ETHICO-MORAL ASPECTS IN NURSING

Ethics
- Ethos - comes from Greek work w/c means character/culture
- Branch of Philosophy w/c determines or study morality (right and wrong)
- Systematic inquiry into principles of right, from good & evil as they relate to conduct
Moral - personal/private interpretation from what is good and bad.

TYPES OF ETHICS
Those of particular concern to the nurse are:
1. BIOETHICS - branch of ethics that studies moral values in the biomedical sciences
2. CLINICAL ETHICS concerned with ethical problems at the bedside that arise within the context of caring for actual
patients
Ex.: Informed consent & how one ought to respond to requests for assisted suicide
3. NURSING ETHICS study of ethical issues that arise in the daily practice of nursing & of the analysis used by nurses to
make ethical judgement
Ex.:cost-containment, breaches of patients confidentiality, illegal practices of colleagues

Ethical Principles:
1. Autonomy the right/freedom to decide (the patient has the right to refuse despite the explanation of the nurse) Example:
surgery, or any procedure
2. Nonmaleficence the duty not to harm/cause harm or inflict harm to others (harm maybe physical, financial or social)

3. Beneficence - for the goodness and welfare of the clients

4. Justice equality/fairness in terms of resources/personnel

5. Veracity - the act of truthfulness

6. Fidelity faithfulness/loyalty to clients

Moral Principles:
1. Golden Rule
2. The principle of Totality The whole is greater than its parts
3. Epikia There is always an exemption to the rule
4. One who acts through as agent is herself responsible (instrument to the crime)
5. No one is obliged to betray herself You cannot betray yourself
6. The end does not justify the means
7. Defects of nature maybe corrected
8. If one is willing to cooperate in the act, no justice is done to him
9. A little more or a little less does not change the substance of an act.
10. No one is held to impossible

Law - rule of conduct commanding what is right and what is wrong. Derived from an Anglo-Saxon term that means that which
is laid down or fixed
Court -body/agency in government wherein the administration of justice is delegated.
Plaintiff complainant or person who files the case (accuser)
Defendant accused/respondent or person who is the subject of complaint
Witness individual held upon to testify in reference to a case either for the accused or against the accused.

Written orders of court

Writ legal notes from the court

Subpoena
1. Subpoena Testificandum a writ/notice to an individual/ordering him to appear in court at a specific time and
date as witness.
2. Subpoena Duces Tecum- notice given to a witness to appear in court to testify including all important
documents

Summon notice to a defendant/accused ordering him to appear in court to answer the complaint against him

Warrant of Arrest - court order to arrest or detain a person

Search warrant - court order to search for properties.

Private/Civil Law - body of law that deals with relationships among private individuals
Public law - body of law that deals with relationship between individuals and the State/government and government agencies. Laws
for the welfare of the general public.

Private/Civil Law can be :

Contract law involves the enforcement of agreements among private individuals or the payment of compensation for
failure to fulfill the agreements

EGBJune09 1
 Ex. Nurse and client nurse and insurance
Nurse and employer client and health agency
- An agreement between 2 or more competent person to do or not to do some
lawful act.
- It maybe written or oral = both equally binding
(2) Types of Contract:
1. Expressed when 2 parties discuss and agree orally or in writing the terms and conditions during the creation of the
contract.

Example: Nurse will work at a hospital for only a stated length of time (6 months), under
stated conditions (as volunteer, straight AM shift, with food/transportation allowance)

2. Implied one that has not been explicitly agreed to by the parties, but that the law considers to exist.

Example: Nurse newly employed in a hospital is expected to be competent and to follow

hospital policies and procedures even though these expectations were not written or
discussed.

Likewise: the hospital is expected to provide the necessary supplies, equipment needed to
provide competent, quality nursing care.

Feature/Characteristics/Elements of a lawful contract:

1. Promise or agreement between 2 or more persons for the performance of an action or restraint from certain actions.
2. Mutual understanding of the terms and meaning of the contract by all.
3. A lawful purpose activity must be legal
4. Compensation in the form of something of value-monetary

xxx

Persons who may not enter into a contract: minor, insane, deaf, mute and ignorant
TORT LAW is a civil wrong committed against a person or a persons property.
- Person/persons responsible for the tort are sued for DAMAGES
- Is based on:
ACT OF COMMISSION something that was done incorrectly or
ACT OF OMMISION something that should have been done but was not.

Classification of Tort
1. Unintentional
a. Negligence misconduct or practice that is below the standard expected of ordinary, reasonable and prudent person
- Failure to do something due to lack of foresight or prudence
- Failure of an individual to provide care that a reasonable person would ordinarily use in a similar circumstance.
- An act of omission or commission wherein a nurse fails to act in accordance with the standard of care.

Doctrines of Negligence:
1. Res ipsa loquitor the thing speaks for itself the injury is enough proof of negligence
2. Respondeat Superior let the master answer command responsibility
3. Force majuere unforeseen event, irresistible force

b. Malpractice stepping beyond ones authority

(6) elements of nursing malpractice:

1. Duty the nurse must have a relationship with the client that involves providing care and following an acceotable standard
of care.

2. Breach of duty the standard of care expected in a situation was not observed by the nurse
-is the failure to act as a reasonable, prudent nurse under the circumstances
-something was done that should not have been done or nothing was done when it should have been done

3. Foreseeability a link must exist between the nurses act and the injury suffered

4. Causation it must be proved that the harm occurred as a direct result of the nurses failure to follow the standard of care
and the nurse should or could have known that the failure to follow the standard of care could result in such harm.

5. Harm/injury physical, financial, emotional as a result of the breach of duty to the client
Example: physical injury, medical cost/expenses, loss of wages, pain and suffering

6. Damages amount of money in payment of damage/harm/injury

2. Intentional Tort

EGBJune09 2
 Unintentional tort do not require intent bur do require the element of HARM
Intentional tort the act was done on PURPOSE or with INTENT
- No harm/injury/damage is needed to be liable
- No expert witnesses are needed
1. Assault an attempt or threat to touch another person unjustifiably
Example: (1) A person who threatens someone with a club or closed fist.
(2) Nurse threatens a client with an injection after refusing to take the meds orally.

2. Battery wilful touching of a person, persons clothes or something the person is carrying that may or may not cause harm but
the touching was done without permission, without consent, is embarrassing or causes injury.
Example: (1) a nurse threatens the patient with injection if the patient refuses his medsorally. If
the nurse gave the injection without clients consent, the nurse would be committing battery
even if the client benefits from the nurses action.

3. False Imprisonment unjustifiable detention of a person without legal warrant to confine the person
Occurs when clients are made to wrongful believe that they cannot leave the place
Example: (1) Telling a client no to leave the hospital until bill is paid
(2) Use of physical or chemical restraints
(3) False Imprisonment Forceful Restraint=Battery

4. Invasion Of Privacy intrusion into the clients private domain

Right to be left alone

Types of Invasion the client must be protected from:

a. use of clients name for profit without consent using ones name, photograph for advertisements of HC
agency or
provider without clients permission
b. Unreasonable intrusion observation or taking of photograph of the client for whatever purpose without clients
consent.
c. Public disclosure of private facts private information is given to others who have no legitimate need for that.
d. Putting a person in a false/bad light publishing information that is normally considered offensive but which is
not true.

5. Defamation communication that is false or made with a careless disregard for the truth and results in injury to the
reputation of a person

(2) Types:
Libel >defamation by means of print, writing or picture
Example:
1. writing in the chart/nurses notes that doctor A is incompetent because he didnt respond
immediately to a call
Slander >defamation by the spoken word stating unprivileged (not legally protected) or
false word by which a reputation is damaged
Example:
1. Nurse a telling a client that nurse B is incompetent
2. Person defamed may bring the lawsuit
3.The material (nurses notes) must be communicated to a 3rd party in order that the persons
reputation maybe harmed

xxx
Public Law:

Criminal Law deals with actions or offences against the safety and welfare of the public.

HOMICIDE > Killing of any person without criminal intent may be done as self-defense
ARSON > Burning of property
THEFT > Stealing
SEXUAL HARASSMENT
ACTIVE EUTHANASIA
ILLEGAL POSSESSION OF
CONTROLLED DRUGS

xxx

EGBJune09 3
EGBJune09 4
ETHICO-MORAL ASPECTS OF (5) VALUES ESSENTIAL FOR PROFESSIONAL NURSES
NURSING PRACTICE 1. Altruism >The concern for the welfare &
well-being of others
Nurses need to:
2. Autonomy >The right for self- determination
Develop sensitivity to the ethical
of professional practice
dimensions of nursing practice
Ex.: When the nurse respects
Examine their own & clients value patients right to make decisions
Understand how values influence their about their health care
decisions 3. Human - Respect for the inherent worth &
Think a head about the moral problems dignity uniqueness of individual &
they are likely to face. Ex.: birth, death, populations
marriage Ex.: when the nurse values &
respects all patients & colleagues
*Values are important because they influence 4. Integrity - Acting in accordance with an
decisions & actions, including nurses ethical appropriate code of ethics &
decisions even though they may be unspoken standards of practice
questions of values underlie all moral dilemmas Ex.: when the nurse is honest &
provides care based on ethical
VALUES framework that is accepted within
- enduring beliefs or attitudes about the profession
worth of a person, objects, idea or action 5. Social - Upholding moral, legal &
- concepts/ ideas that give meaning to Justice humanistic principles.
ones life & provide a framework for ones Ex.: when the nurse works to
decision ensure equal treatment under the
laws & equal access to quality
BELIEFS (OPINIONS) care.
- Interpretations or conclusions that people
hold as true PROFESSIONAL BEHAVIORS ASSOCIATED
- Based more on faith that fact & may/ may WITH 5 VALUES
not be true 1. Demonstrate understanding of cultures,
- Beliefs do not necessarily involves values belief & perspectives of others
Ex.: If I study hard, I will get good grade 2. Demonstrates accountability for own
actins
ATTITUDES 3. Documents accurately & honestly
- Mental positions/ feelings toward a person, 4. Designs care with sensitivity to individual
object or idea patient needs
- Often judged as bad or good, positive or 5. Advocates for patients particularly the
negative, beliefs are judged as correct or most vulnerable
incorrect. 6. Take risks on behalf of patients &
colleagues
VALUES 7. Plans in partnership with patients
- Are learned through observation & 8. Honors the rights of patient & families to
experience & are heavily influenced by a make decisions about healthcare
persons sociocultural environment that is 9. Provide information so patients can make
by: informed choices
o Societal traditions, cultural, ethical, 10. Provide culturally competent & sensitive
religious groups, family or peer care
groups 11. Protects the patients privacy &
confidentiality
PROFESSIONAL VALUES 12. Provides honest information
- Are acquired during socialization from 13. Promotes universal access
nursing experience, from teachers, peers 14. Seek to remedy errors made
& code of ethics 15. Support fairness
16. Encourage legislation
*Nurses & nursing students need to examine
the values they hold about life, death &
illness. One strategy for gaining awareness of ETHICS came from the Greek word ETHOS meaning
personal values is to consider ones attitude custom/character or moral duty
about specific issues as abortion/ euthanasia Method of inquiry that assist people to
understand the morality of human
VALUES CLARIFICATION behaviour
- Process by which people identify, examine Refers to the expected standards of moral
& develop their own individual values behavior
How people make judgement in regard to right or
wrong

EGBJune09 5
 Critical reflection about morality and rational Is nursing a profession?
analysis about it YES. It is a calling, vocation, occupation based on
JOHNSTON- examination of all ethical and bio- scientific body of knowledge which needs training both
ethical issues from the prospective of nursing theory in theory and practice guided by a Code of Nursing
and nursing ethics Ethics, governed by the Nursing Act of 2002, to SERVE
VERCOE- the fields of nursing ethics be focused on mankind for a FEE or FREE.
the needs and experiences of practicing nurses, the
exploration of its meaning and that of ethical practice PROFESSION
in terms of the perception of these nurses An occupation or calling requiring advance
training
BIOETHICS Experience in some specific or specialized
body of knowledge
Also known as applied or practical ethics Provides service to society in that special
Specific domain of ethics that focuses on moral field
issues in the field of health care The term profession is honoric and should
Result of life and death dilemmas faced by health be carried with pride and honor
care practitioners
Systematic study of human behaviour in the field of PROFESSIONAL NURSE
life science and health care in the light of moral Completed a basic nursing education
values and principles program
Licensed in his/her country or state to
NURSING ETHICS practice professional nursing
- Refers to the ethical issues that occur in nursing
practice NURSING PRACTICE
- Refers to the conduct or behaviour which by reason Primary responsibility promotion of health and
of public approval or practice has become customary prevention of illness
among professional Collaborate with other health care providers
o Curative
MORALS/ MORALITY o Preventive
Greek work MORALIS o Rehabilitative aspects of care
Refers to private, personal standard of o Restoration of health
what is right & wrong in conduct, o Alleviation of suffering
o Towards a peaceful death
character or attitude
Nurses should distinguish MORALITY & Provide nursing care through the utilization of the
LAWS. nursing process
LAWS reflect the moral values of o Therapeutic use of self
o Executing health care techniques and
society, they offer guidance in determining
what is normal procedures
o Essential primary health care
An action can be moral but not legal, on
o Comfort measures
the other hand, an action can be moral
o Health teachings
but illegal
o Administration of written prescription for
Morality is what you believe is right and good
treatment
Health Care Ethics o Therapies
Division of ethics that relates to human health o Oral
Realm of human values, morals, customs, personal o Topical
o Parenteral medications
beliefs and faith
o Internal examination during labour in the
absence of antenatal bleeding and delivery
MORAL DEVELOPMENT
o Suturing of perineal laceration
- The process of learning to tell between
Establish linkages with community resources
right & wrong & of learning what ought not Coordination with the health team
to be done Provide health education to individuals, families and
- Complex process that begins in childhood communities
& continues throughout life Teach, guide and supervise students in nursing
- 2 well known theorist: education programs
o Lawrence Kohlberg The nurse is required to maintain competence by
Rights & formal reasoning continual learning through continuing professional
o Carol Gilligan education
Emphasizes care &
QUALIFICATIONS AND ABILITIES OF A
responsibility
PROFESSIONAL NURSE

Professional Preparation
NURSING o Have a license to practice
An occupation requiring a unique body of o Bachelor of science degree in nursing
knowledge and skills and which serves o Be physically and mentally fit
society Personal Qualities and Professional Proficiencies
o Interest and willingness to work and learn

EGBJune09 6
 o Warm personality and concern for people
o Resourcefulness and creativity, well
balanced emotional condition
o Capacity and ability to work cooperatively
with others
o Skill in decision making
DEFINITION OF LICENSE
A legal document given by the government that
permits a person to offer to the public his or her skills
and knowledge in a particular jurisdiction
CONTRACT
Meeting of minds between two persons whereby one
binds himself, with respect to other, to give
something or to render some service
A promise or a set of promise which the law
recognizes as a duty and when that duty is not
performed the law provides a remedy
MORAL THEORIES
- Provide framework
(3) TYPES OF MORAL THEORIES
1. CONSEQUENCE-BASED (Theological
theories)
- Looks to the consequences of an action in
judging whether the action is right of
wrong
- Focus on issues of fairness
- UTILITARIANISM
o Views the good act as one that
bring the most good for the greater
number or the least harm for the
greatest number
- PRINCIPLE OF UTILITY
o From the utilitarian perspective, th
point of morality is to promote
what is intrinsically good by
maximizing benefits & minimizing
harm
TELEOLOGICAL APPROACH
Greek word TELOS or goal or end
The right thing to do is the good thing to do
Act utilitarianism- good resides in the promotion of
happiness or the greatest net increase of pleasure over
pain
If the act helps people, then it is a good act
If the act hurts people then it is a bad act
2. PRINCIPLE-BASED (Deontological
theories)
- Involve logical & formal processes &
emphasize individual rights, duties &
obligations
- The morality of an action is determined
not by its consequences but whether it is
done according to an important objective
DEONTOLOGICAL APPROACH OR DUTY
ORIENTED THEORY
Basic rightness or wrongness of an act depends on
the intrinsic nature rather than upon the situation or
its consequences
Greek word DEON meaning DUTY
Immanuel Kant- rational human being with freedom
and social worth
A person is morally good and admirable if his actions
are done from a sense of duty and reason
3. RELATIONSHIP BASED OR CARING
THEORIES
- Stress courage, generosity, commitment &
need to nurture & maintain relationship
Other Moral Theories:
FLETCHERS GUIDELINES FOR MAKING ETHICAL
DECISIONS
1. Consideration for people as human beings
2. Consideration of consequences
3. Proportionate good to come from the choices
4. Propriety of actual needs over ideal or potential
needs
5. A desire to enlarge choices and reduce chance
6. A courageous acceptance of the consequence of the
decision
W.D ROSS- PRIMA FACIE DUTIES- WHAT ONE
SHOULD DO WHEN OTHER RELEVANT FACTORS IN
A SITUATION ARE NOT CONSIDERED
Duties of fidelity- telling the truth, keeping promises
Duties of reparation- righting the wrong we have
done to others
Duties of gratitude- recognizing the service others
have done for us
Duties of justice- preventing distribution of pleasure
or happiness that is not in keeping with the merit of
people involved
Duties of beneficence-helping to better the condition
of other beings
Duties of self improvement- bearing ourselves with
respect to virtue or intelligence
Duties of nonmaleficence- avoiding or preventing
injury to others
VIRTUE ETHICS APPROACH
ARETIC, Greek word ARETE, heart of the person
performing the act
Traits and virtues of a good person, courage,
temperance, wisdom, and justice
DIVINE COMMAND ETHICS
Supreme or divine that sets down rules to
provide guidance to moral decisions
(5) ATTRIBUTES OF CARING
1. Compassion sorrow for the suffering or
trouble of another, with an urge to HELP.
2. Competence condition in qualification of
being able to perform according to STANDARD.
3. Commitment DEDICATION to a long-term
course of action, engagement or involvement.
4. Confidence belief in ones own abilities, to feel
CERTAIN.

EGBJune09 7
5. Conscientious doing things according to what
is right, showing care and precision, HONEST
(held in respect, HONORABLE)
MORAL PRINCIPLES
- Broad general concepts such as autonomy
& justice, they provide the foundation for
moral values
PRICIPLES
- useful in ethical decisions because even if
people disagree about which action is right
in situation, they may be able to agree on
the principle that apply
(5) BASIC ETHICAL PRINCIPLES
1. >Our bodies, our life, our human
Stewardship nature & everything in this earth
are gifts we have dominion over
>This means we are responsible
for them. We should not harm
them, but rather improve & care
for them
>Ex.: Caring for ones body is a
sign of good stewardship
2. Totality >Refers to the whole. Every
person must develop, use for &
preserve all his parts & functions
for themselves as well as the good
of the whole
3. Doubt >When an act is foreseen to have
Effect both good & bad effects, the
principle of double effect is
applied.
>In order that such act be
permissible the following
conditions should be met:
1. The action itself must be good
or at least neutral
2. The good effects is the one
directed intended by agent & not
the evil effect
3. The good effect is not produced
by means of the evil effect
4. The foreseen beneficial effect
must be equal to or greater than
the foreseen harmful effect
4. >The participation of one agent
Cooperation with another agent to produce a
particular effect or joint effect
>Cooperation becomes a problem
when the action of the primary
agent is morally wrong
>Cooperation may be:
1. FORMAL
When the 2nd agent willingly
participates as when one agrees,
advice, counsels, promotes or
condones
2. MATERIAL
When the 2nd agent does not
willingly participate
5. Solidarity >Means to be one with others. In
the provisions of health care, it is
important for the provider to be in
solidarity with the patient when
seeking the latters best interest
>This is most important when
dealing with the poor,
disadvantaged & marginalized
>Ex.: Should the strong help the
weak?
MAJOR BIOETHICAL PRINCIPLES
EGBJune09
1. Respect for person
a. The recognition of the equality
possessed by every human being
as unique, worthy, rational, self
determining creature having the
capacity & the right to decide what
is best for himself
b. Responsibility of all to treat persons
as an end never as a means
c. The respect for persons autonomy
(self governance). The person
should be allowed to determine his
own destiny, to choose according
to his own values to act accordingly
d. Best practiced in the principle of
free & informed consent
e. The role of autonomy is refusal,
confidentiality & veracity
CONSENT
1. Implied indicates agreement/
nonverbal
2. Expressed verbal
(3) Components of informed consent
1. Must be given voluntary
2. The consent must be given to a client
with
capacity to understand
3. Given enough information to be the
ultimate
decision maker
Exceptions in giving consent
1. Minor
a. Adult who have mental
capacity of a child
b. Married who are minors
c. Pregnant minors
d. Parents & members of the
military
2. Severely injured
3. Mentally illed person
2. Justice
Also termed fairness, means to give to
each one what the deserves or what is due
Means to treat equals equally
3. Inviolability of life
Also proposed sanctity, dignity or
respect for human life
It means choosing life to protect it
This principle includes measures for the
survival of the human species & the
freedom to have children
It is be against violence, pollution of
environment, drug/alcohol addiction,
euthanasia, suicide & capital punishment
4. Non-maleficence
Duty to do NO HARM
Violations of the Principle
1. Physically harming a person as in
suicide, abortion, infanticide
(person who murder infant),
violence
2. Harming a persons reputation &
honor by revealing confidential
information
8
 3. Exposing the person to harm as in
subjecting the person to ETHICAL DILEMAS
unnecessary treatment - Exist when the right thing to do is not
clear/ members of health care team
5. Beneficence cannot agree what the right thing to do
Means to do well, provide a benefit
Bringing the action & choosing the most LEAGL RIGHTS, ROLES & RESPONSIBILITY OF
benefit & least harm THE NURSE
PRICIPLE UTILITY
ROLE RESPONSIBIL RIGHT
Circumstances/ Issues Involving
ITY
Maleficence
1. Provider of To provide safe Right to
- Situations where in not prolonging life is
allowed service care, adequate &
- Obligatory or optional treatment commensurate classified
- Euthanasia with the assistance as
nurses necessary
UNIVERSAL PRINCIPLES OF BIOMEDICAL ETHICS preparation
To determine right or wrong in regard to value issues experience &
Autonomy-
circumstances
1. Greek word AUTOS meaning self and
2. Employee or >To fulfill the >Right to
nomos meaning governance
contractor of obligations of adequate
2. Self determination
3. Freedom to choose and implement ones service contracted working
decision service with condition
4. Informed consent the employer >Right to
5. Allowing the patient to refuse treatment if he >To respect compensation
decides so the right & for services
6. The person making the decision must be responsibilities rendered
deemed competent, intellectual capacity, of other >Right to
legal age healthcare reasonable &
Veracity providers prudent
Health care providers are bound to tell the conduct
truth 3. Citizen >Protect the >Right to
Beneficence right of the respect by
Promotes the doing acts of kindness and recipients of others of the
mercy that directly benefit the patient care nurses own
NONMALEFICENCE- >To inform role &
1. To do no harm
2. Not assisting in or performing abortion clients of the responsibility,
3. Not to assist people to commit suicide consequences right to
4. Be involved in mercy killing of various physical safety
JUSTICE alternative of >Right to
1. The right to demand to be treated justly, outcome of reasonable &
fairly and equally care prudent
>To provide conduct for
adequate clients
CODE OF ETHICS supervision &
- A set of ethical principle that all member
evaluation of
of a profession generally accept
others for
- Sets the group expectation & standard of
whom the
behaviour
PRINCIPLES UNDERLYING CODE OF ETHICS nurse is
responsible
1. Refers to the execution of duties
SCOPE OF NURSING
Responsibility associated with the nurses role
- A person shall deemed to be practicing
2. Ability to answer for your own
nursing when she/he singly or in
Accountability action
3. Requires that those with access collaboration with another which initiates
Confidentiality with health information to a 3rd & performs nursing services to individual,
party without consent family, community in any health care
4. Judgement Ability to form opinion or draw setting
- Nurses are primarily responsible for the
sound conclusions
5. Advocacy >Giving patients information promotion of health prevention illness
- Nurses shall collaborate with other health
they need to make decision to
care provider for the curative, preventive,
support those decision
>Implies caretaker is drive to rehabilitative aspects of care, restoration
understand & clearly state of health, alleviation of suffering & when
patients point of view to other recovery is not responsible towards a
health care provider peaceful death

EGBJune09 9
ROLE Assist in maintaining a standard of nursing
- Expectation about how a person practice by making nurses accountable
occupying one position behaves toward a under the law
person occupying another position
TYPES OF LAWS PERTINENT TO NURSES
RIGHTS PUBLIC LAW
- Privileges or fundamental powers that - deals with relationships of between
individuals poses, unless they are revoke individuals & government agencies
or given up voluntarily
CRIME
RESPONSIBILITIES - an act in violation of public law &
- Obligations associates with rights or state punishable by a fine or imprisonment
of being accountable - Crimes may be classified as:
o FELONY
IT SHALL BE THE DUTY OF THE NURSE TO: Crime of serious nature such
Provide nursing care thru the utilization of the as murder, 1 2nd degree
nurse murder called manslaughter
Establish linkages with community resources (killing of another person)
& coordination with the health team Ex.: Patient who died due to
Provide health education incompatible blood
Teach, guide & supervise students in nursing transfusion or drug dose
education programs including the o MISDEMEANOUR
administration of nursing services in An offence of less serious
varied settings nature & punishable by a
Undertake nursing & health human resource fine or short term jail
development training & research sentence or both
The nurse is duty bound to observe the code
of ethics for nurses & uphold the standard CIVIL LAW
of safe nurse practice - Comprises of laws that affect the
The nurse is required to maintain by individual rather the whole society
continued learning.
TORT
STANDARD OF CARE - A civil wrong committed against a person
- Skills & learning commonly possessed by or persons property
members of the professional. - Classified as:
- Purpose: to protect consumer o Unintentional
- The standards are used to evaluate the o Intentional
gravity of care of nurses & therefore o Quasi-intension tort
become legal guideline for nursing
practice I. UNINTENTIONAL
Act committed against person or his
STANDARD OF PROFESSIONAL property
PERFORMANCE Classified as:
Quality of care A. NEGLIGENCE
Performance Appraisal Failure to comply with the
Education standards of due care either by
Collegiality omission or commission
Ethics A misconduct or practice that is
Collaboration below the standard expected of an
Research ordinary reasonable & prudent
Resource utilization
person
SELECTED LEGAL ASPECTS OF NURSING
Doctrines related to Negligence:
PRACTICE Respondeat Superior or
LAW Respondent supervisor
- A system of principles & processes by Let the superior answer
which people attend to control human An employee as well as
conduct in an effort to minimize the use of the employer is liable for
force the any failure

Functions of LAW in Nursing: Res ipsa loquitor

Provide a framework for establishing which Let the thing speak for
nursing action in the care of the client are itself
legal Shows sufficient proof on
It differentiates the nurse responsibilities the persons duty & his
from those of other health professionals neglect to perform it
It helps establish boundaries of independent
nursing action B. MALPRACTICE

EGBJune09 10
 Professional negligence that o Voluntary act that directly cause
occurred while the person was injury or distress
performing as a professional o Types:
The failure of the professional to Slander (Verbal)
act as a reasonable & prudent A false oral statement that
professional with the same unjustly damage a persons
education & experience would act name
in similar situation Libel (written)
A false written or
TYPES OF MALPRACTICE representational statement
1. Failure to make referral to that unjustly damages a
provide the patient with persons name
appropriate teaching before Invasion of Privacy
discharge A violation of the persons
2. Learning a foreign object inside right against unreasonable,
patients abdomen after surgery unwarranted interference
3. Negligence on supervision of with his personal life
subordinate Ex.: Releasing info. About
patient to a 3rd party
(6) ELEMENTS OF HOW TO PROVE allowing unauthorized
MALPRACTICE person
1. Duty
Relationship with a client
2. Breach of duty LEGAL PRECAUTIONS FOR NURSES
Failure to act as a reasonable - Function within the scope of your
prudent education, job description of area/ scope
3. Forseeability of nursing practice
Link must exist between the - Follow the procedures & policies of
nurses act & injury suffered employing agency
4. Causation - Observe & monitor client accurately
Must prove that harm - Communicate & record significant changes
occurred that resulted a nurses in the clients condition to AP
failure - Check any order that client
5. Injury/ harm asked/questioned
Client must demonstrate - Modify the client before initiating any
some type of injury interventions
6. Damages - Protect the client from falls & preventable
The nurse is held liable for
injuries
damages to be compensated
PROHIBITIONS IN THE PRACTICE OF
COMMON MALPRACTICE ACT
NURSING
1. Medication error
Practicing nursing must have certificate of
2. Burning of client
3. FALLS from the bed/ crib registration (COR)
4. Ignoring a client complaint Who uses his own license/ COR of another
5. Mistaken identity Who uses expired/ revoke COR
Who gives false evidence to the board of
II. INTENTIONAL nursing in order to obtain COR
o The person executed the act with Who poses as RN that conveyed that he/she is
purpose or intent RN
o Classified as: Who appends BSN/TN to his name without
Assault being confirmed with a degree
Battery Uses names in advertisement
False imprisonment
(5) LEGAL PROTECTION
ASSAULT 1. Good Samaritan act
An attempt or threat to harm A nurse who renders first aid or treatment
person unjustifiability at the scene of an emergency and who
does so within the standard of care, acting
BATTERY in good faith, is relieved of the
Willful touching of a person or consequences
something the person is carrying 2. Carrying out physicians order
that may or may not cause harm 3. Provide competent care
4. Record Keeping
FALSE IMPRISONMENT 5. Incidental report
Illegal detention of a person
without his consent Components of incidental report
1. Name
III. QUASI-INTENTION TORT 2. date, time
3. describe the facts of incidence

EGBJune09 11
 4. Clients account for incident Ex. Nurse recommends
5. Witnesses of incident patient to another clinic for
6. Identify equipment, name of doses abortion but does not want
7. signature
to perform
6. No one is obliged to betray himself/herself
NURSES BILL OF RIGHTS No one can force any person
1. Registered nurses promote and restore health to answer a question if such
2. Prevent illness will incriminate him/her
3. Protect the people entrusted to their care 7. The end does not justify the means
4. Alleviate suffering Giving sleeping tablets to
5. Provide services that maintain respect for
someone who has chronic
human dignity
illness
8. Defects of nature may be corrected
PATIENTS BILL OF RIGHTS
Corrected by plastic surgery
1. Considerate and respectful care 9. If one is willing to cooperate in the act, no
2. Relevant, current and understandable
injustice is done to him/her
information With patients consent
3. Make decisions regarding his care plan 10. A little more or less does not change the
4. Have advance directive (living will)
substance of an act
5. Every consideration of his privacy
Stealing
6. Confidentiality of communications and
11. The greatest good for the greatest number
records Have more good effects for
7. Review his records concerning his medical
more people than a smaller
care
group
8. Be informed of business relationship among
12. No one is held to the impossible
the hospital educational institution Do not promise impossible
9. Consent or decline to participate
things
experimental research affecting his care
13. The morality of cooperation
10. Reasonable continuity of care when
Formal cooperation is an
appropriate and be informed of other care
evil act and never allowed
options 14. Principle relating to the origin and
11. Be informed of hospital polices and
destruction of life
practices Thou shall not kill
LVING WILLS OR ADVANCE DIRECTIVE
1. Accept or refuse any treatment, service or
procedure used to diagnose or treat physical CODE OF GOOD GOVERNANCE
or mental condition
2. Decision to provide or withhold life- Service to others
sustaining measures o Commitment to a life of sacrifice and
3. This living will is signed by the patient genuine selflessness in carrying out their
4. Witnessed by two other persons who is not professional duties
designated as the persons health care Integrity and Objectivity
representative o Perform their responsibilities with the
5. Directive has force of law highest sense of integrity
Professional Competence
MORAL PRINCIPLES o Knowledge, technical skills, attitudes and
1. The golden rule experience
Do unto others what you
Solidarity and teamwork
would like others do unto o Maintain and support one professional
you organization
2. The two fold effect Social and Civic Responsibility
May have bad and good o Shall always carry out their professional
effect
duties with due consideration of the broader
Must be morally good
Good effect must be willed interest of the public
Global Competitiveness
and the bad effect merely
o Shall remain open to challenges of a more
allowed
Good effect must not come dynamic and interconnected world
Equality of All professions
from an evil action
o Shall treat their colleagues with respect and
Good effect must be greater
strive to be fair in their dealings with one
than the bad effect
3. The Principle of Totality another
The whole is greater than
any of its parts
4. Epikia
AMENDED CODE OF ETHICS FOR NURSES
Exception to the general
rule
5. One who acts through an agent is himself
responsible

EGBJune09 12
 Section 3 Republic Act No. 877 known as the Philippine Existence of a duty on the
Nursing Law and Section 6 of P.D No. 223 the amended part of the person charged
Code of Ethics of Nurses to use due care under
Article I circumstances
o Preamble- health is a fundamental right of Failure to meet the standard
every individual of due care
Article II The foresee ability of harm
o Values, customs and spiritual beliefs held by resulting from failure to
individual shall be represented meet the standard
o Consider the individuality and totality of The fact that the breach of
patients when they administer care this standard resulted in an
Article III injury to the plaintiff
o Human life is inviolable Article 19 of the civil code
o Quality and excellence in the care of patients o One shall act with justice, give
are the goals of the nursing practice every man his due, observe honest
o Accurate documentation of actions and and good faith
outcomes of delivered care is the hallmark Article 20
of nursing accountability o Those who in the performance of
Article IV their obligations through
o The registered nurse is in solidarity with negligence causes any injury to
other members of the healthcare team in another, are liable for damages
working for the patients best interest Common acts of negligence
Article V o Burns resulting from hot water
o Preservation of life, respect for human rights bags, heat lamps, vaporizers, sitz
and promotion of healthy environment bath
o Promotion in local, national, and o Objects left inside the patients
international efforts to meet health and body; sponges suction tips, loose
social needs of the people dentures lodged in the patients
Article VI trachea
o Maintenance of loyalty to the nursing o Falls of the elderly; confused,
profession and preservation of its integrity unconscious, sedated patients
are ideal o Falls of children whose bed rails
Article VII were not pulled up and locked
o The certification of registration of the o Failure to observe and take
registered nurse shall either be revoked or appropriate action
suspended for violation of any provisions of o Failure to report observations to
this code. attending physicians
o Failure to exercise the degree of
DEFINITION AND MEANING OF LAW
diligence which the circumstances
The sum total of rules and regulations by which of the particular case demands
o Mistaken identity- drug given to the
society is governed
Man mad regulates social conduct in a formal and wrong patient
o Wrong medicine, wrong
binding way
Rule of conduct pronounced by controlling authority concentration, wrong route, wrong
and which may be enforced dose
o Authority or right to declare that the rule o Defects in the equipment
o Errors due to family assistance
exists
o Administration of medicine without
o Rule is pronounced or expressed
o Source can be defined a doctors prescription
o A right to enforce the same must be
Acts of negligence:
provided
Controlling authority in our system is the government (1) THE DOCTRINE OF RES IPSA LOQUITUR
Fundaments law of the government is the constitution
Principal sources of pronouncements Injury was of such nature that it would not
o Constitution
normally occur unless there was negligent
o Statutes or legislations
act
o Executive branch
Injury was caused by an agency within
o Case decision/judicial opinions
o Presidential decrees control of the defendant
o Letters of instructions Plaintiff himself did not engage in any
manner that would tend to bring about the
RESONSIBILITY AND ACCOUNTABILITY FOR THE injury
PRACTICE OF PROFESSIONAL NURSING
MALPRACTICE
Professional Negligence
o Commission or omission of an act, The idea of improper or unskilful care of a
pursuant to a duty patient by a nurse

EGBJune09 13
 Stepping beyond ones authority with o Right to privacy is the right to be left alone
serious consequences o Right to be free from unwarranted publicity
Carelessness of professional personnel o Exposure to public view
LESNIK- negligent act committed in the o Divulge information from patients chart to
course of professional performance improper sources or unauthorized person
Defamation
(2) DOCTRINE OF FORCE MAJEURE o Character assassination
o Slander-oral defamation
Irresistible force; unforeseen or inevitable o Libel-written words
No person shall be responsible for those events which o There must be a third person who hears or
cannot be foreseen read the comment before it can be
Floods fire, earthquakes considered defamation

(3) DOCTRINE OF RESPONDEAT SUPERIOR

CRIMES, MISDEMEANORS, AND
Let the master answer for the acts of the subordinate FELONIES
The liability is expanded to include the master as well
as the employee CRIME
An act committed or omitted in violation of
INCOMPETENCE the law
Two elements
Lack of ability, legal qualifications or fitness to o Criminal act
discharge the required duty o Evil/criminal intent
Conspiracy to commit a crime
CONSENT TO MEDICAL AND SURGICAL o Two or more persons agree to
PROCEDURES commit a felony
Principals- who take a
Consent direct plan/part
o Free and rational act that presupposes Accomplices- cooperate in
knowledge of teh thing to which consent is the execution
being given by a person who is legally Accessories- having
capable to give consent knowledge of the
o Signed by the patient or authorized commission of the crime
representative/legal guardian Criminal Actions
o An authorization by a patient or a person o Acts or offenses against public
authorized by law to give the consent on the welfare
patients behalf Criminal negligence
o Nurse secures the consent of the patient o Reckless imprudence- person does
upon admission an act or fails to do it voluntarily
Informed Consent but without malice
o Established principle law that every human o Simple imprudence- did not use
being of adult years and sound mind has the precaution and the damage was not
right to determine what shall be done with immediate or the impending danger
his own body was not evident or manifest
o May choose whether to be treated or not Criminal Intent
Proof of Consent o States of mind of a person at the
o A written consent should be signed to show time the criminal act is committed
that the procedure is the one consented to that he/she knows that an act is not
and that the person understands the nature of lawful and still decide to do it
the procedure anyway

TORTS WILLS

Definition: A legal wrong, committed against A legal declaration of a persons intentions upon
a person or property death
Assault and Battery Testamentary document takes effect after the death of
o Imminent threat of harmful or offensive its maker
bodily contact Decedent- person whose property is transmitted
o Unjustifiable to tough another person or to through the succession whether or not he left a will
threaten to do so If he left a will he is called a testator
Battery Woman is testatrix
o An intentional, unconsented touching of Heir- called to succession either by the provision of a
another person will or by operation of law
False Imprisonment of Illegal Detention A person who dies leaving a will is said t have died
o Unjustifiable detention of a person without a testate
legal warrant within boundaries One who dies without will is said to have died
Invasion of Right to Privacy and breach of intestate
confidentiality Validation of the will in a court is known as probate

EGBJune09 14
 A will which is written, dated and signed by the
testator is called holographic will
An oral will is called nuncupative will or
nuncupation- made during the persons last illness,
that it be done in the place in which he died, one or
more witnesses to the will
Testator must have the expressed intention of making
a will
Must be right of age
Under 18 cannot make a will
Required to have sound mind
Think clearly ability at the time of its execution

NURSES OBLIGATIONS IN THE EXECUTION OF A

WILL

The nurse should note the soundness of the patients

mind
There was freedom from fraud or undue influence
Make a notation on the patients chart of the apparent
mental and physical condition of the patient at the
time of making the will

EGBJune09 15