ETHICAL & LEGAL

RESPONSIBILITIES
IN NURSING

Prepared By:
Shaier Khan
Sr. Nursing Instructor
SWCON
 Definitions
• Values
– Ideals, beliefs, customs, modes of conduct, qualities or
goals that are highly prized or preferred by individuals,
groups, or society
– Usually not written down
• Values Clarification
– Refers to the process of becoming more conscious of
& naming what one values or considers worthy.
• Values Conflict
– Internal or interpersonal conflict that occurs in
circumstances in which personal values are at odds
with those of patients, colleagues or the institution.
 Definitions Continues
• Morals
– Standards of right & wrong
– Learned & internalized at early age
– Society & culture play important role
– Moral orientation generally is based on religious beliefs
• Moral Values
– Preferences reflective of right and wrong, should or
should not, in human behavior.
• Moral Integrity
– A focal virtue that relates to soundness, reliability,
wholeness, an integration of character & reliability
in adherence to moral norms sustained over time
 Definitions Continues
• Moral Thought
– Individual’s cognitive examination of right & wrong,
good & bad.

• Moral Distress
The reaction to a situation in which there are moral
problems that seem to have clear solutions, yet one
is unable to follow one’s moral beliefs because of
external restraints; this may be evidenced in anger,
frustration, dissatisfaction & poor performance in
the work setting.
 Scenario-1
Mr. Anderson, a 92 year old man living in a nursing home and
suffering with Alzheimer’s disease for over 10 years, reaches the
stage where he is no longer able to swallow food effectively. He has
been hospitalized with aspiration pneumonia four times in the last
year. The man’s eldest child, who lives in the same town, has a
durable power of attorney, and visits regularly, insists that a feeding
tube be inserted. He has the support of his two siblings. The staff
feels that a feeding tube would be distressing to the patient. Besides,
they say “He swats away our hands when we try to hold him down
to insert the tube, and he always pulls the tube out.”
 Scenario-2
Mr. Ahmad is an 82 year old nursing home resident who has multiple co-
morbidities including significant dementia. He is combative and often kicks or
punches those who attempt to care for him. In fact, three members of the staff
(two nurses and a nursing assistant) have been treated in the emergency room for
injuries that occurred during the course of caring for him. The man’s wife refuses
medications to sedate him, saying that she is concerned about the side effects.
Communicating the consistency and severity of the problem to the doctors, some
of whom are there as consultants and all of whom only see Mr. Ahmad for brief
intervals, is challenging. While the nursing staff are not willing to abandon Mr.
Ahmad, they are afraid for their safety and are morally distressed because they
feel forced to tolerate physical violence without any power to change the
situation. They know that caring for Mr. Ahmad safely requires giving him
medication, but they are constrained by the fact that the doctors, who must write
the prescription, do not understand the extent of the problem and Mrs. Ahmad,
the patient’s power of attorney, opposes any form of sedation. They feel trapped.
 Definitions Continues
• Ethics
– Declarations of what is right or wrong & what ought
to be.
– A formal process for making logical and consistent
decisions based upon moral beliefs

• Ethical Principles
– Basic & obvious moral truths that guide deliberation
& action.
– Standards of conduct defining the kind of behavior
an ethical person should and should not engage in.
 Advance Directive
Written instruction recognized under state law relating
to the provision of healthcare when an individual is
incapacitated.
Advance Directives may take two forms:
 Health Care Proxy – a written directive designating
a person to make health care decisions on behalf of an
individual when he/she becomes unable to make such
decisions.
 Living Will – a written advance directive in which
an individual specifies choices for medical treatment.
 CODE OF ETHICS
– Written list of a profession’s values & standards of
conduct.
– Framework for decision making
– Offer guidance
– Periodically revised
– Not legally enforceable as laws but consistent violations
indicate an unwillingness by the person to act in a
professional manner and license can be suspended
or revoked.
 Code of Ethics as applied to
Nursing
The ANA approved these nine provisions of the new
Code of Ethics for Nurses on June 30, 2001.
1. The nurse, in all professional relationships, practices
with compassion and respect for the inherent dignity,
worth & uniqueness of every individual, unrestricted
by considerations of social or economic status,
personal attributes or the nature of health problems.

2. The nurse's primary commitment is to the patient, as an

individual, family, group or community.
 Code of Ethics Cont…

3. The nurse promotes, advocates for & strives to protect

the health, safety and rights of the patient.
4. The nurse is responsible and accountable for individual
nursing practice & determines the appropriate
delegation of tasks consistent with the nurse's
obligation to provide optimum patient care.
5. The nurse owes the same duties to self as to others,
including the responsibility to preserve integrity and
safety, to maintain competence & to continue
personal and professional growth.
 Code of Ethics Cont…
6. The nurse participates in establishing, maintaining and
improving healthcare environments and conditions
of employment conducive to the provision of quality
health care & consistent with the values of the
profession through individual & collective
action.

7. The nurse participates in the advancement of the

profession through contributions to practice,
education, administration and knowledge
development.
 Code of Ethics Cont…
8. The nurse collaborates with other health professionals
and the public in promoting community, national and
international efforts to meet health needs.

9. The profession of nursing, as represented by

associations and their members, is responsible
for articulating nursing values, for maintaining
the integrity of the profession and its practice,
and for shaping social policy.
 KEY

ETHICAL

CONCEPTS
 AUTONOMY
– Self-governing; having the freedom to make independent
choices
– Self-determination
– Related to health care, it deals with professionals'
willingness to respect client’s rights to make a free choice
given that they have been provided with all necessary
information & knowledge.
– Not an absolute right except in some cases
 JUSTICE
– An ethical principle that relates to fair, equitable and
appropriate treatment in light of what is due or owed
to persons, recognizing that giving to some will deny
receipt to others who might otherwise have received
these things.
– Obligation to be fair to all people
– 1st statement in ANA Code of Ethics for Nurses
 FIDELITY
 The individual’s obligation to be faithful to commitments
made to self and others.
 In health care, it includes the professional’s faithfulness
or loyalty to agreements & responsibilities accepted as
part of the practice of the profession.

BENEFICENCE
 Views the primary goal of health care as “doing good”
for clients.
• Includes more than just technical competency
• Client is approached in holistic manner
 NON-MALEFICENCE
 Requirement that health care providers “do no harm”
to their client’s – intentionally or unintentionally
 Opposite side of the coin from beneficence
 In current health care practice, the principle of non-
maleficence is often violated in the short run in
order to produce a greater good in the long term
treatment of the client.
 May patients undergo painful & debilitating surgery
to remove a cancerous growth in order to prolong
life in the future.
 VERACITY
TRUTHFULNESS
 Requires the health care provider to tell the truth & not
intentionally deceive or mislead clients.
 Limitations = in situations where telling clients the truth
would seriously harm (principle of non-maleficence)
their ability to recover or would produce greater illness.
 FEELING UNCOMFORTABLE is NOT a good enough
reason to avoid telling clients the truth about their disease,
treatment or prognosis.
 The client has a RIGHT to know this information.
 STANDARD OF BEST INTEREST
 A decision made about individual client’s health
care when they are unable to make an informed
decision for their own care.
 Very important to consider the individual’s expressed
wishes, either formally or what they may have said.
 Based upon what the health care professional or
family decide is best for that individual.
 STANDARD OF BEST INTEREST

 Formal wish= written, living will, patient’s

advocate
 Should be based on the principle of beneficence
 PATERNALISM
Unilateral decision by health care personals which
implies that they know what is best, disregarding
the clients wishes.
 OBLIGATIONS
 Demands made upon individuals, professions, society
or government to fulfill & honor the rights of others
 LEGAL OBLIGATIONS
 They have become formal statements of law & are
enforceable under the law; e.g.
 Nurses have a legal obligation to provide safe and
adequate care for clients assigned to them.

 MORAL OBLIGATIONS
There is no legal obligation for a nurse on a vacation
trip to stop & help a Motor Vehicle Accident victim.
 MAKING
ETHICAL
DECISIONS
Ethical Decision Making Process
 It provides a method for nurses to answer KEY
QUESTIONS about ethical dilemmas & to organize
their thinking in a more logical & sequential manner
Chief Goal
 Determining right from wrong in situations where
clear demarcations do not exist or are not apparent
 Collect, analyze & interpret the data
 State the dilemma
 Consider the choices of action
 Analyze the advantages & disadvantages
 Make the decision
 WAYS TO INCORPORATE
ETHICS INTO PRACTICE
 Encourage patients’ expressions of desires.
 Identify significant others who impact and
are impacted.
 Know thyself
 Read
 Discuss
 Form an ethics committee
 Share
 Evaluate decisions
 References
American Nurses Association. (2001). Code of ethics for nurses
with interpretive statements. Washington, DC.
Cortis, J.D. & Kendrick, K. (2003). Nursing ethics, caring and
culture. Nursing Ethics, 10, 77-88.
Eliopoulos, C. (2005). Gerontological Nursing, (6th ed).
Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-
4428-8).
Epstein, E.G., Delgado, S., (Sept 30, 2010) "Understanding and
Addressing Moral Distress" OJIN: The Online Journal of Issues
in Nursing Vol. 15, No. 3, Manuscript 1.
Michael Josephson (2010): Josephson Institute. 12 Ethical Principles
for Business Executives. Database on internet, retrieved from;
http://josephsoninstitute.org/business/blog/ 2010/12/12-ethical-
principles-for-business-executives/.