1

A SEMINAR ON
LEGAL AND ETHICAL
ASPECTS IN NURSING

INDEX
CONTENT

PAGE NO

1. Introduction

2. Law

3. Nursing standards of care

4. Intentional torts

5. Unintentional torts

6. Liability

7. Legal safeguards for nurses

8. Legal issues related to nursing

10

9. Indian law &regulations related to nursing

13

10.Ethical aspects in nursing

15

11.Ethical principles theories

16

12.Code of ethics and bioethics

18

13.Ethical dilemma & decision making

23

14.Factors influencing dicision making

24

15.Studies related to legal &ethical aspect in nursing

26

16.Conclusion

33

17.Bibliography

34

CENTRAL OBJECTIVE
On the completion of the seminar ,the group gain knowledge regarding legal and ethic aspect in
nursing and apply this knowledge in their practice with positive attitude.

SPECIFIC OBJECTIVE
At the end of the seminar, the group will be able to
Define law &tips of law
Explain nursing standards of care
Classify international torts &unintentional torts
Explain legal safeguards for nurses
Define ethics & ethical principles
Explain code of ethics and international council for nurses code of ethics
Illustrate various issues related to ethics in nursing

LEGAL ASPECTS IN NURSING

INTRODUCTION
Every newspaper contains reports of sensational cases being considered in our courts and
legal are has health care remains at the for font of professions where legal issues
constitute a major area of concern. As a nurse it is important to have an understanding of
the law and how it affects your nursing practice you will be faced with many legal issues
that will require the use of critical thinking abilities to practice sate nursing care. Sate and
competent nursing care includes an understanding of the legal boundaries with in which
you will function and also understanding the federal law it also important to know the
law in your own state & country.

LAW
Law may be defined as the principle and regulations established in a community by some
authority and applicable to it people whether in the form of legislation or of custom and
policies recognized by judicial decision(dictionary.com)
Laws are put in place to preserve public welfare and manage certain relationship wich the
society.

In

India

different

branches

of

the

legal

system are there that the legal system can be divided into 2 branches
Criminal law
Civil law
Criminal law :- Criminal law deals with act like theft,,murder etc. that starts with
lodging of the first information report (FIR) followed for the police investigation and
filing the case in court
Civil law
Civil law deals with cases were harm or injury is caused to right of individuals the
procedure of civil cases starts with filing of a petition in the relevant court by affected
party only. A tort is a civil wrong or Injury for which the court provides or remedy in the
form of money damages(Black,1999).Torts can be classified into two
1. Intentional torts
2. Unintentional torts

The result of tort may be physical harm, psychological harm, harm to livelihood or some
other less tangible value ,such as harm to reputation intentional torts are will acts that
violate another persons right for example battery, assault are Intentional torts
Unintentional torts is an action causing harm to another person or property that was not
intended to happen the most common cause of an Unintentional torts is negligence,
malpractice

NURSING STANDARDS OF CARE

Nursing standard of care are the legal guidelines for minimally safe and adequate nursing
practice the standards of care are defined in the nurse practice acts of the state board of
nursing of each state ,Professional and specialty organization standards, and written
policies and procedures of the employing institution. Nursing specialty organization
define the standard of care for nurse to be certified in specialty areas ,such as the
operating room or critical care areas .Written polices and procedures of an employing
institution define the standards of care for nurses at that institution these polices are
usually quite specific and are in policy and procedure manuals found on most nursing
units .eg:- a policy and procedure will outline the steps to taken how administering o
medication . These polices& procedure whether a nurse is acting professional duties, It he
or she involved in a malpractice trial, The court will inform jury about the standards of
care and then the jury will determine whether you have acted the way a reasonable nurse
would have acted in similar circumstances.

INTENTIONAL TORTS
ASSAULT
Assault is any intentional threat to bring about harmful or offensive contact witch another
individual .No actual contact is necessary the low protects pat cut who are afraid of
harmful contest it is considered an assault threaten to restrain a patient. For a x-ray
procedure when the patient has refusal consent.

BATTERY

Battery is an intentional touching without consent the contact is harmful to the patient
and causes an injury, or it is merely oftensive to the patients dignity. A battery always
include an assault which is why the law commonly combines the two terms assault and
battery for eg: If you threatens a patient to give a patient an injection without patient
consents it is assault, if you actively given the injection it is considered a battery another
example is if patient gives consentfor left knee repair but the surgeons performs right
knee surgery a battery has occurred.

FALSE IMPRISONMENT

Making a person stay in place against his whishes is false imprisonment . The person may
be forced to stay either by physical or by verbal means.If proper procedure were not
carried out first restraing a patient or confining a patient to a locked room could
constitute false imprisonment.

FRAUD

Fraud is willful and purposeful misrepresentation that could cause or has caused loss or
harm to a person or property, situations of fraud in nursing are not common, examples
like trying to obtain a better position by giving in correct information or fake certificates
to a prospective employer
INVASION OF PRIVACY
the intrusion into the personal life of another, without just cause, which can give the pers
on whose privacy hasbeen invaded a right to bring a lawsuit for damages against the pers
on or entity that intruded

UNINTENTIONAL TORTS
NEGLIGENCE

Negligence is conduct that falls below the standard of care for eg: If you are driving a car
and fail to stop at a stop sign. Your action is negligent. In general court define negligence
as failure to use that degree of care that a reasonable person would use under the same
circumstances.
MALPRACTICE

Malpractice is one type of negligence called professional negligence liability resulting

from improper practice based on standards of care required by the profession for which
the person has be educated. Therefore, malpractice is a term used to describe negligence
by nurses in the performance of their duties. The professional person must have had a
professional duty toward the person receiving the care. To establish the elements of
malpractice against a nurse. The patient must allege the following
1. Duty :- refers to an obligation to use due care and is defined by the standards of care
appropriate for nurse patient relation, that is the negligent person must have been in
situation where he or she had a responsibility or duty toward the person harmed.
2. Breach of duty : failure to meet standards of care, the person must be found to have
failed to fulfill his or her responsibility
3. Causation : Most difficult element of liably to prove shows failure to meet the
standards of care actually caused the injury
4. Damage : Actual harm or injury resulting to the patient

LIABILITY
A liability is an obligation or debt that can be enforced by law. A person found guilty of
any tort is considered legally liable, or legally responsible for the outcome. The person
liable usually is required to pay for damages to the other person, these may include actual

costs of care, legal services, loss of earnings and compensation for emotional and
physical stress suffered. Damage may be paid even when the person devices neglignce,
because a court case wolud cost more then paying damages.
It includes
1.

Personal liability - As an educated person, the nurse are always responsIble or

liable for her actions, like giving incorrect amount of medication. Although each person
is legally responsible for his own actions, there also situations in which a person or
organization may be held laiblefor actions taken by others.

2.

Employer liability : In many instances an employer can be held responsible for

torts committed by an employee the law holds the employer responsible for hiring
qualified persons establishing an appropriate environment for correct functioning,
maintaining correct policies and procedures and providing supervision or direction as
needed to avoid or There for if a nurse as an employee of a hospital is guilty of
malpratice the hospital also may be named in the suit.

COMMON SOURCES OF NEGLIGENCE MALPRACTICE

1.

Medication errors that result injury to patient.

2.

Burns caused by equipment, or spills of hot liquid

3.

Falls resulting in injury to patient

4.

Errors in sponge, instrument, needle count in surgical cases

5.

Failure to give adequate report notify physician, adequate monitoring of patient

LEGAL SAFEGUARDS FOR NURSES

CONSENT
A signed consent is necessary for all routine treatment hazardous procedures such as
surgery, treatment programs.

INFORMED CONSENT
Informed consent is a patients agreement to allow something to happen, such as surgery
based on a full disclosure of risks, benefits alternatives and consequences of refusal
(Black, 1999) Informal consent requires that you give the patient all relevant information

required to make a decision that the patient is capable of understanding the relevant
information and patient actually gives consent.
Informed consent documentation includes
*

The Patients signature

The witness signature

The date and time of signing

Verification that the patient voluntarily signed the consent that patient

discussed the risks benefits alternatives and right to refuse the procedure with physician.
*

Verification that the patient understands te procedure and cleared all his

doubts.

The nurse does not legally assumes the duty of obtaining informed consent the nurses
roles are to confirm that a signed consent form is present patient chart and assess whether
the patient understand. What he or she is signing and report to physician if any problem
or doubt in obtaining a valid consent. parents are normally the legal guardians of
pediatric patient, under 18 years old. When a parent refuses medically necessary
treatment for a child healthcare provides petition the court to intervene on the child
behalf.

DOCUMENTATION
Careful documentation is crucial legal saleguard for the nurse. Documentation must be
accurate complete and entered in a timely fashion. The nurse should be sure that the
nursing the plan of care is part of patients permenent record. the note should include the
current nature of problem, how the nurse intervened the patients response if a condition
the patients needs emergency medical attention and intervention to physician incharge
and he is unavailable the note should document the time the physician was called
response etc.

EXECUTING PHYSICIAN ORDER

Physician or health care provider is responsible for direting the medical treatment of a
patient. nurses are responsible for carrying

out that medical treatment

unless the

physicians or health care providers order is in error. There for the nurse will determine
they are harmful, obtain further clarification from physician, if still you believe that
inappropriate inform the supervisor or nurse manager. Make sure all physician or health
care provider order are in writing and dated and timed appropriatelly verbal order or

10

telephone orders are not recommended becuase they have possibilities for error if a
telephone orders is necessary for emergency read back the order provider writes and
signs it as soon as possible usually 24 hours.

GOOD SAMARITAN LAW

Good Samaritan laws are designed to protect health practioners when they give aid to
people in emergency situations. for eg: If you stop at the scene of an automobile accident
and give appropriate emergency care such as applying pressure to stop hemorrhage you
are acting within accepted standards even though proper equipment was not available if
patient subsequently develops completions a result of your action you are immune from
liability as long as you acted without gross negligence (Good Samaritan Law) However,
currently in India there is no such law that offers protection to those who come forward to
help accident victims.

PATIENT EDUCATION
In U.S. Courts affirm the patients right to know and patient education as the legal
duty of the nurse. The nurse should discuss the nursing plan of care with patients and
family members and identity the learning needs. Document the teaching plan a part of
nursing plan of care and also patient response. If a patient refuses health education or
refers the nurse for a family member document patients response.

PRIVILEGED COMMUNICATION
Privileged communication refers to information that is shared by an individual client with
certain professionals but that does not need to be revealed even in a court of law.
Privilege is a limited concept reserved for information given in confidence to the m nurse
within the nurse - patient professional relationship. only a court can determine whether
previlege exists in any specific case. If a court does not determine information is
privileged then you are legally obligated to testify about the communication.

LEGAL ISSUES RELATED TO NURSING

CONFIDENTIALITY

11

Confidentiality are basic concerns in our society, all information regarding a patient
belongs to that patient. A nurse who gives out information without authorization from
the patient or from the legally responsible guardian can be held liable for any harm that
results. Only those professional persons involved in the patients care who have a need to
know about the patient are allow routine access to the patient record, persons not
involved in care may be allowed access to the record only by specific written
authorization of the patient or by court order. Be cautious about what information you
share verbally and with whom and also in social networking. In India the information
technology act deals with the patient privacy and Confidentiality

ADVANCE DIRECTIVE
Advance directives are legal documents stating the wishes of individuals regarding health
care in institutions in which they are no longer capable of giving personal informed
consent. There are several types of advance directives such as living will and durable
power of attorney
A living will provides information on preference regarding end of issues such as
types of care to provide and whether use to various resuscitation measures.
A durable power of attorney for health care is a document that legally designates a
substitutionery decesion maker, should the person be incapacitated. This document
provides individuals with the opportunity to identify a preferred legal decision maker if
they are incapacitated.
If a physician or health are provides has document in the progress notes that the
physician or health care provider and the patient have made the decision not to administer
cardiopulmonary resuscitation, the physician or health care provider should written a do
not resuscitate (DNR) order. A DNR order is written not given verbally.

AUTOPSIES
Autopsy is a medical procedure invloving the examination of the body of a dead
person to determine the cause and manner of death and to assess any disease or injury
that way be present.
The prime aim is to determine of the cause of death the condition of health of the perslon
before he or she died, whether medical diagnosis treatment before death was appropriate
it also used in medical or research teaching

12

For medical teaching research the person has given permission in advance of their
death, where a doctor is not able to write a death certificate or when death is believed to
result from an unnatural cause,warrant autopsy, such autopsy is legal and performed
under a legal authority, the consent of relatives of the deceased is not required.

ORGAN AND TISSUE DONATION

Organ

transplantation is considered to a boon for the medical industry as this

procedure can help in saving lives of people who whould die because of their
dysfunctional organ. In India 5,00,000 people die because of non availability of organs
per year and 1,50,000 people await a kidney transplant but only 5,000 get one h10 lakh
people suffer from corneal blindness and await transplant (Times of India) Asigned
consent is necessary before donating a patients body, tissues or organs. It is important
that before transplantation conducted several related laws should be kept into
consideration.
In earlier times illegal organ trafficking is a major problem because of corrupt and
inefficient health care system for stopping illegal organ transplant the Government of
India had come up with certain laws in 1994 that made organ sale a crime the human
organs transplant Act 1994 laid down certain rules and regulations that were to be
followed while conducting organ transplant. According to organ transplant law no money
exchange between the donor and the recipient was allowed no foreigner could get a local
donor, close relatives of the recipient like sublivings, parents, children and spouse could
donate the organ without clear once from the Government. However they were required
to appear before authorization committee for clearance and approval.
Later The transplantation of Human Organs Bill 2009 passed. It was made
necessary that the medical staff looking forward a request to the relatives of the brain
dead person from donations of organs. The transplantation of Human organs Bill 2013
passed in this bill now along with an authorization Committee there will be a verification
committee ,as well in every block for verification of the details that are offered by the
donor recepient
There are mainly 2 types of donation
6. 1.

Live Donation : Where organ transplant takes place between the patient and his

close friend or family

13

3. Cadaveric Donation : Where a person pledges his organs for harvesting and donated
after his death. For cadaveric donation the person need to register with any NGO who
will arrange an organ donation card for him.

EUTHANASIA
The term euthanasia comes from the Greek word euthanatos ,which means good
death.it refers to the deliberate ending of someone suffering from a terminal or incurable
illness.it can be classified as two
1.active euthanasia
2.passive euthanasia
In active euthanasia occurs in a situation in which the physician prescribes ,supplies or
administers an agent that results in death.
In passive euthanasia occurs as a result of lack of action like withholding the life supports
or medication.
Passive euthanasia is legal in India.On 7 March 2011 the Supreme Court of
India legalised passive euthanasia by means of the withdrawal of life support to patients
in a permanent vegetative state. The decision was made as part of the verdict in a case
involving Aruna Shanbaug, who has been in a vegetative state for 37 years at King
Edward Memorial Hospital. The high court rejected active euthanasia by means of lethal
injection. In the absence of a law regulating euthanasia in India, the court stated that its
decision becomes the law of the land until the Indian parliament enacts a suitable
law. Active euthanasia, including the administration of lethal compounds for the purpose
of ending life, is still illegal in India, and in most countries.

INDIAN LAWS REGULATIONS RELATED TO HEALTH

RELATED TO MEDICAL SURGICAL NURSING
1.The transplantation of Human Organs Act 1994
An Act to provide for the regulation of removal storage and transplantation of human
organs for theropeutic purpose and for the prevention of commercial dealings in human
organs and for matters connected with.

14

2.

Transplantation of Human Organs Bill 2013

3.

Consumer Protection Act

This law come directly consumer rights it includes

1.

The Right to safety:

right to be protected against products, production processes

and services which are hazardous to health or life

2.

The Right to be informed.. : - Right to be given the facts needed to wake an

intorned choice or decision

3.

The Right to choose: - Right to have asscess variety of products and services at a

complete price
4.

The Right to be heard: -

receive full and

Right to reperesented so that Consumers interest

sympathetic consideration in the formulation of execution of eco

nomic policy
5.

The Right to redress:- Right to a fair settlement of just claims

6.

The Right to consumer: -

Acqure the knowledge and skills to be an int..

consume education through like

7.

The Right to a healthy:-

Right to a physical environment that will enhnace

the quality of life environment

8.

The Right to basic needs:- Availability of articles which are basic needs of every

consumer

must be ensured.

RELATED TO OBSTETRICS & GYNAECOLOGICAL

NURSING
1. Medical termination of pregnancy Act 1971
This Act to provide to the termination of certain pregnancies by registered medical
Practioner.. when pregnancies may be terminated where pregnancy may be terminated etc
2. The prenatal diagnostic techniques Act & Rules
This Act prohibits determination and disclosure of sex of foetus, regulation of prenatal
diagnostic techniques, registration of genetic counseling centres ,Laborataries etc

RELATED TO MENTAL HEALTH NURSING

1. Narcotic drugs and psychotrophic substances Act 1985

15

An Act to consolidate and amend the law relating to narcotic drugs to make stringent
provisions for the control and regulation of operations relating to narcotic drugs and
psychotropic substances

2. Mental Health Act 1987

An Act to consolidate and amend the law relating to the treatment and care of mentally ill
persons to, make better provisions with respect to their properly and affairs and for
matters connected there with it.

SOME COMMON LAWS AFFECTS NURSING

* The prohibition of sexual harassment of women at workplace Bill, 2010
* A bill conferring upon women the right to protection against sexual harassment and
towards that end for prevention and redressal of sexual harassment of women.
* Biomedical waste (Management and Handling) Rules 1998
In this law they discussing about rules to apply to all persons who generate, collect,
receive store, transport, treat, dispose or handle biomedical waste in any form.

ETHICAL ASPECTS IN NURSING

INTRODUCTION
Nursing practice involves care during all aspects of health, sickness, personal life and
community life. As a Nurse you will paly on important and often intimate role in the lives
of your patients relationship with patients and with otherson the health care team will
sometimes require partcipation in difficult or controversial decisions. Because we live in

16

a nation of different cultures you will find yourself faced with complicated situations that
arise from these differences with the support of professional code of practice and a
commitment to critical thinking skills, you will contribute a vital and unique voice to the
process of health care delivery

ETHICS
Ethics has been defined a branch of philosophy that involves systematizing, defending
and recommending concepts of right and wrong conduct, often addressing disputes of
moral diversity (Wikipedia. The word ethics is derived from the Greek term ethos, which
means customs Ethics offers a forward process for answering the question about that
one ought to

do in a situation understanding some of basic ethical principles and

guideliness assists us in making logical and appropriate decisions. It helps us identify the
motives for action and define relationships between human beings.

ETHICAL PRINCIPLES
Practioners in health care delivery agree to set of ethical principles that guide professions
practice and decision making. These principles are common to all professions in health
care. There are mainly 6 principles are.
1.

Autonomy

2.

Beneficence

3.

Nonmaleficence

4.

Fidelity

5.

Justice

6.

Veracity

Autonomy
Autonomy

involves the right of self - determination or choice, independence and

freedom. It comes from the latin auto, meaning self and nomy which means control it
represents an agreement to respect the patients right to determine a course of action. For

17

example, the purpose of the preoperative consent is to assure in writing that the health
care team respect the patients independence by obtaining permission to proceed. The
consent process implies that if a patient refuses treatment, in most cases the health care
team will agree to abide by the patients refusal.

Beneficence
The principle of beneficence promotes taking positive, active steps to help others. it
encourages you to do good for the patient. It help to guide decisions in which the benefits
well being. A child immunization causes discomfort during administration but the
benefits of protection from disease both for the individual and for society, outweigh the
temporary discomforts.

Nonmaleficence
It refers to the fundamental agreement to do no harm. It is closely related to the priciple
of beneficence. This principle will be helpful in guiding your discussions about new or
controversial technologies for example a new bone narrow transplant procedure promises
a chance at care, but the long term prognosis in uncertain. The principle promotes a
continuing effort to consider the potential for harm even when it is necessary to promote
health.
Nurses are obligated not to harm patients. This is the principal of
nonmaleficence. Nurses often do have to perform procedures which make patients feel
uncomfortable. An example is administering an injection. A patient needs medication to
relieve a symptom, however, in order to relieve a symptom, the nurse may cause
discomfort. Nonmaleficence must be balanced by beneficence, while providing care. The
intent of the nurse provides a treatment which benefits the patient must outweigh the
discomfort caused. The nurses intent must be to help, not harm.

Fidelity
Fidelity refers to the agreement to keep promises, commitments, responsibilities that one
has made to oneself and others, both implicity and explicity. The principle of fidelity also

18

promotes your obligation as a nurse to follow through with the care offered to patients.
eg: If you assess a patient for pain and then otter a plan to manage the pain the principle
of fidelity encourages you to do best to keep the promise to improve the patients
comfort.

Veracity
Veracity refers to telling the truth or not intentionally deceiving or misleading patient.
For eg: do you tell the truth when you know the truth will cause harm to an individual?
Do you tell a lie when it would make some one makes anxious and afraid?

JusticeDerived from the work of John Rawls, this principle refers to an equal and fair
distribution of resources, based on analysis of benefits and burdens of decision. Justice
implies that all citizens have an equal right to the goods distributed, regardless of what
they have contributed or who they are

ETHICAL THEORIES
UTILITARIAN THEORY
Utilitarianism, developed by Jeremy Bentham and John Stuart Mill, defines the moral
goodness of actions by their consequences

This theory distinguishes good from bad,

with particular emphasis on the happiness generated by the consequences. Those acts are
right that produce greatest happiness for the greatest number. Utilitarianism, at times,
requires that some good be sacrificed. For example, a baby born with an impairment and
a less than "optimal" life would create a great burden for the parents and society. In this
case, it would be best that the child die.

DENTOLOGICAL THEORY
Deontologic theories (theories of duties), developed under the inspiration of Immanuel
Kant, distinguish right from wrong and emphasize adherence to duty as the primary
degree of moral rightness .Right action is determined not by outcomes but by intentions.
Instead of examining the consequences of actions, the choice is examined. The principle
of respect for another is deeply imbedded in this theory and leads to the idea that respect

19

for another includes respect for autonomous decisions. Informed consent is an application
of this respect principle.

FEMINIST THEORY
This theory supports ethical relativism in that it does not support universal acts.
Feminist theory requires examination of context of the situation in order to come to a
moral conclusion. It asks how an action affects the person, the family, and those
depending upon one another (e.g. community).

BIOETHICS :
a discipline dealing with the ethical implications of biological research and applications
especially in medicine(MERRIAM WEBSTER)
Bioethics" has been used in the last twenty years to describe the investigation
and a study of ways in which decisions in medicine and science touch upon our health
and lives and upon our society and environment.
Bioethics is concerned with questions about basic human values such as the
rights to life and health, and the rightness or wrongness of certain developments in
healthcare institutions, life technology, medicine, the health professions and about
society's responsibility for the life and health of its members.

BIOETHICAL ISSUES
ABORTION
The matter of abortion, the quintessential bioethics topic, raises intensely personal
issues for many people. It is a polarising and divisive issue that raises discussions about
morals, science, medicine, sexuality, autonomy, religion, and politics. A central matter is
deciding what we can say about unborn children, initially known as embryos and later,
foetuses. What is their moral status how much do they matter, and what are our
obligations towards them? The matter of 'personhood' arises, as a philosophical and legal
discussion about what rights to grant them.

20

'Personhood' aside, what is our relationship to them, all of us as members of the

human family? Should their lives be protected, or should their mothers be allowed to
make decisions about killing or protecting them? If killing is allowed, under what
circumstances may it take place? If their lives are not protected, what kind of crime is it
to perform an abortion on a woman without her consent, or to cause her to suffer a
miscarriage? AS a client advocate,should anurse be for or against abortion ?.can a nurse
ethically or legally refuse to assist at abortions?
These questions are not easily answered ,but understanding the underlying
principles involved in the issue may help defuse some of the Emotional impact that often
surrounds this topic .the nurse needs to remember that the client must receive copetent
,high quality care regarless of the nurses own personal values or moral belifs.

REPRODUTIVE TECHNOLOGY
Assisted reproductive technology (ART) is a medical intervention developed to improve
an infertile couples chance of pregnancy. Infertility is clinically accepted as the
inability to conceive after 12 months of actively trying to conceive. The means of ART
involves separating procreation from sexual intercourse - the importance of this
association is addressed in bioethics.

Some techniques used in clinical ART include: artificial insemination; in vitro

fertilisation (IVF); gamete intra-fallopian transfer (GIFT)

ART enables children to be conceived who have no genetic relationship to

one or both of their parents. Children can also be conceived who will never have a social
relationship with one or both of their genetic parents, e.g. a child conceived using donor
sperm. Non-infertile people in todays society including both male and female
homosexual couples, single men and women, and post-menopausal women are seeking
the assistance of ART. Concerns in all situations include the child and his or her welfare,
including the right to have one biological mother and father. The fragmented family
created by ART can disconnect genetic, gestational and social child-parent relationships
which have typically been one and the same in the traditional nuclear family.

21

ORGAN DONATION
Modern surgical techniques have made it possible for someone to have diseased or
damaged organs or tissues replaced with healthy ones from a living or dead donor. Major
organs taken from a dead donor include the heart, lungs, kidneys, and liver, and tissues
include bone, corneas, skin, and heart valves. One of the central ethical questions is the
determination of death. People who are on life support may be eligible for organ
donation and important questions arise about correctly determining when they are
actually dead before organ procurement can proceed. Other important ethical questions
include who is eligible to receive an organ; how organ waiting lists are structured; should
payment be permitted for organs and tissues; should reproductive organs and tissues be
permitted for transplant; should face transplants be permitted; how religious and cultural
sensitivities should be handled; confidentiality and privacy of donor and recipient;
ensuring genuine informed consent; and, how should family conflicts about donation be
handled?

EUTHANASIA
Euthanasia is the intentional and painless taking of the life of another person, by act or
omission, for compassionate motives. The word euthanasia is derived from the Ancient
Greek language and can be literally interpreted as good death. Despite its etymology,
the question whether or not euthanasia is in fact a good death is highly controversial.
The fundamental ethical issue in these situation is the right to self determination.in
almost every other health care situation ,a client who is mentally competent can make
decisions about what care to accept and what care to refuse , yet when it comes to the
termination of life ,this right become controversial.

DISABILITY
Here is a significant controversy over whether one ought to speak of "disability" as
a deficit compared to the norm, or whether it is simply a part of the natural diversity
among people. Is disability a biological reality, or is it socially constructed. Is every
biological 'abnormality' a disability, or does a disability necessarily entail some kind of
disadvantage in comparison to most other people? These two different ways of

22

conceptualising disability are known as the medical model and the minority group model
(on which disability rights movements are based). Deciding between these perspectives
has important implications for public policy debates, and social and medical approaches
to disability
Therefore many ethical questions confront us in relation to people with
disabilities, and those who care for them. Is a life with disability worth less? How
should we respond to a request for euthanasia from a person with a disability? Late-term
abortion meets with disapproval by the majority of people, except in the case of severe
fetal abnormality why, and is this right? Should newborns with a disability be killed or
allowed to die? How much healthcare and assistance should we provide to people with a
disability? How do we respond to those whose disability prevents them from
communicating or from making their own decisions for example cognitive and other
mental disabilities?

CODE OF ETHICS
A code of ethics is a set of ethical principles that all members of a profession generally
accept. It is defined as

A specific set of professional behaviors and values the

professional interpreter must know and must abide by including confidentiality, accuracy,
privacy, integrity.
An ethical code is adopted by an organization in an attempt to assist those in the
organization called upon to make a decisions understand the difference between right
and wrong and to apply this understanding to their decision.
The code of ethics serve as guidelines to assist nurses and other professional groups
when conflict or disagreement arises about correct practice or behavior. It will give
guidelines how should they behave with each other, with the public and with
Governments, with the patients. Ethics also tell the public that what they can expect from
a professional and till the professional that what the public expects from them.
Different nursing councils are set code for the nurse, ICN (International Council Nurses)
and Indian Nursing Council (INC) also set codes.

23

INTERNATIONAL CODE OF NURSING ETHICS

The fundamental responsibility of the nurse is fourfold to promote health, to prevent,
these to restore health and to alleviate suffering.
The need for nursing is universal inherent in nursing is respect for life, dignity and rights
of man it is unrestricted by considerations of nationality race, creed, color, age, sex,
politics.
Nurses render health services to the individual the family and the community and coordinate their services with those of related groups.

NURSES AND PEOPLE

The nurses primary responsibility is to those people who require nursing care the nurse
in providing care, promotes on environment in which the values, customs, spiritual belief
of the individual are respected.
NURSES AND PRACTICE
The nurse carries personal responsibility

for nursing practice and for maintaining

competence by .. learning. The nurse maintaining competence by continued learning.

The nurse .. the highest standards of nursing care possible within the reality of a specific
situation.
The nurse when acting in a professional capacity should at all times maintains standards
of personal conduct which reflect credit upon the profession.
NURSES AND SOCIETY
The nurse shares with other citizens the responsibility for in taking and supporting action
to meet the health and social needs of public
NURSES AND CO-WORKERS

24

The Nurse sustain co-operative relationship with co-workers. In nursing and other fields.
The nurse taken appropriate action to safeguard the individual when his care is
endangered by a co-worker.
NURSES AND PROFESSION
The nurse plays the major role in determine and implementry desirable standards of
nursing practice and nursing education.
The nurse acting through the professional organization participates in establishing and
maintaining equitable social and economic working condition in using

ETHICAL DILEMMA
An ethical dilemma (choice between two undesirable alternatives) occurs when
individual values and conflict. This is especially true in relation to health care.ethical
dilemmas usually have no perfect solution and those making disicion may found
themselves in direct conflict with another.
Most health care institution have an institutional ethical committee process
ethical dilemma, it includes doctors ,nurses, social workers etc,this committee help
the nurse who feels confused in presence of ethicl dilemma. Occasionally nurse final
themselves in situations that are legal but are personally unethical, ethical but illegal.
Eg: Abortion is legal, some believe it is unethical, Assisted suicide is illegal, but
some believe it is ethical
Eg. A client went to a surgery for a laproscopic biopsy of an abdominal mass .after
laproscope was inserted ,the physician notised that the mass had metastasized to the
liver,pancreas and colon,and even before the result of the tissue biopsy returned from
laboratory ,the physician diagnosed metastatic cancer with apoor prognosis .when
the client was returned to room ,the physician told the nurse about diagnosis but
warned that under no circumstances were tell the client about the cancer .
When the client awoke ,the first question that he asked the nurse was
do I have cancer? this posed an ethical dilemma for the nurses .if they were tell the
truth to the client would violates the principle of fidelity to the physician . if they lied
to the client to the client ,they would violates the principle of veracity.

25

ETHICAL DICISION MAKING

In ethical dilemma two or more principles apply but support .. inconsistent course of
action.
Step - 1 : Is this an ethical dilemma?
In a review of scientific data does not resolve the question, the question is perplexing
and the answer will have professional relevance for several .. of human concern then an
ethical dilemma exists.
Step - 2 : Gather all information relevant to the case complete assessment of the facts of
the case is critical to an effective decision patient family institutional and social
purgatives are important sources of relevant information.
Step - 3 : Examine and determine your own values and opinions about the issue
Values clarification provides a formulation for clarity and for confidence during
discussions that will be necessary for resolution of dilemma.
Step - 4 : State the problem clearly
a clear, simple statement of the dilemma is not always easy, but it is essential for the next
step to take place.
Step - 5 : consider possible course of action to respect all sides of an issue, it is helpful to
list potential actions, especially ..the list will reflect opinions that conflict.
Step - 6 : Negotiate the outcome
Sometimes courses of action that seen unlikely at the beginning of the process take on
new possibility as they are put to rational and restedful consideration.
Step - 7 : Evaluate the action

FACTORS INFLUENCING ETHICAL DICISION MAKING

Treatment team
The treatment team usually composed of the nurse ,physician,respiratory therapist,social
worker etc the nurse should discuss when therecare conflicting ideas about what to do in
a situation because of different values or principles the nurse may not be sure whether to
support the patients freedom of choice or patients health needs.

Patient feelings and wishes

26

It is the patients right not only to have informed consent but to have his or her wishes
followed .if the patient wishes to have a living will or to be considered do not
resucitateand he is hopelessly ill ,these wishes should be honoured and carried out
according to health care policy.

Social Norms
Local customs can define the ethical behavior of those living within that culture. What
isconsidered normal in one culture can be completely unnatural in another; what is
ethicalin one culture can be unethical in another.

Religious Beliefs
Many believe in life after death. Most religions have a common theme of judgment in the
after life. In the afterlife, many believe good deeds during natural life are rewarded and
bad deeds can be punished. In defining good deeds, religions have developed moral codes
to live by, such as the Ten Commandments, which forbid theft, killing and other
unethical behaviors. How devoutly a person adheres to these moral codes is a factor
defining overall ethical behavior.

Laws
Laws, and a person abiding by them, influence ethical behavior. Fear of prosecution
andpunishment is a great deterrent, and as such, many do not break the law. In the
UnitedStates, ethical behavior is defined by law, such as not stealing or not causing
propertydamage. The level of punishment is roughly tied to the level of crime.

Disease process
Which disease process are affecting the patient ,whether it is irreversible or terminal
according to this affect disicion making

27

ROLE OF ADMINISTRATOR IN ETHICAL DICISION

MAKING
1.Is self- awareness own values and basic beliefs about the rights, dutiesand goals of human
beings
2 .Accepts that some ambiguity and uncertainly must be a part of all ethical decision making
4. Accepts that negative outcomes occur in ethical decision making despite high
quality problem solving and decision making
5.

Clearly communicates expected ethical standard

5 .uses systematic approach to the problem solving and decision making

6 .Conduct a written survey of hospital staff to assess awareness, interests, attitudes, or
perceived problems in the area of bioethics.
7 Establish annual goals for the ethics committee and periodicalIy assess whether
progress is being made toward
8

Arrange meetings with nursing department managers or head nurses to discuss ethical
issues that arise in the various units

achieving them.
9 .Invite members of another local ethics committee to help evaluate the institution's
ethics committee meetings.
10 .Conduct a self-evaluation in which individual members evaluate their own
contributions to the ethics committee and reflect on their hopes for its future.

RESEARCH STUDIES RELATED TO LEGALY ETHICAL

ISSUES IN NURSING
1.A cross cultural review of the ethical issues in dementia care in
Kerala, India and The Netherlands.
Sowmini CV1, De Vries R.

28

Abstract
BACKGROUND:
The paper explores the diverse ethical issues in the care of persons with dementia, in the
Netherlands and Kerala, India. These cross-cultural data are used to suggest newer ways
for addressing the ethical issues in a mutually enhancing manner.
METHODS:
A thorough review of the literature focusing on ethical aspects of the care for persons
with dementia.
RESULTS:
The medical paradigm is dominant in the Netherlands and awareness of dementia as an
organic brain disease is low in Kerala. Institutionalized care is more common in the
Netherlands and home-based care is the norm in Kerala. Institutional care is costly,
whereas home-based care is stressful for caregivers. The advanced directive plays an
influential role in the Netherlands, but this mechanism is yet to evolve in Kerala.
The legal and social setting of the Netherlands has a strong influence on physician
decision-making concerning end of life issues. In Kerala, discussion of these matters is
nearly unknown.
CONCLUSION:
Limited awareness of dementia in Kerala should be addressed in public forums, which
can then be used to garner governmental support. The predominantly institutional model
of care-giving in the Netherlands and home-based care-giving in Kerala, each have their
strengths; policy makers in both societies can usefully apply the values and merits
inherent in both models. A culturally appropriate implementation of the advanced
directive will have beneficial medical, social, and economic impacts in Kerala. The
remarkable disparity between the Netherlands and Kerala in dealing with end-of-life
issues will allow more philosophically and socially informed ways of addressing
the ethical questions that arise in those situations.

29

2.Legal Awareness and Responsibilities of Nursing Staff in

Administration of Patient Care in A Trust Hospital
Hemant Kumar,1 Gokhale,2 Kalpana Jain,3 and D.R. Mathur4

Abstract
Introduction: The enactment of various legal provisions like Consumer
Protection Act, Right to Information Act and standardization of procedures
and practices have brought nursing care under legal ambit. Needless to say,
the level of legal awareness amidst nursing staff in India is abysmally low.
Present study was undertaken to assess the level of legal awareness and
responsibilities of nursing staff in administration of patient care at a trust
hospital.
Methods: An open ended questionnaire was prepared to assess the level of
legal awareness among the nursing staff. The GNM and ANM nursing staff
deployed at the nursing home and general wards only were randomly
screened and specialty nurses were exempted.
Results: The knowledge on various legal provisions, as was applicable to
nursing, across all categories of nurses which were under review, was found
to be poor. The nursing staff had poor knowledge on patients rights and also
on their legal obligations towards patients. The GNM nurses fared better
than ANM nurses. However, 46.67 % of nurses were found to be aware
about cases of omission or commission.
Conclusion: This study substantiated the fact that nurses had poor
knowledge on the law that governed their profession and that in days to
come, it would become increasingly difficult for them to avoid law suits
which were prepared against them, unless remedial actions were taken.
Keywords: Negligence, Consumer protection act, Immunity
3.KNOWLEDGE OF STAFF NURSES REGARDING LEGAL AND
ETHICAL RESPONSIBILITIES IN THE FIELD OF PSYCHIATRIC NURSING

30

RAJESH KUMAR, SANTOSH MEHTA, RAMINDER KALRA

ABSTRACT :
INTRODUCTION .IT HAS LONG BEEN KNOWN THAT THERE IS A DYNAMIC
RELATIONSHIP BETWEEN THE CONCEPT OF MENTAL ILLNESS, THE
TREATMENT OF THE MENTALLY ILL AND THE LAW. THE MENTAL HEALTH
PROFESSIONAL ESPECIALLY NURSES SHOULD KNOW THE BASIC LEGAL
AND ETHICAL ASPECTS OF PSYCHIATRY.
METHODS. THE DESCRIPTIVE STUDY WAS THUS UNDERTAKEN WITH THE
OBJECTIVES TO IDENTIFY THE KNOWLEDGE OF THE STAFF NURSES
REGARDING LEGAL ANDETHICAL RESPONSIBILITIES IN THE FIELD OF
PSYCHIATRIC NURSING AT SELECTED PSYCHIATRIC CENTRE OF JAIPUR,
RAJASTHAN. TOTAL OF 30 NURSES WERE SELECTED CONVENIENTLY AND
QUESTIONED

USING

DEMOGRAPHIC

SHEETAND

STRUCTURED

KNOWLEDGE QUESTIONNAIRE WHICH CONTAINS ITEMS RELATED TO LAW

TERMINOLOGY, ACTS AND
ETHICAL ISSUES.
RESULTS. THE SCORE THUS OBTAINED WAS CATEGORIZED INTO THREE
LEVELS: HIGH (46-60), MODERATE (31-45) AND LOW (0-30). THE FINDINGS OF
THE STUDY REVEALED THAT MAJORITY (90%) OF THE NURSES' POSSESS
MODERATE LEVEL OF KNOWLEDGE. THERE WAS NO SIGNIFICANT
ASSOCIATION FOUND BETWEEN THE KNOWLEDGEWITH AGE, SEX,
MARITAL

STATUS,

EXPERIENCE

AND

QUALIFICATION

DESIGNATION
IN-SERVICE

AND

THEIR

OF

NURSES,

EDUCATION

TOTAL

WHILE

PSYCHIATRIC

CLINICAL

PROFESSIONAL

EXPERIENCE

WAS

SIGNIFICANTLY ASSOCIATED WITH THE KNOWLEDGE LEVEL OF THE

NURSES.

KEY WORDS :
LEGAL AND ETHICAL ISSUES, PSYCHIATRY
NURSING, NURSES

31

4.Euthanasia: the perceptions of nurses in India.

Poreddi V1, Nagarajaiah, Konduru R,
Abstract
Introduction. Euthanasia provokes controversies in various domains, such as the
moral, ethical, legal, religious, scientific, and economic. India legalised passive
euthanasia (withdrawal of life support) for patients with brain death or who are in a
permanent vegetative state in 2011, but research on perceptions of euthanasia among
people in India is limited. This study aimed to examine nurses' perceptions of the practice
of euthanasia as well as factors influencing those perceptions.
Methods. A non-probability quantitative, cross-sectional design was adopted for a
sample of 214 nurses working at a tertiary care centre. Data was collected through selfreported questionnaires at the nurses workplace.
Results. The findings revealed mixed opinions on euthanasia among the nurses.
However, the majority of the participants did not agree with the practice of euthanasia.
Nonetheless, further research is needed on this issue across the country among various
health professionals in the context of current legislation.

6. Nurses response to ethical dilemma in nursing practice : meta

analysis
(Brenadetle Direcky de casterle)
Abstract : Most nurses received that there were barriers in their work environment to
ethical practice compromising their ability to perform ethically. Since most research on
barriers to nurses ethical practice, little is known about how nurses involve themselves in
ethical decision making and action in daily care.

32

Methods. metaanalysis method for data collection in four countries (n= 1592 RN)
Conclusion. was conformist practice (following conventions rather than pursing good
for the patient) constitutes a major barrier for nurses to take the appropriate ethical
actions, as creativity and critical reflection are absent.. There is an urgent need to find
ways to promote nurses ethical development from conventional to post conventional
ethical practice.

6.Ethical challenges in voluntary blood donation in Kerala,

India.
Choudhury LP1, Tetali S.
Abstract
The National Blood Policy in India relies heavily on voluntary blood donors, as they
are usually assumed to be associated with low levels of transfusion-transmitted infections
(TTIs). In India, it is mandatory to test every unit of blood collected for hepatitis B,
hepatitis C, HIV/AIDS, syphilis and malaria. Donors come to the blood bank with
altruistic intentions. If donors test positive to any of the five infections, their blood is
discarded. Although the blood policy advocates disclosure of TTI status, donors are not,
in practice, informed about their results. The onus is on the donor to contact the blood
bank. Out of approximately 16 000 donations in the past 2 years, 438 tested positive for
TTI, including 107 for HIV. Only 20% of the donors contacted the blood bank; none of
them were HIV positive. Disclosure by blood banks of TTI status by telephone or mail
has resulted in serious consequences for some donors. Health providers face
an ethical dilemma, in the absence of proper mechanisms in place for disclosure of test
results, regarding notification to donors who may test positive but remain ignorant of
their TTI status. Given the high cost of neglecting to notify infected donors, the authors
strongly recommend the use of rapid tests before collecting blood, instead of the current
practice, which takes 3 h to obtain results, and disclosure of results directly to the donor
by a counsellor, to avoid dropouts and to ensure confidentiality.

33

CONCLUSION
Legal and ethical issues in nursing continue to increase in scope and importance as the
profession struggles with complex technology, impacts of nursing shortages in all
practice setting and increasing demands of consumers. Thus the need for relevant and
current infromation remains critical. In the research studies conducted indicates that the
nurses need more strengthening their knowledge and practice in legal and ethical aspects.

34

BIBLIOGRAPHY
1.

Potter Perry Basic Nursing 6th edition - Elsevier publication Page No. 53 - 76

2 .Ellis, Hartley Nursing in todays world, 10 th edition - Wollers Kluwer,

Lippincott Williams and Wilkins, Page No. 244 - 326
3. Taylor,lillis,Lenore Fundamental of Nursing, The Orty Science Nursing , 5th
edition - , Lippincott Publication, Page No. 326
4.

Nightingal Nursing time, Journal September 2011

5.

WWW. Times of India.com/organ & Tissue transplantation

6.

WWW.meedindia.net/Health acts in India

7.

WWW.wikipedia.com /euthanasia in India

8.

www.bioethics,org/resourcetopics

9, Health ethics committee,the next generation Judith wlison roson, American hospital
publication
10. Nursing now ;todays issues ,tomorrows trends ,joseph t ,catalano
Page no 115-135 jaypee publications

35