Ethical and Legal Issues Chapter 4 Ethical and Legal Issues

Introduction Nurses are constantly faced with the challenge of making difficult decisions regarding good and evil or life and death Legislation determines what is “right” or “good” within a society

Definitions Ethics: the science that deals with the rightness and wrongness of actions Bioethics: term applied to ethics within the concept of medicine, nursing, and allied health

Definitions (cont.) Moral behavior: conduct that results from serious critical thinking about how individuals ought to treat others Values: ideals or concepts that give meaning to an individual’s life Values clarification: a process of self-exploration through which individuals identify and rank their own personal values

Definitions (cont.) Legal right: a right on which the society has agreed and formalized into law Right: a valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service Absolute right: when there is no restriction whatsoever on the individual’s entitlement

Ethical Considerations Theoretical perspectives Utilitarianism: an ethical theory that promotes actions based on the end results that produce the most good (happiness) for the most people Kantianism: suggests that decisions and actions are bound by a sense of duty

Ethical Considerations (cont.) Christian ethics: do unto others as you would have them do unto you; alternatively, do not do unto others what you would not have them do unto you Natural law theories: do good and avoid evil; evil acts are never condoned, even if they are intended to advance the noblest of ends Ethical egoism: decisions are based on what is best for the individual making the decision

Ethical Dilemmas Ethical dilemmas occur when moral appeals can be made for taking either of two opposing courses of action Taking no action is considered an action taken

Ethical Principles Autonomy: emphasizes the status of persons as autonomous moral agents whose rights to determine their destinies should always be respected Beneficence: refers to one’s duty to benefit or promote the good of others

Ethical Principles (cont.) Nonmaleficence: abstaining from negative acts toward another; includes acting carefully to avoid harm Justice: based on the notion of a hypothetical social contract between free, equal, and rational persons; concept of justice reflects a duty to treat all individuals equally and fairly Veracity: refers to one’s duty to be truthful always

A Model for Making Ethical Decisions Assessment Problem identification Plan Implementation Evaluation

Ethical Issues in Psychiatric/Mental Health Nursing The right to refuse medication The right to the least restrictive treatment alternative

Legal Considerations Nurse Practice Act defines the legal parameters of professional and practical nursing Types of laws Statutory law Common law

Classifications Within Statutory and Common Law Civil law: protects the private and property rights of individuals and businesses Torts Contracts Criminal law: provides protection from conduct deemed injurious to the public welfare

Legal Issues in Psychiatric/Mental Health Nursing Confidentiality and right to privacy Hippa Doctrine of privileged communication Exception: duty to warn Informed consent Restraints and seclusion False imprisonment

Legal Issues in Psychiatric/Mental Health Nursing (cont.) Commitment issues Voluntary admissions Involuntary commitments Emergency commitment The “mentally ill” person in need of treatment Involuntary outpatient commitment The gravely disabled client

Legal Issues in Psychiatric/Mental Health Nursing (cont.) Malpractice and negligence Types of lawsuits that occur in psychiatric nursing Breach of confidentiality Defamation of character Libel Slander

Legal Issues in Psychiatric/Mental Health Nursing (cont.) Types of lawsuits that occur in psychiatric nursing (cont.) Invasion of privacy Assault and battery False imprisonment

Nursing Actions to Avoid Liability Respond to the patient Educate the patient Comply with the standard of care Supervise care Adhere to the nursing process Document care Follow-up and evaluate Maintain a good interpersonal relationship with the client and family