditation
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 It is a process by which a voluntary organization or

governmental agency appraises and grants
accredited status to institutions and/or programs

Nursing Code of Ethics

 Code of ethics is formal statement of a group’s
ideas and values that serve as a standards and
guidelines for the groups’ groups’ professional
actions and informs the public of its commitment

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Responsibility & Accountability #1
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 \is fourfold:
To promote health
To prevent illness
To restore health
To alleviate suffering
 Nurses act in a manner consistent with their
professional responsibilities and standards of
practice
 Nurses advocate practice environment conducive to
safe, Competent and ethical care
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Responsibility & Accountability #2
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 Nurses carefully handle nursing practice on

specific ethical issue and resolve the ethical
problems systematically
 Nurses are accountable for their professional
judgment and action
 Nurses work in accordance with dependent,
interdependent and collaborative functions

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Causes of License Suspension
60
 Professional negligence
 Practicing nursing w/o a license
 Obtain license by fraud
 Felony convictions
 Not reporting substandard medical or nursing care
 Providing patient care under the influence of
drugs/alcohol
 Giving narcotics w/o order
 Falsely portraying self to public or any HCP as a
nurse 02/13/20
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 Y
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 GALATOOMA!

THANKYOU FOR YOUR ATTENTION

ASSIGNMENT(20%)
63

TAKE ONE EXAMPLE OF ETHICAL DILEMMA AND

THEN BY USING
PROCESSES TO SOLVE ETHICAL DILEMMA SOLVE
IT, BY RELATING TO CODE OF ETHICS
G-1(1-20), G-2(21-40), G-3 (41-60) G-4 (61-80)
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