Week 9 - Ethical and Legal Issues in Nursing
Case studies and questions related to case studies.
• Social media and social networking are not the same thing
Ethics and the Law
• Who is responsible for obtaining consent?
○ The person doing the procedure
An ethical analysis may include?
• Is it right to give a new liver to someonewho is an alcoholic?
Legal Responsibilities of Nurses
• Major and even routine nursing procedures require consent from the nurse (e.g. foley and
○ Ask for consent
• Chart activities
• Nurses have the responsibility to inform/doctorhealth care team know if the patient does
not have enough knowledge
Chapter 18: Ethical and Legal Issues in Nursing
Identifying and ArticulatingEthical Issues
• Identification of an ethical issue is not always a straightforward activity.
• Different parties can view issues in different ways
• What makes ethical issues are things that concern deeply held values and beliefs about how
we treat other people.
• Informed Consent: Example of an Ethical Issue
○ The Right to be Informed: It is now widely recognized that a capable person has the
right to be informed about a proposed treatmentand to decide whether to consent to
that treatment. For consent to be valid, it must have the following attributes:
Must be provided by a competentperson
Must be informed (appropriate and sufficient informationmust be given in a
way that the patient understands, and the informermust be satisfied that the
Must be voluntary (without coercion or pressure)
○ How much informationmust a physician provide?
Current standards are patient centered.
Information provided is sufficient if it meets the standard that a reasonable,
average patient in that patient's situation would expect.
It is not only the patient or guardian (rather than the physician) who should
decide whether medical treatmentwill be performed (and where and by whom
it will be performed) but it is also a doctor's duty to inform the patient or
guardian of all material risks.
□ What is material is determined by the question, "what would a reasonable
patient or guardian want to know?"
□ Material risks are also those risks that pose a real threat to the patient's
life, health or comfort.
Merely signing a consent form in which it is acknowledgedthat the nature of the
operation has been explained to the patient does not necessarily prove that the
duty to inform has been observed.
□ Giving ALL relevant details is important
Those who recognize problems with consent in specific cases have a moral
obligation, if not a legal obligation, to ensure that fully informed consent is
○ Ethics Informs Law
Nurses are often the first people on the healthcare team to perceive a problem
in the informed consent process. in the informed consent process.
□ Nurse often have access to information about healthcare professionals,
programs, and institutional problems that most patients do not.
□ Nurses are typically more familiar with patient and family values and know
when these patients need to know more to make an informed decision.
The law is ethics codified.
□ Shaped by what a societybelieves is ethical.
□ What the law requires us to do is the minimum, while ethics obliges us
over and above what is required by law.
□ "The Code of Ethics of Registered Nurses" (from the CNA) is not a legal
document, but spells out what behaviours, values and ethical actions are
expected of RNs.
Nurses need to be aware of the requirementsfor informed consent and the
kinds of disclosure that are seen as relevant by courts.
○ Legal Responsibilities of Nurses
Important difference between
□ Getting patient consent for what nurses do
According to the CNPS: "A nurse carrying out an invasive nursing
procedure should provide an explanation and document that the
explanation was given and consent obtained."
□ "Any touching of a patient requires verbal and in some cases,
□ The person carrying out the procedure should provide
relevant information to the patient.
□ Participating in the consent process for what other healthcare
Nurses NOT responsible for providing information. Physician, as the
caregiver performing treatment, provides this.
Nurses DO have an ethical responsibility to let the doctors know
when it seemsthe patient needs more informationto make an
If physician does not comply,nurses must be advocates.
For both types of situations, important to remember informed consent is a
PROCESS not an event.
□ Getting a patient's signature on a form is not the consent, but simply
evidence that the patient agrees that he or she has been informed about
the procedure and its consequences.
Ethical or Legal Issue? Alike but Different
• Ethical and legal issues are closely linked
○ A legal action and an ethical action one might consider taking may be the same action,
but not necessarily.
• The Need to Understand Legal Requirements
○ There are four reasons why nurses should be familiar with the law and have a basic
understanding of Canada's legal system.
i. The CAN "Code of Ethics" and each provincial regulatory body impose certain
requirements with respect to nurses' levels of professional knowledge and skill.
If nurses do not meet this requirement,they are subject to disciplinary action.
ii. Nurses have access to drugs that are regulated by both legislation and hospital
procedures governing their use, dispensation, and handling. They need to know
the relevant laws and policies that apply to those drugs.
iii. Nurses need to be fa