1. Chapter Two Ethical and Legal Issues Chapter 2-1 Fourth Edition Linda D. Urden Kathleen M. Stacy Mary E. Lough Priorities in C RITICAL C ARE N URSING Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

2. Slide 2 Objectives  Discuss ethical principles as they relate to critical care patients.  Discuss strategies to address moral distress in critical care nursing.  Discuss the concept of medical futility.  Describe what constitutes an ethical dilemma. (Continued)

3. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 3 Objectives (Continued)  List steps for making ethical decisions.  Identify legal and professional obligations of critical care nurses.  Describe the elements of certain torts that may result from critical care nursing practice.  Identify and discuss specific legal issues in critical care nursing practice.

4. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 4 Morals are the “shoulds,” “should nots,” “oughts,” and “ought nots” of actions and behaviors. Ethics are concerned with “why.” Morals and Ethics

5. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 5 Moral Distress  Occurs when one knows the ethically appropriate action but cannot act on it  Leads to emotional and physical stress

6. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 6 Box 2-1 Ethical Principles in Critical Care  Autonomy  Beneficence  Nonmaleficence  Veracity (Continued) (Continued)

7. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 7 Box 2-1 Ethical Principles in Critical Care (Continued)  Fidelity  Confidentiality  Privacy  Justice, allocation of resources

8. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 8 Medical Futility Medical futility can be defined as “any effort to achieve a result that is possible but that reasoning or experience suggest is highly improbable and that cannot be systematically reproduced.” (Continued) (Continued)

9. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 9 Medical Futility (Continued)  Rapid rise in health care cost/inflation  Limitation of resources and funds to both primary and secondary care  Potential rationing of resources

10. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 10 End-of-Life Care  Palliative care  “Care and comfort” of patient

11. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 11 Code of Ethics for Nurses Nursing is concerned with: Protection of patient health. Protection of patient health. Promotion of patient health. Promotion of patient health. Restoration of patient health. Restoration of patient health. Prevention of patient illness. Prevention of patient illness. Alleviation of patient suffering. Alleviation of patient suffering.

12. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 12 Box 2-3 Steps in Ethical Decision Making  Identify the health problem.  Define the ethical issue.  Gather additional information.  Delineate the decision maker.  Examine ethical and moral principles.  Explore alternative options.  Implement decisions.  Evaluate and modify actions.

13. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 13 Box 2-4 Types of Torts  INTENTIONAL TORTS: Assault, battery, false imprisonment, trespass, infliction of emotional distress  SPECIFIC TORTS: Defamation, slander, libel, invasion of privacy  UNINTENTITONAL TORTS: Negligence, medical/nursing treatment torts, professional malpractice, abandonment  STRICT LIABILITY: Product liability

14. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 14 Administrative Law and Licensing Statutes  Health care agencies/boards  Governed by administrative law

15. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 15 Negligence and Malpractice Four elements of negligence and malpractice 1.Duty and standard of care 2.Breach of duty 3.Causation 4.Injury or damages

16. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 16 Box 2-7 Six General Areas of Nursing Negligence 1.Improper administration of treatments 2.Improper administration of medications 3.Inadequate or false written and verbal communication 4.Insufficient supervision of patients 5.Improper postoperative treatment and wound care 6.Incorrect perioperative instrument or sponge count

17. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 17 Nurse Practice Acts  Right to practice and right to employment  Monitor practice, implement standards of care  Enforce rules and regulations  Issue sanctions and license revocation  Disciplinary action for unauthorized practice, negligence or malpractice, incompetence, chemical or other impairment, criminal acts, or violations of specific nurse practice act provisions

18. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 18 Specific Patient Care Issues  Informed consent and authorization for treatment  Valid consent: − Voluntary, obtained, and informed  Consent must be informed and timely − Diagnosis, condition, prognosis, material risks and benefits of treatment, explanation of procedure or treatment, providers of treatment, probable outcome (Continued) (Continued)

19. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 19 Specific Patient Care Issues (Continued)  The right to accept or refuse medical treatment and the law of Advance Directives  The right to informed consent  The right to refuse treatment  Withholding and withdrawing treatment  Ethical, legal, and practical problems  Specific guidelines to guide decision makers

20. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Slide 20 Advance Directives and the Patient Self-Determination Act (OBRA 1990) All adults must be provided written information on an individual’s rights under state law to make medical decisions, including the right to refuse treatment and the right to formulate advance directives All adults must be provided written information on an individual’s rights under state law to make medical decisions, including the right to refuse treatment and the right to formulate advance directives Living Wills Living Wills Durable Power of Attorney for Health Care Durable Power of Attorney for Health Care