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This book has considered ethics in the context of human vulnerability. We are vulnerable because we can be affected by things across the life span, and we can be affected by things because we are physical beings – part of the world around us and subject to the passage of time. Consequently, a life can come to an end at any time. For this reason, death is not only completely normal, but inevitable. Nevertheless, death is typically regarded as something regrettable. Issues of personhood and autonomy lie at the centre of bioethical debates about the ending of human life, especially where this involves abortion and euthanasia. Against the backdrop of these issues, this chapter provides an overview of the main legal and ethical considerations relating to abortion and euthanasia.
The focus of this chapter is consent. Consent concerns the granting or withholding of permission to receive care. This chapter addresses the legal requirements of consent for adults and children, and looks at the place of guardianship and advocacy in decision-making. It also considers the situation of people who are not mentally competent who may require emergency care or who need to be restrained against their will. Consent is fundamental to the moral and professional principle that health care should be geared to the patient’s interests as the patient understands them. This is sometimes referred to as ‘patient-centred care’.
This chapter addresses the topic of information we receive about or from patients and introduces the concepts of privacy and confidentiality in relation to the management of patient information. In this chapter we also outline legal requirements for reporting harmful conduct of health professionals and others. Providing excellent nursing care for a patient requires that each nurse involved in the patient’s care acquire relevant information from the patient (or a representative) concerning the patient’s symptoms, their lifestyle, their medications, their concerns and their experiences. Therefore, nurses routinely see, hear, read and record things about other people that are not normally discussed outside the health-care setting, and have privileged access to matters of patient privacy. This brings with it certain legal and moral obligations. Therefore, managing information about patients is one of the most important ethical and legal roles nurses play in health care and, owing to modern technology (as we discuss below), it is arguably one of the greatest challenges faced by professional practice.
As a nurse, you will be called upon to support, care for and protect people who are vastly different from yourself. How you respond to the diversity of human beings will be a measure of your own humanity as well as your professionalism. Certainly, caring does not come as easily to some nurses as it does to others. So why do people want to support the ill or incapacitated? What is it about human nature that causes people to care for each other at all?This chapter will provide a response to this question through a description of the human person as a dynamic unity of personal factors (such as biology and psychology); interpersonal factors (such as relationships with immediate family and close friends); and social factors (such as type of education, or socioeconomic status). The concept of vulnerability will be discussed, where you will see that it is vulnerability that gives us the capacity to care for each other.
This Chapter will focus on one of the main parts of the civil law that is relevant for nurses: the law of negligence. The law of negligence is a part of the civil law that allows a person to bring legal proceedings against another person to correct a wrong or harm that the other person has done to them. Usually the person who has been harmed (the plaintiff) will seek payment of damages in compensation for their injury from the person whose act or omission caused the harm (the defendant). This Chapter will outline the key parts of the law of negligence. The particular focus of the Chapter will be on the special rules that have developed in the law of negligence in relation to health care professionals, including nurses. By understanding how the law will apply to things nurses do that cause people harm, it should be possible for nurses to better avoid acting negligently.
In examining the challenges facing the nurse in the area of aged care some of the philosophical and ethical aims of this book are most acutely demonstrated. In general, in advanced capitalist societies such as Australia, there is a tendency to regard ageing in a negative light. The importance that society attaches to productivity as a measure of value, and the decline of traditional family and community structures, have seen societal attitudes towards the aged shift, from one of respect to a more general disregard or devaluing of the possible contributions of the elderly. It is in this context that the role of the nurse as a builder of capability and a supporter of autonomy becomes most significant. While there are limits to the therapeutic benefit that a nurse can provide to a person’s physical health, nurses can play a substantial role in supporting and promoting the exercise of autonomy in the face of physical changes, especially in the context of ageing.
A sound understanding of moral and legal obligations is critical to developing responsible nursing practice and building the nurse-patient relationship. Ethics and Law for Australian Nurses provides a practical framework for understanding the ethical and legal dimensions of nursing practice. The fourth edition has been thoroughly revised to include updates to legislation, the NMBA professional standards and case examples. A new chapter on the legal system and a fully revised chapter on duty of care and negligence provide a thorough overview of the law as it applies to nursing practice. The text also includes expanded material on the regulation of nursing practice, advanced care directives, cultural safety, practice in the context of digital environments, person-centred care and assisted dying. Written in an accessible and engaging style, Ethics and Law for Australian Nurses provides a comprehensive guide for nurses training and practising in clinical, research and policy settings.
Just like everyone else, nurses sometimes make mistakes that can result in harm to others. The Nursing and Midwifery Board of Australia (NMBA) Code of Conduct for Nurses (NMBA 2018) makes a number of statements in relation to the safe conduct of nursing practice. These statements reflect the expectation that nurses are aware of and committed to industry-wide standards of safety and quality in their practice. Consequently, one could infer that nurses have a moral obligation to deal with clinical errors and incidents in an open, honest and constructive fashion. Some clinical incidents will be the result of clinical error, which is a failure by a clinician to observe the appropriate standards of knowledge and practice. The causes of mistakes can vary greatly too, from the simple and obvious, to complex and systematic problems of workplace culture. How you, as a nurse, respond to your own clinical errors and incidents and those of others is a measure of your professional and moral character and competency.
The focus of this chapter is culture and developing nursing care that is culturally sensitive and culturally safe. To many nurses in Australian culture, the idea of concealing the truth seems improper. Truthfulness underpins our practices of informed consent and also forms the basis of clear communication and trust in the nurse–patient relationship. However, in different cultures there is a common expectation that patients will not be told of certain diagnoses, and that the burden of knowledge and decision-making is delegated to family members. Placing a very high value on truthfulness and the right to know assumes a desire to know the truth on the part of the patient and the community. Not all people or communities hold this desire. In such cases, imposing Western values would be paternalistic, overbearing and disempowering, and would therefore constitute culturally insensitive care. The presence of different cultures in our community brings about social diversity and requires culturally sensitive and culturally safe care from nurses and midwives.
The focus of this chapter is the moral aspects of the nurse–patient relationship. Rights and obligations are like two sides of the same coin. A legal right comes with a corresponding obligation, or duty. A right is a legal entitlement to do something, and an obligation is the constraint upon individuals’ behaviour that comes with that entitlement. However, the nurse–patient relationship involves more than legalities. As discussed in Chapter 1, interpersonal relationships involve moral values, such as respect, beneficence and compassion.
In this Chapter we will focus more on what law is in general, and on some of the basic philosophical and legal principles that make up the Australian legal system. Accordingly, this Chapter will briefly introduce the main features of the Australian legal system, including: the different parts or ‘arms’ of the Government; the sources of law; and some key features of different branches of law relevant to nursing. A basic knowledge of the legal system is fundamental to understanding the law as it applies to nursing practice. Indeed, the very first principle of the Code of conduct for nurses requires that ‘Nurses respect and adhere to their professional obligations under the National Law, and abide by relevant laws’ (Nursing and Midwifery Board of Australia, 2018). This Chapter will look at this aspect of the role of law in nursing through a discussion of a nurse’s ‘scope of practice’.
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