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Chapter 26
Group Discussion
Have you had any ethical dilemmas? How did you deal with them?
Bioethics
Ethical questions arising in health care
Principles of bioethics
Beneficence: duty to act to benefit others Autonomy: respecting rights of others to make decisions Justice: duty to distribute resources equally Fidelity: maintaining loyalty and commitment to patient Veracity: duty to communicate truthfully
Involuntary admission (commitment): made without patients consent Emergency involuntary hospitalization
Patients Rights
Right to treatment: requires that medical and psychiatric care and treatment be provided to everyone admitted to public hospital Right to refuse treatment: right to withhold or withdraw consent for treatment at any time
Issue of right to refuse psychotropic drugs has been debated in courts with no clear direction yet forthcoming Informed consent must be obtained by physician or other health care professional to perform treatment or procedure Presence of psychosis does not preclude this right
Implied consent
Many procedures nurse performs has element of implied consent (e.g., giving medications) Some institutions require informed consent for every medication given
When behavior is physically harmful to patient/others When least restrictive measures are insufficient When decrease in sensory overstimulation (seclusion only is needed) When patient anticipates that controlled environment would be helpful and requests seclusion
Recent legislative changes have further restricted use of these means and some facilities have instituted restraint free policies
Patient Confidentiality
Ethical considerations
Confidentiality is right of all patients ANA Code of Ethics for Nurses (2001) asserts duty of nurse to protect confidentiality of patients
Legal considerations
Health Insurance Portability and Accountability Act (HIPAA), 2003
Health information may not be released without patients consent, except to those people for whom it is necessary in order to implement the treatment plan
Exceptions
Duty to Warn and Protect Third Parties
Tarasoff v. Regents of University of California (1974) ruled that psychotherapist has duty to warn patients potential victim of potential harm
Most states have similar laws regarding duty to warn third parties of potential life threats Staff nurse reports threats by patient to the treatment team
Negligence/Malpractice
Negligence or malpractice is an act or an omission to act that breaches the duty of due care and results in or is responsible for a persons injuries Elements necessary to prove negligence
Duty Breach of duty Cause in fact Proximate cause
DamagesCause in fact
Evaluated by asking except for what the nurse did, would this injury have occurred?
Damages
Include actual damages as well as pain and suffering
Foreseeability of harm
Evaluates likelihood of outcome under circumstances
If nurse knows physicians orders need to be clarified or changed, it is nurses duty to intervene and protect patient Abandonment
Legal concept may arise when nurse does not leave patient safely back in hands of another health care professional before discontinuing treatment
Avoiding Liability
Respond to the client Educate the client Comply with the standard of care Supervise care Adhere to the nursing process Document carefully Follow up and evaluate Maintain a good interpersonal relationship with client and family