NUM1205 Legal and Ethical Requirements in Nursing and Midwifery Practice exm PDF

Preview

Summary

weekly notes...

Description

NUM1205 Legal and Ethical Requirements in Nursing and Midwifery Practice

Module 1 Distinguish Ethics from Law • Briefly compare and contrast different ethical theories • Discuss the importance and role of hospital ethics committees • Briefly discuss the importance of professional codes …………………….. Ethics versus Law Ethics • Examines the values and actions of people (what people ought to do). (Kerridge, Lowe & Stewart, 2013) LAW • Binding rules of conduct. • Rules and regulations that guide society. • Provides guidance for health professionals. • Patient retains the right to refuse treatment. • Overriding state interests can mandate against a patient’s wishes. • When laws are broken, offence is punishable by authority figure. ………… Ethics and Law Distinctions between Law & Ethics LAW • External – rules and regulations of society. • Conduct and actions: what a person did or failed to do. • Society as a whole, as opposed to the individual in society. • Courts, statutes, professional bodies (NMBA/AMA). ETHICS • Internal to oneself: values, beliefs and individual interpretations. • Motives, attitudes and culture: why one acted as one did. • Good of the individual within society as opposed to all of society. • Ethics committees and professional organisations. Law Ethics ………………….. Ethics and Law • Ethics and law are different but may overlap. • Laws reflect the ethical values and morals within a society. • Ethics and the law share some common ground but they are quite distinct.

• An issue may have a legal and ethical component but sometimes may conflict – issues can be: – “morally right but legally wrong” or – “morally wrong but legally right”

Ethics and law Morally wrong but legally right – Slavery – Apartheid – South Africa – Nazi Germany – Termination of pregnancy? – Animal testing? – Women being paid less for doing the same job ………………………………………………. Ethics and law Legally wrong but morally right – Euthanasia? – Killing one person to save four people who will die if the other person is not killed? – Speeding to the hospital with a person who needs urgent medical assistance Ethics and law • The law is static and cannot be bent just because you don’t agree with it! • Ethics: labile – views can change just because circumstances change – even though there is no change in knowledge. ……………………………………………………………………………………………………………….. Ethics • “Branch of philosophy/theology concerned with the question what constitutes a good life” (Atkins et al. 2017, p.26.) • We need ethics: – To assist in decision making – To contribute to the debate on ethical issues • The ‘big issues’ – termination of pregnancy – euthanasia and end of life wishes • Everyday issues –

– telling a patient their diagnosis when the relatives have asked you not to – washing a patient who does not want to be washed ……………………………………………………………………………………………………………….. History of ethics

More of the dead philosophers... history Aristotle • Increase education = decrease in church power to explain = increase in scientific discovery • Proposed humans did not always depend on divine law for expression • People could make good decisions and act in good ways without recourse to God • By 13th century, with increasing influence fro Islamic scholars and writers, this idea began to gain key philosophy • An increase in education equated with decrease in the way the church explained the world which in turn lead to increased scientific discovery (Kerridge, et al. 2013.) More of the dead philosophers.. . St Thomas Aquinas - Merged church and Aristotelian thought; • Church always has last say, but people could make good and bad choices independently • Although church was final arbiter of God’s will, it didn’t mean people lacked conscience and they could act independently • Relativist / proportionist / deonto-teleologist (Kerridge et al. 2013)

//////////////////////////////////////////////////////////////// What is ethics? • “Ethics is a generic term for various ways of understanding and examining the moral life”. (Beauchamp & Childress 2013, page 1) • “ethics is the study of what we ought to do” (Staunton & Chiarella, 2017, p.21) • Philosophical study of moral judgments on moral problems. What is Ethics? • “an analytical and methodological inquiry into how moral judgements are and should be made” (Kerridge, Lowe, Stewart 2009, p.8) • Ethics is prescriptive (What we should do, not necessarily what we actually do) • Concerned with human well being and maintenance of a peaceful society • As a system of overriding rules and principles which function by specifying that certain behaviours are either required, prohibited or permitted. //////////////////////////////////// What ethics is not • Gut feelings • Ethical codes of practice • Hospital policy • Medical authority • Professional etiquette • Law • Public opinion • Religion (Kerridge et al. 2013 pp 4- 11.) These may affect ethical thought – or be based on ethics – but they are not ‘ethics’ (Staunton & Chiarella, 2017.) /////////////////////////// Ethical practice • Ethical practice is based on critical, reflective thinking about one’s duties and obligations as a health care professional in relation to clients or patients and as a member of a profession fulfilling a social contract. • Health care ethics is applied ethics. • Further reading Beauchamp & Childress, 2016, p.36 • Theoretical perspectives informing ethical practice

///////////////////// Definition of Ethics • The word Ethics is derived from the Greek word “Ethos” – meaning character, customs or habitual uses (Kerridge, et al. 2013) • Determining right conduct from wrong • Concerned with motives and attitudes • Ethics is associated with the principles of morality (what is good or desirable as opposed to that which is bad or undesirable) ///////////////////////// Morals • Morals are personal principles that are acquired from life experiences, family and peer relationships, religion, culture and the law. • Morals – what is considered right or wrong based on social custom. • In contrast ethics – what is right or wrong based on reason. • Ethics – system or philosophy of conduct and principles. • Morals provide the “principles or rules that should guide human conduct “ (Atkins et al. 2017, p.28) Values • Values – personal beliefs about the truths and worth of thoughts, objects or behaviour. • Values – “abstract standards that give a person a sense of what is right and wrong and establish a code of conduct for living” (Videbeck, 2004, p. 4). • May also include honesty, hard work, truthfulness and sincerity. • Values usually derived from societal norms, family orientation and religion. • Values may change over time. \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ Personal/Professional values Where do your values come from? • Individual differences - opinions - family values/socialisation - peer influence/pressure - religion life experience - etc. All of these influence our decision-making. “Values give you a sense of worth in the workplace” (Atkins, DeLacey, Britton, 2014) • Two people often have differing opinions and would reach a different decision in any given situation – producing a dilemma. \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ What is a dilemma?

• A predicament. A quandary. A Deadlock. A Stalemate. A Plight. A Difficulty. A fix. A jam. A spot. A pickle! • “He was faced with the dilemma of killing the injured animal or allowing it to die in agony”. • When a situation has two or more possible outcomes and neither (or none) are desirable. • The best outcome has to be chosen – best still being undesirable - but choose the outcome that produces the least disvalue or most benefit. \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ Who should make the decision? • The best person for the job. • Usually and wherever possible, the person about whom the decision is to be made! • If not possible – the person’s significant others together with the multidisciplinary team. • The decision MUST be in the best interests of the person for whom the decision is made regardless of your own personal beliefs and values. \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ Hospital Ethics Committees Ethics committees can: 1) Provide structure and guidelines for potential problems 2) Serve as an open forum for discussion 3) Function as a true patient advocate by placing the patient at the core of the committee discussions \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ Ethics Committee Guidelines • Recognise the difference between ethical and legal rights of individuals. • Health professionals understand and appreciate that their ethical views and values often differ greatly from those of the patient’s culture and value system. • When legal issues have not been addressed, health professionals are guided by the ethics of the profession and personal values. • Nurses may need to remove themselves from particular patient care – if values of patient/nurse interferes with quality nursing care. • Ethical dilemmas have no perfect answers, just better answers. Legal questions have right and wrong answers. \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ Professional Codes for Healthcare • Code of ethics for nurses (2018) ICN (2012) • Code of ethics for midwives (2018

• Code of professional conduct for nurses (2018) • Code of professional conduct for midwives (2018) • RN Standards for Practice (2016) • Midwifery Standards for Practice (effective 2018 October) • All found at: http://www.nursingmidwiferyboard.gov.au/Codes-GuidelinesStatements/Professionalstandards.aspx /////////////////////////////////////////////////////// Provisions of the codes ➢ First International Code of Ethics for Nurses established in 1953 – ➢ The codes address fundamental values and commitments that relate to ethical obligations, duties, standards and commitments to society. ➢ Codes promote ethical analysis and aid decision making in clinical situations. ➢ Understanding of ethical theories and principles, values, and decision making models are essential. \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ Bioethics ➢ Is concerned with the ethical issues arising from health care, biological and medical sciences. ➢ “From the Greek bios meaning life and ethikos, ithiki meaning ethics” (Johnstone, 2016, p.13-15) ➢ Triggered by - and a response to - the new scientific/technological developments in biomedical and life sciences. ➢ Examples to consider: Termination of pregnancy / contraception / organ donation and transplantation / withdrawal of life-sustaining treatment / in vitro fertilisation (IVF) / cloning and stem cell research / female genital mutilation and male circumcision / Genetic engineering / palliative care. \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ Ethical Theories ➢Two main theories: ➢Utilitarianism ➢Deontology \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ Utilitarianism ➢ A form of teleogy → consequentialism → utilitarianism. ➢ Producing utility → benefit and value → happiness.

➢ The “greatest happiness principle” is the prime principle of life. ➢ Actions are good or bad according to their consequences rather than by any intrinsic value they may have. (Johnstone, 2016, p.60) \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ Principles of Utilitarianism ➢The greatest good for the greatest number. ➢The end justifies the means. ➢What is right is what is most useful or valuable. If only undesirable results are possible – having the least disvalue. (Johnstone, 2016.) \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ Strengths of Utilitarianism • General happiness is a good principle. • All decisions on right and wrong are easy to make. • The promotion of happiness seems to be a good moral principle. • The individual does not have to make difficult or distasteful decisions as “happiness” is what is important and right. • A life-governing principle to “do good” keeps the individuals in society on an even plane. Weaknesses of Utilitarianism • Calculating good and harm is time consuming and one might get the calculations wrong! • How is happiness measured? Is it only physical, or may psychological happiness be considered; and what of social happiness and wealth. • The individual is robbed of personal choice in decision making, as one must always and only do what maximises good. • It may be expecting too much of all individuals to devote their lives to always doing and being good. • Can result in horrific acts! \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ Deontology ➢ “DEON” – Duty – “ology” – study of… ➢ So – study of duty. ➢ What is my specific duty in this specific situation? ➢ Where does duty come from? ➢ Relationships.

Principles of Deontology ➢Right is right and wrong is wrong. ➢Duty and obligations are of prime importance. ➢Promises must never be broken. ➢One must never – “thou shalt not…” Strengths of Deontology • Specific rules form an easy moral code to follow. • Conscious feelings are easy to attach to duty: “I must keep my promise” “I must not harm an innocent” • These are easier to base one’s life actions upon rather than a vague “good for all” code. • Specific rules absolve the individual: “It’s wrong, so I must not do it”. • Conflicts in society are less: “Thou shalt not kill”. Individuals can be true to themselves and not have to consider the consequences for everyone else Weaknesses of Deontology • “ Duty” is a great burden for an individual. • There may be a situation where two equal duties conflict. • The decision about the duty may be easy but the consequences of it may be impossible to bear. • It is not necessary to consider the needs of others when decisions are made but those “others” and what happens to them may be very important to the individual. • The individual has no freedom to act against the duty/rule, no matter how severe or far-reaching the consequences might be. \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ Utilisation of Theories ➢ As with all theoretical approaches, they provide the health care professional with a frame of reference. ➢ No single theoretical approach is appropriate in all contexts of healthcare. ➢ Should combine the best features of both theories. ➢ Professionals work within the confines of their code of conduct and take into account their own beliefs, cultural and social influences as well as those of their clients. Factors that influence ethical dilemmas ➢ The health professional’s perception of his or her level of influence within the health care setting. ➢ The level of clinical expertise and competence.

➢ The degree of ethical concern. ➢ The past experience with ethics education (Hamric, 2011). Ethical decision making ➢Ethical dilemmas involve situations where a choice must be made between alternatives that an individual perceives he or she can accept and reasonably justify on a moral plane or where there is not a more favourable or appropriate choice that dominates the situation.(Beauchamp & Childress, 2013) ➢ Study of ethical dilemmas in health care often called Bioethics (Staunton & Chiarella, 2017, p.17) A Model for Ethical Decision-Making ➢ Clearly state the problem ➢ Get the facts ➢ Consider the ethical principles ➢ Consider how the problem would look from another perspective or using another theory ➢ Identify ethical conflicts ➢ Consider the law ➢ Making the ethical decision Decision making process – six questions ➢ What is my duty in this particular circumstance? ➢ By carrying out my duty, will my actions produce the best available consequences for all concerned? ➢ Will my actions cause harm? (Nonmaleficence) ➢ Am I going to do or promote good? (Beneficence) ➢ Am I respecting the patient’s wishes? (Autonomy) ➢ Are my actions fair? (Justice) ➢ The last four statements refer to ethical principles and will be the next issues we consider in the unit. SUMMARY • Ethical dilemmas arise frequently in healthcare. • The best person to make a decision that will affect the life of an individual, is the individual. • Consider your duty as a nurse and promote beneficial consequences – or the action with the least disvalue. • Consider the ethical principles (next lecture) • Act within:

– the law – the confines of the Professional Code of Conduct for the Nurse/Midwife March 2018 – your scope of professional practice – professional boundaries and – your contract of employment.

\\\ \\ \ \ \ \

\ \ \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ Module 2 Ethical Principles and Doctrines On completion of the lecture, students will be able to: Define and explain the concepts relating to beneficence, non-maleficence, autonomy and justice and apply them to the practice situation; Define and explain the concepts relating to various ethical doctrines and apply them to the practice situation. Ethical principles • Beneficence • Non-maleficence • Autonomy • Justice • Veracity – telling the absolute truth. • Fidelity – loyalty, fairness, advocacy and dedication. • Respect for others- highest principle Beneficence Prima facie principle comes from the Latin word “benefices”. “Bene” means “well” or “good”.

“Facere” means “to do”. So, “beneficence” means “to do good”. (Johnstone, 2016, p.39.) Establishing an obligation to help others Central to utilitarianism- principle of utility- the greatest good Beneficence (act for good) One ought to prevent evil or harm. One ought to remove evil or harm. One ought to do or promote good. (Beauchamp & Childress, p.151) Beneficence- concepts Action to benefit others: Acts of beneficence: mercy, altruism, empathy, charity, kindness Balance probable outcomes of actions with risk and cost and possible harms Positive beneficence does support specific moral rules of obligation Rules of beneficence Promote and defend the rights of others Remove harm occurring to others Remove conditions that will cause harm to others Help people with disabilities Rescue a person in danger (Beauchamp and Childress 2013) Beneficence Specific beneficence: Directed to specific parties such as children, friends and patients General beneficence: Goes beyond these relationships. This obligation is more controversial and can be demanding or generate philosophical debate Obligatory beneficence The obligation of health professionals to act for the benefit of others when in a position to do so. Obligation of Beneficence • Y is at risk of significant loss of life or health, or damage to life and health, • X’s action is needed to prevent this loss or damage, • X’s action has a high probability of preventing it, • X’s action would not present significant risks, costs, or burdens to X • The benefit that Y can be expected to gain outweighs any harms, costs, burdens that x is likely to incur

Obligation of Beneficence • Mrs J is a terminally ill Jehovah’s witness. • Medical officer ordered a blood transfusion against the patient’s wishes. • Significant loss of self image if receives the transfusion • Nurse’s action refusing to give transfusion high probability of preventing the patient’s loss of image • Nurse’s action does not present significant loss to her • Benefits gained by Mrs J outweigh any harms to the nurse Non-maleficence Concept associated with the maxim: Primum non- nocere, which means Above all (or first) “DO NO HARM!” (Beauchamp & Childress, 2013) One ought not to inflict evil or harm Non-maleficence and healthcare Non-maleficence is the cornerstone of health care on which practices and legislation are based, providing us with rules and laws relating to duty of care, negligence and malpractice. In essence: A person who is treated by a health practitioner should not be worse off as a result of their treatment than when they initially presented. The principle of non-maleficence is reflected in the Hippocratic Oath: “I will use treatment to help the sick according to my ability and judgement, but I will never use it to injure or wrong them”. (Beauchamp & Childress, 2013, p.150) “Causing” harm The principle of non-maleficence: – Focuses on actions which either permit or cause or intend to permit or cause, harm or risk of harm. – Includes failure to act in situations that permit, cause or risk harm. (Which answers the question I asked above). – One should not inflict harm on a person including yourself Atkins et al. 2017, p.94 “Harm”- What is harm?...