NUM1205　Legal and Ethics PDF

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1.

Deontology : The view that actions are intrinsically right or wrong in themselves

2.

Two components of the principle of beneficence: To contribute to peoples welfare and balance benefits and risks for them.

3.

Difference between confidentiality and privacy and which law protects patient confidentiality? The ethical principle of confidentiality involves the process of not divulging information without the client's consent. The ethical principle of privacy involves the patient's right not to share information if they so choose. Tort law protects patient confidentiality

4.

Name and describe the four main principles of bioethics that are the basis upon which all nurses ethical decisions should be made.  Beneficence - above all else to do good.  Non Maleficence - obligation to do no harm and prevent harm.  Justice - is conduct that treats people equitably.  Autonomy - the right to self determination/ the capacity to make an informed un-coerced decision

5.

How do you support autonomy 

Shaping instrumental circumstances- providing information (pamphlets)

 Rational persuasion (tell them the reasons why they need to do things)  Assessing the cause of impaired decision making capacity (removing obstacle if possible eg. hearing aids)  Mentioning opportunities

6.

Ageing factors effecting autonomy

 Decreased physical function: mobility; agility; flexibility.  Decreased mental function: memory; reflexes.  Decreased sensory function: hearing and sight  Increased morbidities: Alzheimer's; arthritis; heart disease; stroke; cancer. 7.

Elijah is an 8 year old boy, admitted for an emergency appendicectomy. His parents Samuel and Hannah are with him and are extremely anxious. As the nurse looking after them, explain how you would promote: autonomy; beneficence; veracity; fidelity; and justice. Additionally what will happen if you omit these actions?: • Samuel and Hannah should be given information about the surgery and what to expect in the immediate postoperative period. • They should also be given plenty of opportunity to ask questions and their questions should be answered as fully as possible. • Nursing staff should also reassure the parents that they will be notified as soon as Jody is admitted to the postanaesthesia area or sooner if there are any complications with the procedure. • They should be allowed to stay with their son and accompany him to anaesthetic room and be informed as soon as possible that surgery is complete, how it went and when they can re-join their son. • As soon as it is feasible, Samuel and Hannah should be invited to sit with their son post-operatively and given further opportunity to ask questions. The above are all actions - if you omit these actions, Samuel and Hannah's anxiety will increase, they will feel helpless and this is an avoidable harm, so, by their very nature, you are using the principle of non-maleficence.

8.

Valid consent must include which four elements?: The procedure, the proceduralist, capacity and consent given voluntarily

9.

What is needed for consent to be legally binding

 Freely and voluntarily given  Person fully informed of procedure and alternatives  Must have legal capacity/be legally competent 10. What affect your capacity to give consent?  Developmentally delayed  Under the influence of drugs and alcohol  On pain meds or in pain  Brain injury  Emergency  Psychiatric patient 11. What is the purpose of keeping documentation and medical records?

 Maintains a record of Assessment, diagnosis, treatment, interventions, times  Demonstrate accountability in court, if it wasn't documented it didn't happen  Ensure continuity of care by providing communication between health care professionals 12. When can patient records be disclosed - when permission is given or implied by the person - when risk of serious and imminent harm to the person - when risk of serious and imminent harm to others - when required to by law

13. If surgery is performed on a patient without their consent, what torts or civil wrongs might have been committed? ( intentional torts): Assault, battery, false imprisonment and negligence 14. Assault: Intentionally creating in the mind of another fear for their physical wellbeing. Touching is not essential. It is the victim's perception, not yours. Good intentions are not a defense

15. Battery: Unlawful physical contact. Act must be intentional. Act must involve actual touching of the complaintants body. No consent, exists to keep people free of unwanted touching

16. False Imprisonment: Being confined against your will. Intentional and anlawful restraint of person against their will. Physical contact is NOT essential for false imprisonment. Can be physical or psychological. Duration is not an issue. Criminal equivalent is deprivation of liberty. Can include the use of drugs to subdue

17. Negligence: Failure to take proper care over something or someone to avoid acts and omissions which would be likely to harm any person they can reasonably foresee - causing foreseeable harm . It occurs when an individual acts in such a way as to cause another foreseeable harm. Based on the principle that a person must take reasonable care to avoid acts or omissions which would be likely to harm any person they ought reasonably foresee as being so harmed.

Example of negligence: - failure to follow standards of care (in relation to scope of practice) - failure to use equipment safely - failure to communication adequately (most frequent) - failure to document adequately - failure to assess and monitor adequately

18. Criminal negligence: Mistake causes death of patient. Possible that HCP prosecuted for

criminal negligence Must be gross negligence. HCP charged with manslaughter-- if not merely negligence, but gross negligence.

19. Defences to negligence: No duty of care required No suffering or damage sustained by plaintiff Plaintiff contributed or consented to risk Time limitations Voluntary assumption of risk Contributory negligence An intervening act

20. To whom do we owe a duty of care?: You must take reasonable care to avoid acts or omissions, which you can reasonably foresee would be likely to injure your neighbour.

21. JD was an 82 year old man who lived in a nursing home and had had several strokes. He was aphasic (Unable to speak) and, although he appeared to understand some of what was said to him, the extent of his understanding was never certain. He was paralysed down one side and spent much of his day in a large chair in front of the television at the nursing home. He had two children who visited him infrequently. During the winter time, JD often developed chest infections that usually responded to oral antibiotics. During one of these infections he appeared to be more unwell than usual and began spitting all his medications out, as well as spitting out all food and fluid. He became quite dehydrated, and was transferred to the local hospital. An IV infusion was commenced, but he kept pulling it out and seemed much more settled when it was removed. What are the legal considerations?: Is there impairment of decision making capacity? Self-determination is the legal equivalent of autonomy. Expect a discussion on mental competence and assessment of that. Is there advance health directives in place? If so, there should be a discussion on implementing those care strategies? Is there a "living will"? Is there an enduring power of attorney (EPA)? What role the EPA has in regard to JD's health decisions. Who is the NOK and/or Who is the surrogate or proxy for the NOK? 22. Requirements of civil negligence:  It can be an act or omission  A duty of care exists between the plaintiff and the defendant; This duty of care has been breached  Actual harm to the plaintiff has occurred as a result of the breach  The harm was foreseeable. 23. Negligence is the most frequent action brought to court against a health care professional.: True 24. Veracity is not: an obligatory principle of healthcare 25. Veracity is: Truth telling, 　Compelling the whole truth to be told, Incorporating the concept that all individuals should tell the truth. 26. Vicarious liability: The responsibility for financial compensation of a company for a negligent employee. Vicarious Liability makes an employer liable for the torts of the employee while their

employees are in performance of the work.

27. The justification for veracity includes: a. respect for autonomy; b. close connections to the obligation of fidelity and promise keeping; c. adherence to rules of veracity is essential to foster trust; 28. The subject of the allocation of resources involves: ethics, justice and economics. 29. Extraordinary treatment: Extraordinary treatment is the medical treatment that cannot be used or obtained without excessive expense, pain or other burden or that does not offer a reasonable hope of benefit 30. John, a 54 year old male patient, consented to surgery for probable malignancy in his thyroid gland. After the surgery, the physician told him that the diagnosis had been confirmed and that the tumor had been successfully removed, but he did not inform him of the likelihood of lung metastases and death within a few months. However, the physician informed John's wife about the fuller diagnosis and about the prognosis and it was agreed to conceal the diagnosis and prognosis from John. The physician told John that only "preventive" treatment was needed and John consented to radiation therapy and chemotherapy. The physician did not inform John of the probable causes of his subsequent shortness of breath and back pain. Unaware of his impending death, John died 3 months later. Embracing the ethical principles of beneficence, non-maleficence and respect for autonomy, consider the following: If the full truth (Veracity) was told to John; What effect could it have had? Would it have been appropriate? Would another course of action have been better? ： If the full truth was told, it may be considered truth dumping, diminishing the therapeutic benefit of hope (giving up, accepting the inevitable). May cause him to become depressed and withdraw) It may allow him to make an informed autonomous decision about his treatment (may choose not to go ahead and enjoy what time her has left). It may allow him to get his affairs in order. There are no rights and wrongs. There are numerous considerations in each case. Could have considered partial disclosure, small amounts of information at a time. 31. The doctor of necessity/emergency： ： Undertaking life-saving procedures in an emergency without the patient's consent 32. Mable is an 82 year old lady who has lung cancer. She was diagnosed 8 months ago and is extremely poorly. She has been suffering terrible pain for over a month, which is not relieved by high dose analgesia, she is struggling to breathe and is suffering various unpleasant symptoms. Mable has asked her doctor and the nursing staff repeatedly to be given an injection to end her life. She is adamant that she wants to die as she feels her quality of life is extremely poor and she has stated on several occasions that a dog wouldn't be treated like this. Identify possible legal issues from this case study? ： Lung cancer- poorly. Struggling to breathe is this caused by the analgesia or Mable's condition? Doctrine of double effect may kill the pain and the patient. Pain not relieved by high dose analgesia - one month Wants to die Quality of life poor Has requested an injection to end her life- illegal cannot kill if intent- murder. Euthanasia not legal in Australia, Assisted suicide would be conspiracy to murder in Australia. Capacity? Pain, level of coherence following high doses of pain relief. Advance directive? Living will in the presence of a lawyer-Not for resuscitation etc.

Supreme Court to decide- short term pain, have they tried alternatives, quality of life poor will get worse. 33. When Patricia was diagnosed with Alzheimer's disease, she decided she might need another individual to make informed medical decisions, should she not be able to make them for herself. Which document would she need to complete?: Medical durable power of attorney; 34. Kate is a 17 years old patient, unmarried and 8 weeks pregnant. She is a rather remarkable girl in that she lives independently while still a senior in a high school. She tells you that she was an adoptee given back to foster care, and then abused in that system. She is now an emancipated minor who works 30 hours per week at a service industry job while also ranking in the top 10% of her class. She is University-bound, with a full-ride scholarship for pre-med undergraduate studies at a prestigious university. Kate has absolutely no family support, and the former boyfriend who is the father of her unborn child/foetus simply disappeared upon learning of the pregnancy. Kate is scared, has no private health insurance, and says she doesn't want to be pregnant or a mum ("Perhaps someday, but not now!"). She rejects the adoption option, based on her own experience growing up, and wants an abortion. Kate lives in Western Australia. What are the relevant laws, and identify any legal issues from this case study? Explain how the theory of utilitarianism would relate to this case as oppose to the theory of deontology.: More than 20 weeks pregnancy considered viable only if there are severe disabilities or the mother would be harmed examples include a severe medical condition, heart disease and cancers. Two Doctors must agree to the moth(er's abortion. Less than 20 weeks pregnancy in WA is only considered if the medical practitioner perceives that continuation of pregnancy would lead to more physical and mental risk than termination of a pregnancy. Alternatively that the woman would suffer serious personal, family consequences if the pregnancy continued (Atkins, 2017, p.257). Additionally there must be informed consent and counselling by another medical practitioner who is not involved in the procedure. Children less than 16 - A children's court decides if it is inappropriate to involve the parents Utilitarianism - Greatest good for all- abortion of benefit to society prevents unwanted pregnancies, increased quality of life for single mothers versus possible state dependency. Consider if abortion was not legal? Cost to society of unwanted pregnancies- adoptions cost to mothers of illegal abortions Deontology - A duty to maintain pregnancy and life. 35. Ethical issues at the beginning of life  Abortion  Surrogacy  genetic engineering  severe disability  neonatology  IVF 36. Ethical issues at the end of life  Doctrine of double effect  Ordinary vs extraordinary treatment  Acts and omissions doctrine  Futility of treatment  Killing and letting die

 Withholding or withdrawing treatment  Assisted suicide  Euthanasia  Advanced directives- living wills, do not resuscitate  Conditions that override prima face obligation to treat- futility, death, burden vs benefits, QOL 37. What is prima face obligation to treat At first glance- you see a patient and immediately think we need to do this or that End of life...however, in this particular situation we are not going to do it because...

38. Coroners court: investigates sudden or unexplained deaths to establish if death resulted from natural causes or from homicide

39. Coronial inquest: Determines the cause of suspicious death 40. In order for a patient to refuse treatment on religious grounds what must they be? - competent. - making the decision voluntarily and free from undue influence. - informed in broad terms. - aware of the anticipated circumstances that subsequently arise as a result of the refusal. 41. There is currently no mandatory reporting of elderly abuse in Australia. If a nurse suspects abuse, what must they be guided by? ・Their employers policy; ・Registered Nurse Standards for Practice; ・ the Code of Ethics for Nurses in Australia Nursing and Midwifery Board of Australia (NMBA) 2018); (International Confederation for Nurses (ICN) 2012); ・Code of Conduct for Nurses in Australia (Nursing and Midwifery Board of Australia (NMBA) 2018). 42. Consider: duty of care; consent; confidentiality; cultural sensitivity and therapeutic relationship. Are the elderly any different to other patients in terms of legal and ethical issues? ：NO but can be more complex 43. The Empowerment Model: Supports self determination, informed choice and the ability of adults, including the elderly, to make their own decisions. 44. 7 Key principles of the empowerment model：  Competence  Self determination  Appropriate protection  Best interests  Importance of relationships  Collaborative responses  Community responsibility 45. Relationships Australia identify the following forms of Elder Physical abuse: Elder psychological/emotional abuse Elder social abuse Elder financial abuse Elder sexual abuse Elder neglect Which two do they identify as the most common? ：Financial and neglect

46. Assisted autonomy involves the nurse creating an environment whereby the elderly person is aware of and can access the support they need to make their own decisions and act as independently as possible for as long as possible, as oppose to being a passive recipient of care by 'shaping instrumental circumstances'. What are the other three areas in which the nurse can assist?：Using rational persuasion; Assessing causes of impaired decision making; Mentioning opportunities 47. Two contributing factors to making mistakes in health care (why do nurses make mistakes) : Systems factors—coordination of care, routine treatment processes and application of guidelines and policies Human factors-- result from judgement and decision-making processes of individual health care professionals and can be divided into three categories. Name one of the categories. Example of human errors-- Skill based errors, Cognitive errors, Rule violations 48. Strategies that the World Health Organisation (WHO) recommend to reduce personal error： Know yourself: eat well, sleep well, look after yourself Know your environment Know your task(s) Preparation and planning; "What if ...?", Build "checks" into your routine Ask if you don't know! Mental preparedness Assume that errors can and will occur Identify those circumstances most likely to breed error Have contingencies in place to cope with problems, interruptions and distractions Mentally rehearse complex procedures 49. The World Health Organisation promote the acronym 'HALT' to support nurses in avoiding the making of mistakes. What does each letter stand for?：Hungry? Angry? Late? Or Tired? 50. What is involved when the 'Australian Open Disclosure Framework' is put into action?：An open discussion with a patient (and/or relatives) about an incident that resulted in harm to that patient while they were receiving health care (ACSQHC, 2013); Apology or expression of regret; Factual explanation of what happened; What is being done to redress the situation; Opportunity for a patient to speak openly about their experience 51. What is root cause analysis? and questions to ask A structured approach to incident analysis What happened? Who was involved? When did it happen? Where did it happen? How severe was the actual or potential harm? What is the likelihood of recurrence? What were the consequences? Focuses on prevention, not blame or punishment Focuses on system level vulnerabilities rather than individual performance

It

examines

multiple

factors

such

as:

communication;

environment/equipment;

training;

rules/policies/procedures; fatigue/scheduling; barriers.

52. Name four reasons why human beings vulnerable to error in professional practice?：  Limited knowledge of specific situations  Limited knowledge of possible outcomes  A perspectival nature of knowledge  Inherent ambiguity of life: f...