Chapter 2: Ethical and Legal Issues Flashcards
The study of moral conduct within the context of health care.
Bioethics (or biomedical ethics)
Refers to norms about right and wrong human conduct that form a social consensus.
Morality
Moral virtues are socially valued ________ traits.
Character
What are 5 moral virtues for health professionals?
- Compassion
- Discernment
- Trustworthiness
- Integrity
- Conscientiousness
Combines active regard for another’s welfare with an emotional response of sympathy, tenderness, and discomfort at another’s misfortune or suffering.
Compassion
The ability to make judgments and decisions without being unduly influenced by extraneous considerations (fears, personal attachments, etc.)
Discernment
Involves ability and strength of character, dependability, and reliability.
Trustworthiness
Firm adherence to moral and ethical principles.
Integrity
Results in careful, dependable, and competent practice.
Conscientiousness
Means to do good, promote the well-being of the patient, and prevent harm.
Beneficence
Means to refrain from doing harm. Obligates the clinician to avoid inflicting harm direction or intentionally.
Nonmaleficence
Nonmaleficence balanced with ______ maximizes benefits while minimizing harm.
Beneficence
Refers to the human right to make one’s own decisions. Clinicians show respect for this when they engage in truth telling, obtaining consent, protecting confidential information, helps others make important decisions, and respecting others.
Autonomy
Truth telling
Veracity
The principle of fairness. To treat others equally and to refrain from discrimination.
Justice
What are the 5 elements of informed consent that are related to treatments and procedures?
- Decisional capacity
- Disclosure
- Understanding
- Voluntariness
- Consent
The ability to understand and make decisions. It depends on the match between the patient’s abilities and the specific decision making task.
Decisional capacity
What two factors can affect decision making capacity?
- Physiological (illness, hypoxia)
2. Situational (medically naive person admitted to the ER)
When makers are authorized to make decisions for patients when decisional capacity is impaired.
Surrogate decision
What is “substituted judgement?”
When the surrogate decision maker makes the decision that the incompetent patient would have made if they were competent
What is the “best interests” standard in regards to surrogate decision making?
If the surrogate decision maker doesn’t know what the person would have made. Surrogate makes the decision that’s in the best interest of the person
Includes a core set of information about the treatment or research procedure procedure. Includes fasts or descriptions, clinician’s recommendation, the purpose of seeking consent, and the nature and limits of consent.
Disclosure
part of informed consent
Implies that the patient agrees to the intervention without undue influence.
Voluntariness
part of informed consent
The acceptance or refusal of the treatment or research study after the patient is adequately informed. Can be withdrawn orally or in writing at any time.
Consent
Written consent for _______ activities is not required.
Noninvasive
A document that someone can fill out regarding their healthcare wishes or select a surrogate to make decisions during periods of incapacity.
Advance Directives
It is the ________ responsibility to accurately and completely document the patient’s wishes and supporting documentation in the patient record.
Nurse’s
Directives that specify preferred treatment during periods of incapacity. They represent written evidence of a patient’s wishes.
Living will
A legal document in which one person assigns authority to another to act as his or her surrogate if he or she is unable to make healthcare decisions.
Durable power of attorney (or healthcare proxy)
The ____________ requires healthcare facilities to develop programs to inform patients and staff about advance directives.
Patient Self Determination Act
Implementation of the ______________ significantly increased the number of insured people in the United States.
Patient Protection and Affordable Care Act
Obligates the nurse to be truthful with patients and members of the healthcare team. For example, there is an increased emphasis on the need to disclose healthcare errors to colleagues, the patient, and the institution.
Veracity
Obligates the clinician to appropriately restrict access to the patient and to the health record.
Privacy
Requires clinicians to share information about the patient only with the patient and those health professionals who are involved in caring for the patient.
Confidentiality
Refers to faithfulness in keeping a promise. The nurse makes an implied promise to care for a patient based on the social contract the profession of nursing has established with the public.
Fidelity
Describes a situation where research and practice would suggest that there is a less than 1% chance that the treatment with have an intended effect. Example: CPR in a cachetic patient with metastasized cancer.
Quantitative medical futility
Describes a situation where the treatment will have the intended effect but will not achieve a desired effect. Example: tube feeding a patient who suffered a severe stroke will provide nutrition but will not restore neurological function.
Qualitative medical futility
Application of a systematic way of thinking about an ethical dilemma that will help you reach a conclusion.
Ethical reasoning
What 5 steps should you use in your ethical reasoning process?
- Review facts and assumptions about the case
- Define the ethical dilemma in specific terms
- List possible courses of action
- Chose a course of action
- Evaluate the choice
Step in ethical reasoning: > Clinical data and treatment options > Relevant law > Patient preferences and beliefs > Goal of treatment
Review facts and assumptions about the case
Step in ethical reasoning:
> Requires a choice between courses of action that involves fundamental concepts of right and wrong
> Usually involve concepts of rights, duties, and responsiblities
Define the ethical dilemma in specific terms
Step in ethical reasoning:
> Consider patient preferences, professional standards, relevant law, and personal values and principles
Choose a course of action
Step in ethical reasoning:
> Consistent with ethical principles?
> Consistent with decision made in similar causes?
> Consequences of the decision?
Elevate the choice
Multidisciplinary groups that review ethical dilemmas and advise clinicians.
Ethics committees
Provide “on call” assistance to patients, families, and clinicians when confronted by ethical dilemmas.
Ethics consultation services
What are the 6 patient rights?
- High quality hospital care
- A clean and safe environment
- Involvement in care
- Protection of privacy
- Help when leaving the hospital
- Help with billing claims
Describes a competent level of nursing care as demonstrated by the nursing process (includes assessment, diagnosis, outcome identification, planning, implementation, and evaluation).
Standards of care
Describes a competent level of behavior in the profession role (includes activities related to quality of care, performance appraisal, education, collegiality, ethics, collaboration, research, and resource utilization).
Standards of professional performance
Describes the discipline of nursing, its scope, and the profession’s responsibility to society.
Nursing’s social policy statement
The scope of this involves promoting, supporting, and restoring health; preventing illness; and assisting with acitivies that contribute to a peaceful death.
Basic nursing practice
The person who actually does the _______ has the primary responsibility.
Harm
The _____ may not be responsible if the employee is acting beyond his or her scope of employment.
Employer
A civil action for financial damages for injury to a person, property, or reputation.
Tort
An unintentional tort which is the most common cause of cases involving nurses.
Negligence
Torts generally result in ___________.
Financial settlements
Contain purposeful action and the intent to do an act. The intention does not have to be hostile or malicious. There must be an understanding that the harmful outcome is highly likely or that the act was done with reckless disregard for the interest of the patient.
Intentional torts (ex: assault, battery, defamation)
A credible threat that causes another to become apprehensive of being touched in a manner that is offensive, insulting, provoking, or physically injurious.
Assault
The wrongful injury to the reputation of another.
Defamation (oral = slander; written = libel)
Occurs when an unauthorized person has access to confidential information.
Invasion of privacy
False or misleading statements that the patient relies on to his or her detriment.
Fraud and misrepresentation
The unlawful restriction of the freedom of a person, including physical restraint
False imprisonment
The systematic study of moral conduct and provides the framework for studying and examining moral dilemmas.
Ethics
