1.4 Ethical and Legal Issues Flashcards
Legislation
- Determines what is right and good in society
Bioethics
- Ethics in the scope of medicine, nursing, and allied health
Ethics
- Philosophy that deals with systemic approaches to distinguish right and wrong behaviors
Moral Behavior
- Critical thinking on how an individual should treat others
Values
- Personal beliefs about what is important and desirable
Values Clarification
- Self-exploration where people rank their own personal values
- Important for nurses to explore to evaluate their own decisions
Right
- Legally recognized claim or entitlement that includes freedom from government and interference or discriminatory treatment.
- Entitlement to a benefit or service
Absolute Right
- An absolute right when there are no restrictions on the individuals entitlement
Legal Right
- A right that has been formerly agreed upon by Law
Utilitarianism
- Theory that promotes actions based on end results that produce the most good (happiness) for most people.
- GREATEST HAPPINESS PRINCIPLE
- Promoting happiness is right and promoting unhappiness is wrong
- Ethical decisions should be based on the end result
Kantianism
- Decisions and actions are bound by a sense of duty
- Sense of duty determines right and wrong (instead of end result like utilitarianism)
Christian Ethics
- Do to others as you would have them done to you
- Focused on love and forgiveness
Natural Law theories
- Do good and avoid evil
- Human nature and knowledge determine right and wrong
Ethical Egoism
- Decisions are based on what is best for the individual making that decision
Ethical Dilemma
- Requires individual to make a choice between 2 unfavorable options
- Arises when there is no clear reason to choose one option over the other
- TAKING NO ACTION IS CONSIDERED TAKING AN ACTION
Autonomy
- The right for people to determine their own destiny if they are capable for making choices for themselves.
Beneficience
- Duty to provide good to others
- Acting in the interest of the client
Advocacy
- Acting on another persons behalf as a supporter or defender
Nonmalficence
- Provider should do no harm to their clients
Justice
- Individuals have the right to be treated equal
Veracity
- Duty to be truthful
Ethical Decision Process
- Assessment - Gather subjective/objective data and consider personal/client values
- Problem Identification - Identify the conflict between 2 or more alternative actions
- Planning - Explore risks/benefits of each alternative, consider ethics behind each decision, select an alternative
- Implementation - Act on the decision and communicate it to others
- Evaluate - Evaluate the outcome
Rights of Patients
- The right to treatment (cannot be denied of appropriate treatment)
- The right to refuse treatment (unless treatment is required to prevent death or serious harm). In psychiatric care, patients are a harm risk to themselves so medications may be administered without consent.
- The right to least restrictive treatment alternative (effective treatment without limiting their freedom)
Nurse Practice Act
- Defines legal parameters of nursing
Statutory Law - Enacted by US congress
Common Law - Derived from decisions made in previous cases and can vary from state to state
Civil Law - Protects private and property rights of individuals and businesses
(Examples)
Tort - Intentional/Non-Intentional where patient has been wronged
Contract - Party claims the other party has failed to fulfill an obligation
Criminal Law - Protection from actions that are detrimental to public welfare
Health Insurance Portability and Accountability Act (HIPAA)
- Protects confidentiality on a federal level
- Individuals have the right to their medical records, have corrections made, and decide who it can be shared with.
Doctrine of Privileged Communication
- Gives professionals privilege to refuse to share information about and with their client
EXCEPTIONS TO ABOVE LAWS
Duty to Warn - Professional must protect their client but also protect an individual who is being threatened by that client
Elder abuse must also be reported.
Informed Consent
- Preservation and protection of an individuals right to decide to accept/reject treatment
Knowledge - Adequate information to base their decision
Competency - Un-impaired cognition during decision making (or legal representative)
Free Will - Voluntary decision
Seclusion/Restraints
- Discontinued as early as possible
- Orders must be renewed every 4 hours for adults and 2 hours for 9-17 y/o. Every hour for children under 9.
- In person evaluation is needed 1 hour before use of restraints/seclusion
- If a person is both restrained and secluded they must be monitored by staff in person or via audio/video
- Staff involved are responsible for monitoring physical/psychological well-being.
False Imprisonment
- Unauthorized confinement of a person with physical/verbal means.
- Can be charged if the patient voluntarily came into the hospital and is being restrained/secluded against the clients wish.
Hospital Admissions
Voluntary Admission - Can stay as long as the treatment is deemed necessary and can leave at any time unless they are deemed harmful to themself or others
Involuntary Commitment
- Emergency commitment where patient is a danger to themself/others Time-limited and court ordered.
- Can also be used for mentally ill patients (unable to make decisions of treatment, likely to harm themselves or others, someone unable to fulfill basic personal needs)
Involuntary Outpatient Commitment (IOC)
- Court ordered outpatient treatment
- Due to repeated involuntary hospitalizations, severe persistent mental illness, or risk of becoming homeless, violent, or suicidal.
Gravely Disabled - Individual (due to mental illness) is in danger of serious harm from not being able to provide basic needs. The court will appoint them a guardian/conservator/or committee to manage them.
Negligence
- Failure to exercise care towards a person that a reasonably prudent person would do in that circumstance
- Contrasted against what a reasonably prudent professional would have done in the same circumstance.
Malpractice
- Conducting an act of a professional that does not meet the standard of competence and results in provable damage to the client.
- Weighed against professional standard
Breech of Confidentiality
- Revealing aspects of a clients case or hospitalization if potential for harm can be proven
Defamation of Character (Libel/Slander)
- Share false malicious information that is detrimental to the clients reputation
- Libel (In writing)
- Slander (Spoken)
Invasion of Privacy
- Searching client without probable cause
Assault and Battery
Assault - Fear of being touched without consent
Battery - Unconsented touching of another person
- HARM OR INJURY DOES NOT HAVE TO OCCUR
False Imprisonment
- Holding a client against their will outside of an emergency situation
How to Avoid Liability
- SBAR (Effective communication with patient/caregiver)
- EHR (electronic health record) Use accurate and complete documentation in medical records.
- Comply with standards of care (ANA standards)
- Knowing the client and helping them be involved with their care and understanding their care
- Practice with nurses level of competence and scope of practice by keeping up to date on new EBP and education.
