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Legal & Ethical Practice
Transcript of Legal & Ethical Practice
Relationship Between Ethics & Law
"We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects the first, affects all indirectly." (Martin Luther King, Jr.)
Law establishes rules that define our rights & obligations.
Some authors of nursing ethics take the position that legal = ethical
Laws can be considered (by some) to be unethical.
Certain illegal acts can be viewed by many as ethical.
Human behaviour & motivation are more complex than can be fairly mirrored by law.
Legal system judges actions rather than motivations.
Influenced by political climate or other elements, law changes.
Thus, there are many reasons to illustrate the disparity between that which is legal & which is ethical.
Help understanding use of restrains (restriction of movement/control of behaviour)
Increase muscle atrophy
Loss of bone mass
Controversial - emotional distress, loss of dignity, loss of independence, dehumanization, increase agitation, depression
When & How becomes a legal issue
2001 Ontario, Bill 85,Patient Restraints Minimization Act
CNO Practice Standard, Restraints
Confidentiality & Privacy - Personal Health Information Proteciton Act
Understanding the Personal Health Information Act
Personal health information practices
Knowledgeable consent and substitute decision-makers
The client’s right to access and amend his/her personal health information
Potential for harm
Disclosure without consent
OHN & Confidentiality
OHNs and confidentiality
I'm an occupational health nurse (OHN) in a small community hospital. I'm frequently asked by my manager to allow staff from human resources, other managers and/or corporate lawyers access to employee files as they do not understand my obligation to maintain confidentiality of the client's chart. How should I handle such requests?
Using technology to transfer health information
Claudia is a community nurse for renal dialysis
clients. One day while caring for a client in his home,
she receives a call from another client on her cellphone.
After establishing that it isn’t an emergency, Claudia tells
her that she will phone her back in 10 minutes from a
telephone with a land line.
Is it appropriate for Claudia to switch to a land line?
Yes - Claudia should try to speak to clients on phones that
have a land line.
No - Claudia should stay on her cellphone and not make
her client wait.
Assumptions & Least Restraints Policy
Nsg intervetions promote well-being & prevent harm
A policy on LEAST RESTRAINT does not mean nurses accept abues
Clients or SDM are involved in decision making
CONSENT is essential
All possible alternatives have been considered before proceeding
Assess & analyze behaviour
Behaviours have meaning
Nurses legal & ethical responsibilty to assess & implement alternative measures before....
You are staff working at a local hospital and are currently confronted by a client situation. You have been asked to come to a hearing to talk about the ethical issues surrounding the case. To prepare for the hearing, below are areas to focus on:
A. Review the case and discuss the ethical values/ principles as well as legal issues that are evident to you in this scenario?
B. Can you identify any ethical dilemmas?
C. Using the CNO model for working through ethical/legal situation, review the assessment/description of situation and discuss what are important factors that need to be considered when working through this situation?
test your knowledge
Ethel is 75 years old and she lives in a long-term care home. She is able to make decisions about her diet and other activities of living but unable to make decisions about her health care treatments.
Can Ethel appoint someone to make decisions only about her health care treatments?
yes or no
In what situations are nurses accountable for obtaining consent?
Elements of consent
Hierarchy of SDM
Nurse's role advocating for incapable patients
Elements of consent
Consent & emergency situations
Six guiding principles for nurses in Ontario to consider when applying practice standards.
Health Care Consent Act
Age of consent
Accountability from health care professionals in obtaining consent
Substitute Decisions Act
Hierarchy of substitute decision-makers
"When you see me walking, stumbling,
Don't study and get it wrong.
'Cause tired don't mean lazy
And every goodbye ain't gone.
I'm the same person I was back then,
A little less hair, a little less chin,
A lot less lungs and much less wind.
But ain't I lucky I can still breath in"
Karen Scullion, seventeen years old, has been admitted for surgery to evaluate a soft tissue mass suspicious for sarcoma. Radical resection of the tissue mass along with extensive skin grafting was performed.
While Karen was in the recovery room, the physician saw her parents to inform them of the results of the surgery. They were understandably shaken. Both parents insisted that Karen not be told the results until she “gets stronger”. The mother informed the physician that Karen’s favourite aunt recently died of cancer. Karen became so upset that in a matter of months she went from being near the top of her class at school to being in danger of failing several subjects. Her parents expressed the fear that, if Karen learns that she has cancer, she will suffer an even more serious breakdown. At first the physician insisted that Karen must be told the truth, but, after considerable pressure from the parents, agreed to withhold the information from her.
A few days later when the physician was making rounds with Nurse Chan, Karen asked if the surgery went well. The physician assured her that everything was okay, and said that she should just focus on her physiotherapy and concentrate on getting home.
Nurse Chan and the other nurses feel that Karen has a right to know the results of the surgery as soon as possible, and are further concerned that without such knowledge she cannot give informed consent to the extensive post-surgery rehabilitation she requires. When Nurse Chan approaches the physician about this, he responded that the parents probably know their daughter best, and said hat he wants to wait until the parents “come around”.
Discussion on Consent
I - Identify the facts
D- Determine relevant ethical, legal considerations (values, principles, law)
E - Explore options
A - Act- Recommend & implement
Decision Tree For Obtaining Consent
In what situation is consent required under HCCA?
1. Treatment & property
2. Admission to care facility & property
3. Personal assistance services & treatment
4. Treatment & discharge from hospital
True or False ?
Substitute decision-makers are identified in the
Health Care Consent Act as those who can make treatment decisions for clients incapable of making own their decisions.
Susie, an RPN is assigned to Bobby with Cerebral Palsy, 13, requiring a routine catheterization. Is consent required?
1. No, because treatment is ordered by doctor.
2. Yes. because of Bobby's age.
3. Yes. because consent is required for any treatment.
4. No, because it is a routine activity.
Nurses in my facility are being asked to witness signatures from clients (or their substitute decision-makers) for the purpose of obtaining consent for a procedure. The physicians tell us that we are only responsible for witnessing the signature and not for getting the informed consent. Is this true or are we accountable for determining that an informed consent was obtained?
"But a bird that stalks
down his narrow cage
can seldom see through
his bars of rage
his winds are clipped and
his feet are tied
so he opens his throat to sing."
"Men themselves have wondered
What they see in me.
They try so much
But they can't touch
My inner mystery."