INTRODUCTION LAW AND ETHIC

LEGAL AND ETHICAL

Legal is when the law is involved in some situation needed, when it being an instrument of social regulation intervenes in medical practice. Where patients complaints should be taken as an opportunities for organization to resolve unsatisfactory situation and to improve the quality of care.

COMMON ISSUES AND TERMS USED IN ETHICS LAW

Laws are written with the interests of society as the major consideration. Law is a system of rules and guidelines which are enforced through social institutions to govern behaviour , wherever possible. It shapes politics, economics and society in numerous ways and serves as a social mediator of relations between people. Law is an area potential of conflict. Laws are rules that are external to an individual and that members of the society must obey. The values and practices of society often inform the development of laws, although its take such a considerable time to change, and that the health care professions are often left unsure of their legal position. Even law and ethics seen as complementary to one another, there are also seen to be placed on opposite side of coin.

ETHICS

Ethics refers to the branch of philosophy that provide rules and principles that can be used for resolving ethical dilemmas. Ethic is often about exploring values and beliefs and clarifying what people understand, think and feel in a given situation, (often from what they say as much as what they do). Ethics should be used as a daily tool to support decision-making and to enable rather than disable practice e.g :- the terminology used in daily is different and the words need greater explanation and understanding, where its need to be more than one interpretation for the words. Belief and values are very personal, dependent on many things, so not least an individuals backgrounds, society, and personal view.

CONCEPTUAL MODELS OF LAW AND ETHICS

In practicing medicine, a range of issues may arise that require consultation from a lawyer, a risk manager, or an ethicist. Indeed, in some hospitals the Risk Manager is an attorney with a clinical medicine background. There are, however, important distinctions between law itself and risk management.

Law is the established social rules for conduct; a violation of law may create criminal or civil liability.

Risk Management is a method of reducing risk of liability through institutional policies/practices.

Risk Management is guided by legal parameters but has a broader institution specific mission. It is not uncommon for a hospital policy to go beyond the minimum requirements set by the legal standard.

When legal and risk management issues arise in the delivery of health care, there may be ethical issues, too. Conversely, what is originally identified as an ethical problem may raise legal and risk management concerns. More understand about the conceptual models of law and ethics, we must know that::

Law is derived/expressed through:

federal and state constitutions federal and state statutes (ex. Revised Code of WA.) federal and state regulations (ex. WA. Administrative Code) federal and state case law (individual lawsuits-decisions at appellate level.)

Risk Management is derived from:

law and professional standards and is expressed through institutional policies/practices.

Medical Ethics is derived/expressed through:

law institutional policies/practices policy of professional organizations professional standards of care, fiduciary obligations

ROLES OF MEDICAL ETHICS AND THE LAW

Within their distinctive roles, the disciplines of law and medical ethics nevertheless significantly overlap. Consider that both disciplines address: Access to medical care (provision of care, emergency treatment, stabilization and transfer). Informed consent. Confidentiality of health care information and exceptions to confidentiality (mandatory reporting obligations such as : child and elder abuse, duty to warn). Privileged communications with health care providers. Advance directives are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity, and appoints a person to make such decisions on their behalf. Abortion where is the nurses assist in the performance of abortions under the act of medical termination of pregnancy (MTP) and take care of patients following the procedure. They have the right to refuse to assist in the procedure if the abortion is illegal. Physician-assisted suicide. Significant distinctions between law and medical ethics in philosophy, function and power. A court ruling is a binding decision that determines the outcome of a particular controversy. A statute of administrative code sets a general standard of conduct, which must be adhered to or civil/criminal consequences may follow a breach of the

standard. Lawmakers (court and legislatures) frequently do turn to the policy statements (including any medical ethics statements) of professional organizations when crafting laws affecting that profession. Thus, health care providers may greatly influence legal standards by their work in creating professional ethics standards. Conversely, an ethics pronouncement with is not adopted into law maybe a significant professional and moral guidepost but it is generally unenforceable. Good ethics has been described as beginning where the law ends. The moral conscience is a precursor to the development of legal rules for social order. Law and medical ethics thus share the goal of creating and maintaining social good and have a symbiotic relationship as expressed in this quote. Conscience is the guardian in the individual of the rules which the community has evolved for its own preservation. MEDICAL MALPRACTICE

Is professional negligence by act or omission by a health care provider in which care provided deviates from accepted standards of practice in the medical community and causes injury or death to the patient. Standards and regulations for medical malpractice vary by country and jurisdiction within countries. Medical professionals are required to maintain professional liability insurance to offset the risk and costs of lawsuits based on medical malpractice. AUTONOMY

It refers to individual independence in holding a particular view, making choice and taking action based on value and beliefs ( Beauchamp and Childress, 2001). The concept of respect for autonomy recognizes the inherent worth of the individual and that a competent human being is qualified to make decision in his/her

own best interests. The concepts informed consent is firmly rooted in the principle of respect for autonomy. DECISION MAKING CAPACITY AND CONSENT Assessing for decision-making capacity, involves determining whether or not a patient or subject is psychologically or legally capable of adequate decision-making. Illness or medications may impair the ability of patients to make decisions about their health they may be unable to make decisions at all or may make choices that are not in their best interests and may result in serious harm. It is important to remember that this capacity relates to the specific medical decision at hand and does not imply a global ability to make any or all decisions about health care or other matters. Only a court can deem a patient incapable of making global health care decisions. If that is the case, the patient is deemed to lack competence and a surrogate is appointed for the patient. Rarely do we need to involve the court or deem someone to lack competence. Instead, we more commonly refer to decision-making capacity as it relates to individual medical decisions. BENEFICENCE

It means doing good and includes prevention of harm, removal of evil and promotion of good (Frankena, 1973). Nurses should have their goal to promote the well-fare of clients in their care. These might include recommendations regarding diet, exercise, smoking and alcohol consumption.

NONMALEFICENCE

It refers to the concept of preventing harm to others and is an important principle for nurses. Harm is the interference with mental or physical well being of others (Beauchamp and Childress,2001) . Basic rules include not killing, not causing pain, not disabling, and not depriving of freedom. Non-maleficence encompasses both harm and the risk of harm. The harm maybe either intentional or non intentional. Nurses have the obligation to exercise due care in professional practice so that unintentional harms do not occur. Due care is a legal and ethical standard of performance by which professional abide. As professionals, nurses must possess sufficient knowledge and skills and render care that is cautious, diligent and thoughtful. CONFIDENTIALLY

Confidentiality is the presumption that what the patient tells the physician will not be revealed to any other person or institution without the patients permission. The common law of confidentiality reflects that people have a right to expect that information given to a nurse or midwife is only used for the purpose for which it given and will not be disclosed without permission. PERSONAL INTEGRITY

In discussions on behaviour and morality, one view of the property of integrity sees it as the virtue of basing actions on an internally consistent framework of principles. This scenario may emphasize depth of principles and adherence of

each level of postulates or axioms to those it logically relies upon. One can describe a person as having ethical integrity to the extent that everything that person does or believes actions, methods, measures and principles all of these derive from a single core group of values. Integrity is a necessary foundation of any system based on the supremacy and objectivity of laws. Such systems are distinct from those where personal autocracy governs. The latter systems are often lacking in integrity because they elevate the subjective whims and needs of a single individual or narrow class of individuals above not only the majority, but also the law's supremacy. Such systems also frequently rely on strict controls over public participation in government and freedom of information. To the extent these behaviours involve dishonesty, turpitude, corruption or deceit, they lack integrity. Facially "open" or "democratic" systems can behave in the same way and thereby lack integrity in their legal processes. DISTRIBUTIVE JUSTICE (FAIRNESS) IN ETHICAL TERMS

Fairness mean fair, equitable and appropriate treatment in light of what is due or owed to person. The outlines the equity or fairness part of justice in saying that individual treatment should be consistent and equal should be treated equally. Example: A pregnant woman is owed a certain standard of care, then that woman has a right to that standard of care and someone has corresponding duty to provide the care to the appropriate standard. Example : A first woman asking for information on breastfeeding in the postnatal ward, because she have read widely, had previous

experience of breastfeeding and have plenty of support available when she returns home. A second woman by contrast may be a first time mother, who has not attended any parent classes, not read or know much about breastfeeding and have little support at home. In this condition it show the information, advice and support needs to be different for this two women. On the face of it, their question may be the same and one would expect the same type of answer, but in finding out a little background information the midwife would be justified in not treating these two women in the same way as their needs are very different. It is clear that midwives must be aware of and consider equity and justice in their dealings with women, but they also have consider women as individual and be able to justify different practices in the basis of need. If is there an injustice is committed if that standard of maternity care is not available and it could be said that the woman has failed to receive the expected standard of maternity care she is entitled. ETHICAL OATHS AND CODES

Ethical codes and oaths are statements of the moral principle and values that govern the conduct of a group, profession, or individual. In the health professions, ethical codes embody the ideal of compassion for the suffering and respect for the dignity of all human being, as well as the highest standards of clinical research and practice. That Code defines what women and their families have the right to expect in any encounter with the midwife. These can be summarized under the following: Act always in the best interest of woman and their families. Practise always in a safe and competent way. Be personally accountable for maintaining your competency and skills. Practise only within the scope of your competence. Do not

compromise the safety of the individual woman of her family either by act of commission or omission. Do not ask someone else to do something that is neither appropriate to their skills or beyond their competence. Do not forget the skills of midwifery, compassion, interpersonal skills and support for women and their families. Respect the life, dignity and rights of the individuals you care for. MORALS

Moral is the differentiation of intentions, decisions, and actions between those that are good (or right) and those that are bad (or wrong). A moral code is a system of morality (for example, according to a particular philosophy, religion, culture, etc.) and a moral is any one practice or teaching within a moral code. LEGAL DOCUMENTATION

Documentation is used to communicate the care provided and record any significant events. It can function as evidence, to investigate a complaints or for criminal and other court proceeding. All documentation relating to patients must be kept securely and mechanism must be in place to safeguard confidentiality. Nursing and midwifery documentation must be written legibly. Documentation should include the following : 1) Direct quotations from the patient, family, or visitors. 2) Data that has been gathered. 3) Actions taken. 4) Individuals notified about concerns and issues. 5) Evaluation of actions.

CONCLUSION

The professional education of a midwife requires an understanding of human value systems. This subject specifically explores two of these systems, the ethical and legal and spheres and interactions, both complementary and conflicting, specifically in relation to midwifery practice. The development of human values (personal, professional and institutional) are examined and the meaning and role of ethics in the professional life of a midwife is explored. This provides a foundation for discussion and analysis of the many controversial questions with which midwives are intimately and inexorably involved. The law and legal frameworks are examined and the value systems embodied in these structures are exposed. The role of the law and the role of the midwife in the law are studied. The Professional Responsibilities of Midwives is when midwives hold in confidence client information in order to protect the right to privacy, and use judgment in sharing this information except when mandated by law.

REFERENCES

1- Diane M. F, M. A. (2009). Myles, Textbook for Midewives. London, Churchill Livingstone. 2- Herron, A. (2009). Autonomy and Midwifery. Health and Social Science . 3- Malaysia, L. o. (2006). Act 436, Midwives ACT 1966. Malaysia: percetakan nasional malaysia berhad. 4- Nicola V.W, S. M. (2011). Illustrated Dictionary of Midwifery. Edinburgh, London: Elsevier. 5- Shirley R.J. (2000). Ethics in Midwifery. Second Edition, TORONTO : Mosby .
6- Steven Pantilat, M. (2008). Decision-Making Capacity. California.: University

of California Regents. 6- Lisa A. Vincler, JD, Law and Medical Ethics, http://depts.washington.edu/bioethx/topics/law.html 7Lubin & Meyer PC, 2009, JD, The innovative leader in medical malpractice and personal injury law, http://www.lubinandmeyer.com/cases/nurse-midwife-malpractice.html