By Milion R(BSc,
MScN)
Learning Objectives
By the end of this session the you will able to:
1.Define the term ethics and Identify types of ethics
2.Differentiate common ethical theories
3.Describe general legal concepts in Nursing.
4.Identify nursing code of ethics at the International
and the national level
5.Recognize Health related Legal issues in Ethiopia
6.Recognize the ethical dilemma and ethical decision
making in nursing
01/23/25 By Milion R(BSc, MScN) 2
Understanding the concept of
Ethics
Ethics versus Morality
Ethics: is derived from the Greek word ethos, meaning
custom or character.
is the study of philosophy that deals with the
distinction between right and wrong, and the moral
consequences of human action.
Morals- pertaining to the rightness or wrongness of an act.
Is principles and rules of right conduct (It is private or
personal)
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. By Milion R(BSc, MScN) 3
Types of Ethics
i. Descriptive: It is the description of the
values and beliefs of various cultural, religious
or social groups about health and illness.
ii. Normative: a study of human activities in a
broad sense in an attempt to identify human
actions that are right or wrong and good and
bad qualities.
iii. Analytical: analyzes the meaning of moral
terms.
It seeks the reasons why these action or
attitudes are either wrong or right.
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Common Ethical theories
Ethical theories may be compared to lenses
that help us to view an ethical problem.
Different theories can be useful because they
allow us to bring different perspectives in to
our ethical discussions.
There are four ethical theories:
1. Deontology
2. Teleology
3. Intuitionism
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4. The ethic of caring
By Milion R(BSc, MScN) 5
Theories Cont’d
1. Deontology (Duty or rule-Based
theory)
This theory proposes that the rightness or
wrongness of an action depends on the nature
of the act rather than its consequences.
This theory holds that you are acting rightly
when you act according to duties and rights.
The theory denotes that duties and rights are
the correct measuring rods for evaluating
action.
E.g. informed consent, respect of patient…
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Theories Cont’d
2. Teleology (utilitarian or end based
theory)
This theory looks to the consequences of an action
in judging whether that action is right or wrong.
According to the utilitarian school of thought, right
action is that which has greatest utility or
usefulness.
Utilitarian hold that no action in itself is good or
bad, the only factors that make actions good or
bad are the outcomes, or end results that are
derived from them.
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Theories Cont’d
Types of Utilitarian Theories
2.1. Act utilitarianism: suggests that people
choose actions that will in any given
circumstances increase the over all-good.
2.2. Rule utilitarianism: suggests that
people choose rules that when followed
consistently will maximize the over all good.
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Theories Cont’d
3. Intuitionism
The notion that people inherently
(naturally) know what is right or wrong;
determining what is not a matter of
rational thought or learning.
For example, nurse inherently known it is
wrong to strike (assault) a client, this does
not need to be taught or reasoned out.
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Theories Cont’d
4. The ethic of caring (case based
theory)
Unlike the preceding theories which are based
on the concept of fairness (justice) an ethical
caring is based on relationships.
It stresses courage, generosity, commitment,
and responsibility.
Caring is a force for protecting and enhancing
client dignity.
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Legal Concepts in Nursing
General Legal Concepts
Law can be defined as rules made by humans who regulated social
conduct in a formally prescribed and legally binding manner.
Standard/Rules of conduct inherent in human nature
and essential to human society & guide human
function.
Designed to protect the rights of the public
Purpose of Nursing Law
Protect – patient and nurse
Scope of practice (define it)
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Functions of Law in Nursing
It provides a framework for establishing which
nursing actions in the care of client are legal.
It differentiates the nurse's responsibilities from
those of other health professional.
It helps establish the boundaries of independent
nursing action.
It assists in maintaining a standard of nursing
practice by making nurses accountable under the
law.
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Legal Concepts Cont’d
Types of law
Law governs the relationship of private
individuals with government and with each
other.
1. Public Law:
Regulates relationships between individuals and
government
Government is directly involved
2.Private Law or Civil law: is the body of law that
deals with relationships, between individuals.
It is categorized as contract law and tort law.
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Legal Concepts Cont’d
i. Contract Law: involves the enforcement of
agreements among private individuals or the payment
of compensation for failure to fulfill the agreements.
ii. Tort Law: A civil wrong made against a
person or property
Torts are divided into two main categories
1.Intentional tort
2.Unintentional tort
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Intentional Torts
When a person commits a wrong against another and
knows and desires the consequences of his or her act.
Example
Assault
Battery
False Imprisonment
Fraud
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Intentional Torts
Assault:
Assault is the behavior that makes a person fearful of
harm (is the threat to bring about harm)
Eg. Threating a pt to give an injury,
Restrain a pt for an X-ray procedure when the pt has refused consent.
Battery
Battery is an intentional physical contact with a
person that causes injury (touching without consent)
The contact is harmful to the pt & causes an injury,
or
Eg. Giving an injection without pt consent,
The pt gives consent for left knee repair, but the surgeon perform
right knee surgery.
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Intentional Torts…
False Imprisonment
Any unlawful confinement/ quarantine within
fixed boundaries, can be physical
Making a person stay in space against his/her
wishes,
Eg. Restraining or confining a pt to a locked room without
proper consent.
Fraud:
Is a willful and purposeful misrepresentation
that could cause harm to a person or property
Eg. Giving incorrect information to obtain better
position/job.
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Unintentional Torts
When acting in a careless manner causes
damage or injury
However there is no intent to do harm by the
person committing or omitting the act
Examples
Negligence
Malpractice
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i. Negligence (breach of duty) is the failure of an individual
to provide care that a reasonable person would ordinarily use in a
similar circumstance.
Ex. Car accident by a nurse, failure to follow-up, to disclose,
failure to give care.
ii. Malpractice
Failure of a person with professional training to act
in a reasonable manner
Wrongful conduct
Improper discharge of professional duties
Failure to meet the standards of acceptable care
Ex. Wrong medication is a malpractice.
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Common Malpractices
Failure to maintain safety
Improper technique/treatment
Failure to monitor and report
Medication errors
Failure to follow policy/procedures
Poor documentation
Improper use of equipment
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Kinds of Legal Actions
There are two kinds of legal actions:
a) Civil actions: Deals with the relationships
between individuals in a society.
Example: a man may file a suit against a
person who he believes cheated him.
a) Criminal actions: Deals with disputes
between an individual and the society as a
whole.
Example: if a man shoots a person, society
brings
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him toBytrial(check).
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Nursing Practice : is an act for professional
Nursing practice regulate the practice of nursing.
Legally define and describe the scope of nursing
practice, which the law seeks to regulate, there by
protecting the public as well.
Standard of Practice: is a means which attempts
to ensure that its practitioners are competent and
safe to practice through the establishment of
standard practice.
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Legal Issues Cont’d
The standards:
Reflect the values and practices of the
nursing profession
Provide direction for professional nursing
practice
Provide a frame work for the evaluation of
nursing practice
Defines the profession’s accountability to
the public and the client outcomes for which
nurses are responsible
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Legal Issues Cont’d
Standard of nursing practice requires:
The helping relationship be the nature
of client-nurse interaction
Nurse to fulfill professional
responsibilities
Effective use of nursing process
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Legal Issues Cont’d
The profession maintains standards in
practice in part through appropriate entry.
Credentialing: is the process of determining
and maintaining competence-nursing
practice, through:
1) Licensure
2) Registration
3) Certification
4) Accreditation
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Legal Issues Cont’d
1) Licensure : It is legal permit a government
agency grants to individuals to engage in
the practice of a profession and to use
particular title.
2) Registration : Is listing of an individual's
name and other information on the official
roster of a governmental agency.
3) Certification: is the voluntary practice of
validating that an individual nurses met
minimum standards of nursing competence
in specialty areas
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Legal Issues Cont’d
4) Accreditation: is a process by which a
voluntary organization or governmental
agency appraises and grants accredited
status to institutions and/or programs.
The purpose of accreditation of programs in
nursing is:
i. To foster the continuous development and
improvement in quality of education in
nursing
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Legal Issues Cont’d
ii, To evaluate nursing programs in relation
to the stated physiology and outcomes
and to the established criteria for
accreditation.
iii, To bring together practitioners,
administrators, faculty, and students in
an activity directed towards improving
educational preparation for nursing
practice.
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Protecting Yourself
Follow standards of care
Document (accurately, completely, timely,
factually)
Confidentiality
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Health related Legal issues in
Ethiopia
1. Abortion: Grounds on Which Abortion is Permitted, revised
abortion law of Ethiopia
1. When the pregnancy puts the woman’s life at risk
2. Fetal impairment or deformity
3. When pregnancy follows Rape or incest
4. When pregnancy occurs in minors (stated maternal age
<18 years)
5. The woman is physically and mentally unable to care for
the born child
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Ethical Dilemmas & ethical decision
making in Nursing
Dilemma is a
situation in which two
or more choices are
available
It is difficult to
determine which
choice is best and
the needs of all these
involved cannot be
solved by the
available
alternatives.
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Ethical Dilemmas Cont’d
Models for Ethical decision-making
Ethical decision-making is real life issue.
Each situation will be different, depending
on the people involved and the context.
However, ethical decision-making models
provide mechanisms or structures that help
you think through or clarify an ethical issue.
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Ethical dilemma decision making step
1. Medical indications:
What is the patient medical problem? History?
Diagnosis?
Is the problem acute? Chronic? Critical?
Emergent? Reversible?
What are the goals of treatment? etc
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2. Patient preference:
What has the patient experienced about
preferences for treatment?
Has the patient been informed of benefits and
risk, understood, and given consent? etc.
3. Quality of life:
What are the prospects with or with out
treatment, for a return to the patient's normal
life?
Are there biases that might prejudice
(predisposition) the provider's evaluation of a
patient's quality of life? etc
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4. Contextual factors:
Are there family issues that might
influence treatment decisions?
5. Reflection
Decide with the correct
measures
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CASE SCENARIO
w/ro fazilet came to the hospital where
comprehensive abortion care is given. she is 32
years old, her complain was absence of menses
for two consecutive months. She has had
nausea but not vomiting, nausea becomes
worsening during the morning just after she
wake-up from her bed. She feels tired than
usual since the last week, she has lost her
appetite especially for types of foods that
contain food odor.
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cont....
She noticed she has a frequency of urination.
She has no abdominal cramp, discomfort, or
abdominal bloating. She was worrying if she is
pregnant, which is unplanned, unwanted, and
unsupported. She had regular monthly bleeding
of (28 days) cycle since her 14 years of age up
to two months ago without interruption.
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cont....
Two months back she met a man at the wedding
ceremony to whom she had sex with him. She has no
history of hospital admission for medical or surgical
problems. She stated that abort the pregnancy unless
she told as she kill her self
Her physical examination revealed:
On her general appearance she looks anxious. Her
vital sign is stable. She has pink conjunctiva and
white sclera. Non-abnormal diagnosis seen on her
lymph nodes, chest, and CVS.
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cont....
On abdominal examination, her abdomen is
flat and moves with respiration. No abnormal
mass felt on palpation.
On Bimanual pelvic examination, the cervix
is positioned anterior and no cervical motion
tenderness, no adnexal mass, and the fundus
measured 8 weeks size uterus
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cont...
on lab. investigation
blood group and RH factor A+
HGB 12g/dl
Urine HCG positive
on obstetrics US
there is viable singleton intrauterine pregnancy
GA 9 wks
Index/conclusion 1st TMP
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The ethical dilemma
I was such in a twisted situation that :
if i refuses to perform the procedure of
termination of pregnancy, either she may go to
unsafe abortion or may take measures on her
own life;
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The ethical dilemma
if i performs the procedure, clearly i violates the law
of abortion service.
This is one of Ethical Dilemma “respecting patient’s
autonomy and terminating the pregnancy vs.
breaching client autonomy and respecting the law of
abortion of the country”
However, despite the fact it is illegal to violate the
law, i has decided to do the procedure to save her life
which will be endangered.
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Cont.….
The experience in such dilemmas of patient
autonomy and safeguarding the law from being
violated can be analyzed using the model for
clinical analysis.
The analysis can help in decision making or
resolve an ethical dilemma.
This model includes a medical indication,
patient preference, quality of life consideration
and related factors
01/23/25 By Milion R(BSc, MScN) 43
Medical Indication
In the medical aspect of the case, I am concerned
with the
patient’s eligibility.
The client came with a complaint about the
absence of menses.
Therefore, her history, Physical examination,
and laboratory result suggested that she is
pregnant.
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Medical Indication
The GA by early obstetrics US is 9 weeks.
Physical examination revealed that uterine
size is comparable with gestational age and
favorable uterus.
It now appears the diagnosis is first-trimester
pregnancy from a casual partner.
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Cont.…
The pregnancy is not wanted
The management planned was to terminate
the pregnancy with manual vacuum
aspiration (MVA).
The probability of mortality and severe
complication of the procedure is very rare.
A determination to go through MVA would
end in the safe termination of the pregnancy
and the relief of psychosocial stress.
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Cont.…
The goal of management was :
to relief her psychosocial pain, terminate the
pregnancy safely.
To use the opportunity to educate on future
reproductive health.
But due to the law of abortion service in the
country do not allow me to do; I was in stress
until I decided the condition.
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Patient preference
It is the Principle of Respect for Autonomy.
This quadrant gives attention to the needs of the
client .
In this case, my client was 32 years old, so that
she was legally competent to have a decision
about her concern.
The client decided to terminate the pregnancy for
which she preferred dying than having a baby
from a casual partner who has his wife and
children.
Therefore, as indicated here she is mentally and
legally competent enough to make a decision.
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Quality of life consideration
The Principles of Beneficence, Non-
maleficence
It is absolutely clear that she would benefit a
lot from the procedure in terms of psychosocial
wellbeing and physical health that would have
easily get her to start her normal life.
on the contrary, if she would fail to have the
safe abortion care she would kill her self.
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Quality of life consideration
cont.…
She would experience several actual &
potential complications from the procedure
such as sepsis, uterine perforation,
bleeding, infertility, pelvic inflammatory
disease (PID), physical disability and
death.
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Contextual (related) factors
This is The Principles of Justice and Fairness.
In this case scenario, the remarkable contextual
feature affecting the case analysis is:
the fear of the legal issue that can affect
clinical decisions.
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Reflection
The specific dilemma which was faced at that
time was between respecting patient autonomy
and terminating the pregnancy or breaching
patient autonomy to safeguard the law.
In this case, the decision made was right in a
patient’s preferences perspective, though I has
violated the law.
It is because of her honesty and being lonely
that makes her tell the reality and put me in a
dilemma to do and not to do.
01/23/25 By Milion R(BSc, MScN) 52
Cont…
One of the ethical codes of clinical care is
autonomy (the right of self-determination,
respecting the choice of the person who can
decide).
I must respect the patient’s choice and the right
to get treatment because she was physically and
mentally competent enough to decide by herself.
Because of this I decided to respect her choice.
01/23/25 By Milion R(BSc, MScN) 53
01/23/25 By Milion R(BSc, MScN) 54
Euthanasia:
From the Greek words “Eu”, goodly or
well + “thanatos”, death, => meaning
“good death”.
The practice of intentionally ending a life
in order to relieve pain and suffering.
The painless killing of a patient suffering
from an incurable and painful disease
Mercy killing to prevent a prolonged and
painful death.
It is also known as:
- Physician Assisted Suicide
- Physician Aid in Dying
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- Mercy Killing
By Milion R(BSc, MScN) 55
Types of Euthanasia
1.Active euthanasia: Is a deliberate attempt to
end life.
e.g., deprivation of oxygen supply, administering
an agent that would result in death.
2. Passive euthanasia: allowing death by
withdrawing or withholding treatment.
This includes:
- Switching off life-support machines
- Disconnecting the feeding tube
- Not carrying out a
life-extending operation
- Not giving the patient life-extending
drugs
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Countries which Support End of Life
Options
8 –Western Countries
5-US States
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Nursing Code of Ethics
Code of ethics is formal statement of a group’s
ideas and values that serve as a standards and
guidelines
Purposes of code of ethics
i. To understand professional nursing conduct.
ii. To provide a sign of the profession’s commitments to the
public it serves.
iii.To outline the major ethical considerations of the
profession.
iv.To provide general
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guidelines for professional behavior.
By Milion R(BSc, MScN) 58
Nursing Code Cont’d
1. ICN Code Of Ethics
The need for nursing is Universal.
Responsibility & accountability
The fundamental responsibility of the nurse is fourfold:
To promote health,
To Prevent illness,
To Restore health, and
To Alleviate suffering
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Nursing Code Cont’d
i. Nurses and people
The nurse’s primary responsibility is to provide care for
people who require nursing care
ii. Nurses and Practice
The nurse caries responsibility for nursing practice and
for maintaining competence by continual learning.
iii. Nurses and Society
The nurse shares with other citizens the responsibility
for initiating and supporting actions to meet the health
and social needs of the public
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Nursing Code Cont’d
iv. Nurses and Co-workers
The nurse sustains a cooperative relationship
with co-workers in nursing and other fields.
v.Nurses and the Profession
The nurse plays the major role in determining
and implementing desirable standards of nursing
practice and nursing education.
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Nursing Code Cont’d
2. ANA Code of Ethics for Nurses
a) Practices with compassion and respect for
inherent dignity
b) Commitment is to the patient.
c) Promotes and protect the health, safety and
rights of the patient.
d) Responsible and accountable for nursing
practice & delegation of tasks to provide
optimum care.
e) Participates in establishing, maintaining, and
improving health care environment.
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Nursing Code Cont’d
Nursing code of ethics in Ethiopia
The Ethiopian nurses association (ENA) code of
ethics comprises key elements of the code.
1. Accountability and responsibility
The fundamental responsibility of the nurse is
fourfold: to
i. promote health,
ii. prevent illness,
iii. restore health and
iv. to alleviate suffering
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Nursing Code Cont’d
2. Respect right and dignity
The nurse in providing care, unrestricted by
consideration of nationality, race, creed, color,
age, sex, politics, religion or social statues.
3. Confidentiality
Keeping the information of the patient/client secret
4. Professional development
The nurse plays the major role in determining and
implementing desirable Standards of nursing practice
and nursing education.
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Responsibilities of nurses for specific
ethical issues
Patient’s bill of rights
Statement on a patient’s bill of rights was
approved by the House of Delegates in February
6, 1973.
The American Hospital association presents a
patient’s bill of rights with the expectation that
observance of these rights will contribute to more
effective patient care and greater satisfaction for
the patients, and the hospital organization.
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Responsibilities of nurses Cont’d
The patient’s rights are as follows:
1.The patient has a right to considerate and
respect full care.
2.The patient has a right to obtain from his
physician complete current information
concerning his diagnosis, treatment and
prognosis in terms the patient can be
reasonably expected to understand.
When it is not medically advisable to give such information
to the patient, the information should be made available to
an appropriate person on his behalf.
He has the right to know by name the physician
responsible for coordinating his care.
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3. The patient has the right to receive from his
physician information necessary to give
informed consent prier to the start of any
procedure and / or treatment.
4. The patient has the right to refuse treatment
to the extent permitted by Law and to be
informed of the medical consequences of his
action.
5. The patient has the right to every
consideration of his privacy concerning his
own medical care program.
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Responsibilities of nurses Cont’d
6. The patient has the right to expect that all
communications and records pertaining to his
care should be treated as confidential,
7. The patient has the right to expect that
within its capacity a hospital must make
reasonable response to the request of a
patient for their services.
The hospital must provide evaluation, service, and/
or referral as indicated by the urgency of the case.
The institution to which the patient is to be
transferred must first have accepted the patent for
transfer.
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Responsibilities of nurses Cont’d
8. The patient has a right to obtain
information as to any relationship of his
hospital to other health care and
educational institutions as far as his care
is concerned.
The patient has the right to obtain information as to
the existence of any professional relationships
among individuals, by name, who is treating him.
9. The patient has the right to be advised if
the hospital proposes to engage in or
perform human experimentation affecting
his care or treatment.
The patient has the right to refuse to participate in
such research
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By Milion R(BSc, MScN) 69
Responsibilities of nurses Cont’d
10.The patient has the right to expect
reasonable continuity of care.
He has the right to know in advance what appointment
times and physicians are available and where.
The patient has the right to expect that the hospital will
provide a mechanism where by he is informed by his
physician or a delegate continuing health care
requirements following discharge.
11.The patient has the right to examine and
receive an explanation of his bill regardless
of the source of payment.
12.The patient has the right to know what
hospital rules and regulations apply to his
conduct as a patient.
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Any
Question?
Shukran for your
Attention !!
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