1. Ethical and Legal Issues
Chapter 4
Ethical and Legal Issues

2. Introduction
Nurses are constantly faced with the challenge of making difficult decisions regarding good and evil or life and death
Legislation determines what is “right” or “good” within a society

3. Definitions
Ethics: the science that deals with the rightness and wrongness of actions
Bioethics: term applied to ethics within the concept of medicine, nursing, and allied health

4. Definitions (cont.)
Moral behavior: conduct that results from serious critical thinking about how individuals ought to treat others
Values: ideals or concepts that give meaning to an individual’s life
Values clarification: a process of self-exploration through which individuals identify and rank their own personal values

5. Definitions (cont.)
Legal right: a right on which the society has agreed and formalized into law
Right: a valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service
Absolute right: when there is no restriction whatsoever on the individual’s entitlement

6. Ethical Considerations
Theoretical perspectives
Utilitarianism: an ethical theory that promotes actions based on the end results that produce the most good (happiness) for the most people
Kantianism: suggests that decisions and actions are bound by a sense of duty

7. Ethical Considerations (cont.)
Christian ethics: do unto others as you would have them do unto you; alternatively, do not do unto others what you would not have them do unto you
Natural law theories: do good and avoid evil; evil acts are never condoned, even if they are intended to advance the noblest of ends
Ethical egoism: decisions are based on what is best for the individual making the decision

8. Ethical Dilemmas
Ethical dilemmas occur when moral appeals can be made for taking either of two opposing courses of action
Taking no action is considered an action taken

9. Ethical Principles
Autonomy: emphasizes the status of persons as autonomous moral agents whose rights to determine their destinies should always be respected
Beneficence: refers to one’s duty to benefit or promote the good of others

10. Ethical Principles (cont.)
Nonmaleficence: abstaining from negative acts toward another; includes acting carefully to avoid harm
Justice: based on the notion of a hypothetical social contract between free, equal, and rational persons; concept of justice reflects a duty to treat all individuals equally and fairly
Veracity: refers to one’s duty to be truthful always

11. A Model for Making Ethical Decisions
Assessment
Problem identification
Plan
Implementation
Evaluation

12. Ethical Issues in Psychiatric/Mental Health Nursing
The right to refuse medication
The right to the least restrictive
treatment alternative

13. Legal Considerations
Nurse Practice Act defines the legal parameters of professional and practical nursing
Types of laws
Statutory law
Common law

14. Classifications Within Statutory and Common Law
Civil law: protects the private and property rights of individuals and businesses
Torts
Contracts
Criminal law: provides protection from conduct deemed injurious to the public welfare

15. Legal Issues in Psychiatric/Mental Health Nursing
Confidentiality and right to privacy
Hippa
Doctrine of privileged communication
Exception: duty to warn
Informed consent
Restraints and seclusion
False imprisonment

16. Legal Issues in Psychiatric/Mental Health Nursing (cont.)
Commitment issues
Voluntary admissions
Involuntary commitments
Emergency commitment
The “mentally ill” person in need of treatment
Involuntary outpatient commitment
The gravely disabled client

17. Legal Issues in Psychiatric/Mental Health Nursing (cont.)
Malpractice and negligence
Types of lawsuits that occur in psychiatric nursing
Breach of confidentiality
Defamation of character
Libel
Slander

18. Legal Issues in Psychiatric/Mental Health Nursing (cont.)
Types of lawsuits that occur in psychiatric nursing (cont.)
Invasion of privacy
Assault and battery
False imprisonment

19. Nursing Actions to Avoid Liability
Respond to the patient
Educate the patient
Comply with the standard of care
Supervise care
Adhere to the nursing process
Document care
Follow-up and evaluate
Maintain a good interpersonal relationship with the client and family