1. ETHICAL & LEGAL
ISSUES IN CRITICAL
CARE
Rehana Tabassum
BSN-Post RN
Specialization in ICU/CCN
2. Ethics :
Ethics derived from the Greek word “ethos”,which
means “way of living”, ethics is a branch of
philosophy thats concerned with
human conduct, more specifically the behaviour of
individuals in society.
.
• It helps us to differentiate between right and wrong
or what we have
3. Ethics in critical care is based on four fundamental
principles:
(1) beneficence, or the health care person obligation to
do good for patients;
(2)nonmaleficence, or the duty to avoid harm;
(3) autonomy, or respect for a patient's right to self-
determination; and
(4) justice, or the fair allocation of healthcare resources
Ethics in critical care
4. ETHICAL ISSUES
• Critical care nurses face ethical issues every day
– Informed consent
– Withholding or withdrawal of treatment
– Organ and tissue transplantation
– Confidentiality
– Distribution of health care resources
– Advanced technology for life-sustaining treatments
• Greater frequency in critical care
5. Bioethics
• Bioethics is the study of ethical issues and judgments made within the
biomedical sciences, including care of patients, the delivery of
healthcare, public health, and biomedical research. Bioethics takes
into account the difficult and practical realities that arise in the clinical
care of people with illnesses.
6. Bioethical Principles
• Non maleficence :
-Never harm anyone
-Not to intentionally inflict harm
• Beneficence:
-Maximize benefit and minimum harm .
-Duty to prevent harm, remove harm, and promote the good of another person
• Autonomy :
-Respect and not to interfere the choice and action of an autonomous
individual.
-Right of self-determination concerning medical care
7. CONT.
• Justice : Fair distribution of benefits and burdens . ( health care
Resources )
• Veracity: An obligation to tell truth .
• Fidelity: To keep promise and fulfill commitments .
• Confidentiality – Respect for right to control information
8. The Nurse’s Ethical Responsibilities
• The nursing profession is guided by the American Nurses
Association (ANA) Code of Ethics for Nurses With Interpretive
Statements
10. Ethics Committees and
Consultation Services
• Many healthcare organizations have an ethics committee or an ethics
consultation service
• Ethical committees are usually multidisciplinary and include
representatives from various patient care professions and disciplines
(eg, nursing, medicine, social work, spiritual care)
• Committee members may also consult at the bedside, providing
education, clarification, or dialogue necessary to assist decision
makers in resolving an ethical problem
11. Their framework for Ethical Decision making includes:
Recognize the Ethical Issue,
Get the Facts,
Evaluate Alternative Actions,
Make a Decision and Test it,
Act and Reflect on the Outcome.
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15. Nurse Involvement in Ethical Decision Making
• Advocacy
– Open communication of patient’s wishes and ethical concerns
– True collaboration with health care team members
• Dilemmas can result in moral distress
• Formal mechanisms
– Bioethics committees
– Ethics consultation
• Opportunities for critical care nurses
– Institutional Ethics Committee membership
– Ethics forums and rounds
– Peer review
– Quality improvement committee membership
– Institutional review boards (research)
16. Ethical Dilemmas in Critical Care
• Withholding and withdrawing treatment
– Patient or surrogate decision in best interest
– Nurse can refuse on moral grounds
• Limits to treatment and medical futility
• Allocation decisions
– Allocation of organs for transplantation.
– Allocation of beds.
17.
18. Common Legal Issues in Critical
Care
•
Negligence (Breach of Duty):
In a malpractice suit, the plaintiff has to show that some type of injury
or harm occurred as a result of the nurse’s actions or inaction.
Malpractice law requires that there be a causal relationship between
the conduct of the nurse and the injury to the patient
19. • Vicarious Liability: In some cases, a person or facility can be held
liable for the conduct of another. This is called vicarious liability.
• Types:
-Respondeat superior: (“let the master answer for the sins of the
servant”) is the major legal theory under which hospitals are held liable
for the negligence of their employees.
-Corporate liability: Occurs when a hospital is found liable for its own
unreasonable conduct. For example, if it is found that a unit is
chronically understaffed and a patient suffers an injury as a result of
short staffing, the hospital can be held accountable.
20. • Negligent supervision: is claimed when a supervisor fails to
reasonably supervise people under his or her direction. For example,
if a nurse is rotated to an unfamiliar unit and informs the charge nurse
that she has never worked in critical care, it would be unreasonable
for the charge nurse to ask her to perform invasive monitoring.
• Rule of personal liability: Liability—that is, nurses are expected to
make sound decisions by virtue of their specialized education,
training, and experience.
21. Legal risk areas
• Assault : Act not performed but develop a fear related to touch and
gives threat verbally or non-verbally.
• Battery : Is the use of force against another, resulting in harmful,
offensive or sexual contact.
• Invasion of privacy : Intrusion into an individual's private and
confidential matters.
• False imprisonment : Is the unlawful restraint of a person against her
will by someone without legal authority.
22. • Defamation : The action of damaging the good reputation of
someone; It two types are :
1. Slander; damaging reputation verbally
2. Libel ; damaging reputation in written form
23. This Photo by Unknown author is licensed under CC BY-NC-ND.
