Legal and Ethical Issues in Nursing
Content
1LEGAL AND ETHICAL ISSUES IN NURSING
LEGAL STANDARDS
Some things are right or wrong by laws
NURSING ETHICS
A standard for professional behavior
A guide to identify our conduct in relation to
NURSING ETHICS
A standard for professional behavior
A guide to identify our conduct in relation to
PATIENTS
FELLOW NURSES
HEALTH CARE TEAM
OUR COMMUNITY
OUR PROFESSION
STANDARDS
current license
know scope of practice
commit to fulfill legal responsibility
accountability
meet ethical / moral obligations of practice of nursing
PRACTICE
acceptance of assignments
know limitations and function accordingly
work for good of the patient
(patient advocacy)
work within the framework of the nursing
process
CONTINUING EDUCATION
to maintain highest professional competence
toward career goals
legal requirements
opportunities
Public Law:
Constitutional Law—defines/limits powers of governments
Statutory Law—enacted by legislative bodies,state boards and professional
practice acts
Administrative Law—appointed to agencies entrusted to enforce
statutory laws
NURSING LIABILITY:
Physician’s orders—nursing responsibility
Floating Assignments—limitations/scope of practice
Inadequate Staffing---notify administration/do not leave unit
Critical Care—assessment skills
Pediatric Care---child abuse, safe dose ranges, legal custody
Classifications
Criminal Law—-felonies / misdemeanors
Civil Law—-relationships
written—-contracts
acts—-”Tort” laws
Tort—a wrongful act or failure to act that causes
injury to person or property
Intentional torts:
Assault and Battery
Defamation---libel/slander
False Imprisonment—restraints
Leaving against Medical Advice (AMA)
Invasion of Privacy---confidentiality
Unintentional torts: Negligence and Malpractice
Negligence is a tort—-a failure to provide degree of care
an ordinarily prudent person would to prevent injury
Most malpractice is some form of negligence.
Types of negligence
Contributory negligence
Comparative negligence
Ethos - comes from Greek work w/c means character/culture
- Branch of Philosophy w/c determines right and wrong
Moral - personal/private interpretation from what is good and bad.
Ethical Principles:
Autonomy – the right/freedom to decide (the patient has the right to
refuse despite the explanation of the nurse)Example: surgery, or any procedure
Nonmaleficence – the duty not to harm/cause harm or inflict harm to
others (harm maybe physical, financial or social)
Beneficence- for the goodness and welfare of the clients
Justice – equality/fairness in terms of resources/personnel
Veracity – the act of truthfulness
Fidelity – faithfulness/loyalty to clients
Moral Principles:
Golden Rule
The principle of Totality – The whole is greater than its parts
Epikia – There is always an exemption to the rule
One who acts through as agent is herself responsible – (instrument to
the crime)
No one is obliged to betray herself – You cannot betray yourself
The end does not justify the means
Defects of nature maybe corrected
If one is willing to cooperate in the act, no justice is done to him
A little more or a little less does not change the substance of an act.
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.
Plaintif – 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
1. Writ – legal notes from the court
A. Subpoena
Subpoena Testificandum – a writ/notice to an individual/ordering him to
appear in court at a specific time and date as witness.
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 :
Contract law – involves the enforcement of agreements among private
individuals or the payment of compensation for failure to fulfill the
agreements
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
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:
Promise or agreement between 2 or more persons for the performance
of an action or restraint from certain actions.
Mutual understanding of the terms and meaning of the contract by all.
A lawful purpose – activity must be legal
Compensation in the form of something of value-monetary
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 person’s
property.
- person/person’s 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. Unintetional
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:
Res ipsa loquitor – the thing speaks for itself – the injury is enough
proof of negligence
Respondeat Superior – let the master answer command responsibility
Force majuere – unforeseen event, irresistible force
b. malpractice – stepping beyond one’s 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 nurse’s act and the injury
suffered
4. causation – it must be proved that the harm occurred as a direct result of the
nurse’s 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
II. Intentional Tort
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
Assault – an attempt or threat to touch another person unjustifiably
Ex.: A person who threatens someone with a club or closed fist.
Nurse threatens a client with an injection after refusing to take the meds orally.
Battery – willful touching of a person, person’s 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:
a nurse threatens the patient with injection if the patient refuses his
medsorally. If the nurse gave the injection without client’s consent, the
nurse would be committing battery even if the client benefits from the
nurse’s action.
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:
Telling a client no to leave the hospital until bill is paid
Use of physical or chemical restraints
False Imprisonment Forceful Restraint=Battery
Invasion Of Privacy – intrusion into the client’s private domain
-right to be left alone
Types of Invasion the client must be protected from:
a. use of client’s name for profit without consent – using one’s name, photograph
for advertisements of HC agency or provider without client’s permission
b. Unreasonable intrusion – observation or taking of photograph of the client for
whatever purpose without client’s 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.
Defamation – communication that is false or made with a careless
disregard for the truth and results in injury to the reputation of a
person
Types:
Libel – defamation by means of print, writing or picture
Example: writing in the chart/nurse’s notes that doctor A is incompetent because
he didn’t 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: Nurse A telling a client that nurse B is incompetent
- person defamed may bring the lawsuit
- the material (nurse’s notes) must be communicated to a 3rd party in order that
the person’s reputation maybe harmed
Public Law:
Criminal Law – deals with actions or offenses against the safety and
welfare of the public.
homicide – self-defense
arson- burning or property
theft – stealing
sexual harassment
active euthanasia
illegal possession of controlled drugs
Homicide – killing of any person without criminal intent may be done as selfdefense
Arson – willful burning of property
Theft – act of stealing
LEGAL STANDARDS
Some things are right or wrong by laws
NURSING ETHICS
A standard for professional behavior
A guide to identify our conduct in relation to
NURSING ETHICS
A standard for professional behavior
A guide to identify our conduct in relation to
PATIENTS
FELLOW NURSES
HEALTH CARE TEAM
OUR COMMUNITY
OUR PROFESSION
STANDARDS
current license
know scope of practice
commit to fulfill legal responsibility
accountability
meet ethical / moral obligations of practice of nursing
PRACTICE
acceptance of assignments
know limitations and function accordingly
work for good of the patient
(patient advocacy)
work within the framework of the nursing
process
CONTINUING EDUCATION
to maintain highest professional competence
toward career goals
legal requirements
opportunities
Public Law:
Constitutional Law—defines/limits powers of governments
Statutory Law—enacted by legislative bodies,state boards and professional
practice acts
Administrative Law—appointed to agencies entrusted to enforce
statutory laws
NURSING LIABILITY:
Physician’s orders—nursing responsibility
Floating Assignments—limitations/scope of practice
Inadequate Staffing---notify administration/do not leave unit
Critical Care—assessment skills
Pediatric Care---child abuse, safe dose ranges, legal custody
Classifications
Criminal Law—-felonies / misdemeanors
Civil Law—-relationships
written—-contracts
acts—-”Tort” laws
Tort—a wrongful act or failure to act that causes
injury to person or property
Intentional torts:
Assault and Battery
Defamation---libel/slander
False Imprisonment—restraints
Leaving against Medical Advice (AMA)
Invasion of Privacy---confidentiality
Unintentional torts: Negligence and Malpractice
Negligence is a tort—-a failure to provide degree of care
an ordinarily prudent person would to prevent injury
Most malpractice is some form of negligence.
Types of negligence
Contributory negligence
Comparative negligence
Ethos - comes from Greek work w/c means character/culture
- Branch of Philosophy w/c determines right and wrong
Moral - personal/private interpretation from what is good and bad.
Ethical Principles:
Autonomy – the right/freedom to decide (the patient has the right to
refuse despite the explanation of the nurse)Example: surgery, or any procedure
Nonmaleficence – the duty not to harm/cause harm or inflict harm to
others (harm maybe physical, financial or social)
Beneficence- for the goodness and welfare of the clients
Justice – equality/fairness in terms of resources/personnel
Veracity – the act of truthfulness
Fidelity – faithfulness/loyalty to clients
Moral Principles:
Golden Rule
The principle of Totality – The whole is greater than its parts
Epikia – There is always an exemption to the rule
One who acts through as agent is herself responsible – (instrument to
the crime)
No one is obliged to betray herself – You cannot betray yourself
The end does not justify the means
Defects of nature maybe corrected
If one is willing to cooperate in the act, no justice is done to him
A little more or a little less does not change the substance of an act.
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.
Plaintif – 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
1. Writ – legal notes from the court
A. Subpoena
Subpoena Testificandum – a writ/notice to an individual/ordering him to
appear in court at a specific time and date as witness.
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 :
Contract law – involves the enforcement of agreements among private
individuals or the payment of compensation for failure to fulfill the
agreements
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
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:
Promise or agreement between 2 or more persons for the performance
of an action or restraint from certain actions.
Mutual understanding of the terms and meaning of the contract by all.
A lawful purpose – activity must be legal
Compensation in the form of something of value-monetary
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 person’s
property.
- person/person’s 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. Unintetional
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:
Res ipsa loquitor – the thing speaks for itself – the injury is enough
proof of negligence
Respondeat Superior – let the master answer command responsibility
Force majuere – unforeseen event, irresistible force
b. malpractice – stepping beyond one’s 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 nurse’s act and the injury
suffered
4. causation – it must be proved that the harm occurred as a direct result of the
nurse’s 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
II. Intentional Tort
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
Assault – an attempt or threat to touch another person unjustifiably
Ex.: A person who threatens someone with a club or closed fist.
Nurse threatens a client with an injection after refusing to take the meds orally.
Battery – willful touching of a person, person’s 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:
a nurse threatens the patient with injection if the patient refuses his
medsorally. If the nurse gave the injection without client’s consent, the
nurse would be committing battery even if the client benefits from the
nurse’s action.
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:
Telling a client no to leave the hospital until bill is paid
Use of physical or chemical restraints
False Imprisonment Forceful Restraint=Battery
Invasion Of Privacy – intrusion into the client’s private domain
-right to be left alone
Types of Invasion the client must be protected from:
a. use of client’s name for profit without consent – using one’s name, photograph
for advertisements of HC agency or provider without client’s permission
b. Unreasonable intrusion – observation or taking of photograph of the client for
whatever purpose without client’s 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.
Defamation – communication that is false or made with a careless
disregard for the truth and results in injury to the reputation of a
person
Types:
Libel – defamation by means of print, writing or picture
Example: writing in the chart/nurse’s notes that doctor A is incompetent because
he didn’t 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: Nurse A telling a client that nurse B is incompetent
- person defamed may bring the lawsuit
- the material (nurse’s notes) must be communicated to a 3rd party in order that
the person’s reputation maybe harmed
Public Law:
Criminal Law – deals with actions or offenses against the safety and
welfare of the public.
homicide – self-defense
arson- burning or property
theft – stealing
sexual harassment
active euthanasia
illegal possession of controlled drugs
Homicide – killing of any person without criminal intent may be done as selfdefense
Arson – willful burning of property
Theft – act of stealing
