Ethics and the
Law
ARLEN JAMES -EUIN
21/10/24
• Definition of terms
• Explain the relevant theories
and principles related to ethics
• Compare the ICN’s /ICM’s
code of ethics to the
Nursing/Midwifery Council’s
code of ethics
Objectives
• Identify ethical dilemmas in
nursing/midwifery practice
• Explain the legal framework
in nursing/midwifery
practice(Nursing Personnel
Act of 2014)
Introduction
Terms
• Ethics comes from Greek word
Ethos(character/custom/disposition)
• The systemic study of morality
• It involves moral judgement, moral
decisions, about human behaviour or
conduct
Terms
Morality: Latin(Moralis) custom or
character in which people do things
Morality -------ethics in action
Morality cont’d
Speaks to questions of
Freedom
Privacy
Equality
Duty
Obligation
Choice
Conduct
H OW A P E R S O N O U G H T T O AC T
RESPO NSIBLY
T O W H A T E X T E N T I S T H E AC T I O N
RIGHT OR WRONG
Other Terms
MORAL CODE
VA L U E S Y S T E M
TRAITS
Other Terms
Virtues—concern, decency, loyalty, confidence, growth order , freedom
Vices ----apathy, vulgarity, treason, stagnation chaos slavery
Three categories of
ethics:
Meta ethics
Normative ethics
Descriptive ethics
Categories cont’d
Categories cont’d
Theories of Ethics
Based on the
assumption that
True or false?
people are rational
and make free choices
Cont’d
• Not always and absolutely true
• People act emotionally-make mistakes
• Persons do not make free choices when
under duress(gun pointed at them)
• May not make free choice if job is on the
line
peace
Ethical theories
Happiness wellbeing
Ethical Rules
Apply to all of us ---to achieve good results for
people and situations
Respects –all unique-values & goals
We have judgement and will
Ethical Theories
TITLE FOR X TITLE FOR X
What are the most important things that …from another contrasting or competing
differentiates your subject or big idea… subject or idea.
Theories cont’d
CONSEQUENTIALISM RELATIVISM
Theories cont’d
CULTURAL RELATIVISM DRESS DEVINE COMMAND THEORIES
Something is right because God wills it
Cont’d
ETHICAL EGOISM ETHICAL DECISION MAKING
Each person focuses on self interest
The morally right action is the action that will
provide the person with the maximum long-
term benefit
Cont’d
BEHAVING GOOD TAKES COURAGE
Most of the time we behave good—usually Sometimes it is difficult to do good if we
not a burden could suffer negative consequences
Honest Professional Courage
◦ Admitting to a client that something is faulty
Keep our promises
◦ Declining to do a job if you are not qualified
Do not steal ◦ Speaking out when you see someone doing
something wrong
Do our jobs
Cont’d
INTEGRITY RIGHT & WRONG
Cornerstone of ethical behaviour Determining right or wrong
◦ Act in accordance with a personal code/set of ◦ Law
principles ◦ Codes of conduct
◦ Extend to others the same respect and ◦ Professional ethics
consideration that you desire
◦ Personal ethics
◦ Apply the same moral standards in all situations
Core Principles In Ethics
AUTONOMY BENEFICENCE
The principle of respect for autonomy The ethical principle of beneficence requires
focuses on the right of self-determination. that potential benefits to individuals and to
society be maximized and that potential
It grants importance to individual freedom in harms be minimized
political life, and to personal development .
A duty to help others gain what is of benefit
to them
Persons who are autonomous can choose and People take actions to benefit and promote
act on plans they themselves have selected. the welfare of other people
Principles
NON-MALEFICENCE JUSTICE
The theory of justice proposed by John Rawls is a
The principle of Nonmaleficence requires leading example of “justice as fairness”.
that harmful acts be avoided. Refers to fairness, treating people equally &
without prejudice
It recognizes that intentionally or negligently
causing harm is a fundamental moral wrong Social justice refers to how benefits and burdens
should be distributed fairly among members of a
It does not preclude balancing potential society
harms against potential benefits. “Social justice is the view that everyone deserves
“One ought not to inflict evil or harm” equal economic, political and social rights and
opportunities.” (United Nations 2016 )
(Beauchamp & Childress 2001)
Cont’d
PUBLIC CONCERN
Monitoring of workers use of IT
Security pass codes for workers
Some workers have limited or no access to some
forms of data
Confidentiality
Plagiarism
AI
Cont’d
IMPORTANCE
Gain the goodwill of the community
Create an organization that operates consistently
To protect the organization and employees from
litigation
Avoid unfavourable publicity
Provide excellent service
Strong employee communication/bond
Cont’d
CHARACTERISTICS- SIX PILLARS EFFECTIVE ETHICAL DECISIONS
Trustworthiness – people believe in us and hold us in higher esteem. .
Ethical Decisions. A decision is ethical
Respect - do unto others as you would have them do unto you.
when it is consistent with the Six Pillars of
Responsibility - Our capacity to reason and our freedom to choose make us
morally answerable.
Character – ethical decisions generate and
sustain trust; demonstrate respect,
Fairness –implies adherence to a balanced standard of justice without relevance
to one’s own feelings or inclinations. responsibility, fairness and caring; and are
Caring - an emotional response to both the pain and pleasure of others. consistent with good citizenship.
Citizenship -includes civic virtues and duties that prescribe how we ought to
behave as part of a community. (Source::MAKING ETHICAL DECISIONS JOSEPHSON INSTITUTE OF ETHICS. Effective Decisions. A decision is effective
www.josephsoninstitute.org .
if it accomplishes something we want to
happen, if it advances our purposes.
ONE: TWO:
Statutes Negligence/malpractice
The Law THREE:
FOUR:
Defamation Confidentiality
FIVE: SIX:
Battery mandatory Reporting
Nursing and the law
• A code that regulates nurses’ conduct
• Three main components
• A duty to conform to a specific standard
• Apply to all nurses
• Can be enforced
Statute law
• Statute
• A law enacted by the legislative branch of government(Parliament)
• Statutes Act of 1962– overarching act
• Nursing and Midwives Registration Act 33 of 1960
• NOW
• Nursing Personnel Act 8 of 2014
TORT
• A wrongful act other than a breach of contract that injures another and for which the law imposes
civil liability : a violation of a duty (as to exercise due care) imposed by law as distinguished from
contract for which damages or declaratory relief (as an injunction) may be obtained.
• https://www.merriam-webster.com/dictionary/tort#:~:text=Legal%20Definition-
,tort,an%20injunction)%20may%20be%20obtained
• A tort is an act or omission that gives rise to injury or harm to another and amounts to a civil wrong
for which courts impose liability. https://www.law.cornell.edu/wex/tort
TORT cont’d
Primary aims
• To provide relief to injured parties for harms caused by others,
• To impose liability on parties responsible for the harm,
• To deter others from committing harmful acts.
• Torts can shift the burden of loss from the injured party to the party who is at fault or better suited to
bear the burden of the loss. (Damages can be awarded in the form of monetary compensation,,
injunction and restitution)
• The boundaries of tort law are defined by common law and state statutory law.
https://www.law.cornell.edu/wex/tort
TORTS cont’d
• Three general categories:
• Intentional torts (e.g., intentionally hitting a person);
• Negligent torts (e.g., causing an accident by failing to obey traffic rules); and
• Strict liability torts (e.g., liability for making and selling defective products - see Products Liability).
TORTS cont’d
INTENTIONAL: UNINTENTIONAL:
◦Fraud ◦Negligence
◦Invasion of privacy ◦Malpractice =
◦Defamation of character negligence as it applies
◦False imprisonment to a professional
◦Assault and/or battery person
Negligence or malpractice
NEGLIGENCE MALPRACTICE (SPECIFIC)
•Failure to exercise the care that a reasonably
prudent person would exercise in like
circumstances. The area of tort law known as “Failure of a professional person in
negligence involves harm caused by carelessness, accordance with prevailing professional
not intentional harm.
https://en.wikipedia.org/wiki/Negligence standards or failure to foresee the
consequences of their actions.”
•Overlooking or lacking in due care
Malpractice is considered intentional because
•Carelessness its focus is only on standards of care.
•Deviation from the set standard of care
Negligence can be sometimes unintentional
Cont’d
MEDICAL MAL- PRACTICE ELEMENTS OF MAL -PRACTICE
Professional negligence by act or omission by FOUR elements must be met to prove guilty of
malpractice
a health care provider in which the treatment
Duty - (relationship) nurses' responsibility to provide care
provided falls below the accepted standard of in an acceptable manner
practice in the medical community and causes
Breach of Duty - failed to provide care in acceptable
injury or death to the patient, with most cases manner
involving medical error. Injury (damages)- nurses act caused harm
https://en.wikipedia.org/wiki/Medical_malp
Proximate cause - reasonable cause and effect can be
ractice_in_the_United_States shown between the omission or commission and the
harm
Cont’d
COMMON ISSUES OF MAL-PRACTICE
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
Defamation
• “making some accusatory or false statements”.
• These statements can be libel i.e., written statements or slanders.
Patient confidentiality
A nurse must maintain the If a nurse fails to protect
confidentiality and privacy this information or share
of patients’ data. it with any unauthorized
(electronic data, insurance individual through any
records, or other health- platform, then he/she will
related records). have to face legal actions.
Battery
Battery is associated with physical harassment or “touching someone without their
consent” (RegisteredNursing.org).
Nurses should consider when proximity or physical contact with the patient is
required. They should ALWAYS ASK permission before further proceeding.
Patients have the right to deny the help or physical interaction and even the treatment.
They can ask for legal activity if one touches them without their proper consent.
• It’s a nurse’s professional, moral,
and legal duty to report abuse,
neglect, epidemics, or any other
communicable to infectious
diseases.
Mandatory
• One should also report if they
reporting find any other healthcare
provider is performing unsafe or
illegal practices.
• Nurses should do everything in
the best interest of their
patients.
Consequences of Non -adherence
Loss Loss of trust
by patients, Unpaid leave from
colleagues, and Demotion Job termination
work
employers
Loss of any
Heavy fines or specialized board
Criminal charges Jail time credentials and
penalties
certifications
Cancellation of
licensure on a
temporary or
permanent basis
Nursing Council
oF Trinidad &
Tobago
N U R S I N G P E R S O N N E L AC T # 8 O F
2014
Nursing Personnel Act #8 2014(T&T)
https://agla.gov.tt/downloads/laws/29.53.pdf
https://agla.gov.tt/downloads/laws/29.53.pdf
Nursing Professional registration
https://www.trade.gov/country-commercial-guides/trinidad-and-tobago-licensing-
https://www.trade.gov/country-commercial-guides/trinidad-and-tobago-licensing-requirements-professional-services
requirements-professional-services
https://www.trade.gov/country-commercial-guides/trinidad-and-tobago-licensing-requirements-professional-services
Dangerous Drug Act
https://agla.gov.tt/downloads/laws/11.25.pdf
https://agla.gov.tt/downloads/laws/11.25.pdf
ICN Code of Ethics
Q1 Q5 Q4
2O24 2024
Nurses and people Nurses and practice Nurses and profession
Nurses and global health Professional values Lorem ipsum
Q2 Q3 Big milestone
2024 2024
ICM Code of Ethics
Q1 Q5 Q4
2O24 2024
Midwifery relationships Practice of midwifery Professional Responsibilities
of midwives
Advancement of midwifery
practice Professional values Lorem ipsum
Q2 Q3 Big milestone
2024 2024
ONE: TWO:
definition principles
Key Takeaways THREE: FOUR:
Deontology Cosequentialism
FIVE: SIX:
Use in Nursing Purpose
What ethics is/what it is not
What Ethics is NOT What Ethics is
Ethics is NOT simply about matters of a private nature Ethics is a community enterprise based on universal
or about personal feelings, attitudes and values principles and reasoned public debate
It is not about mysterious occult processes, feeling in Ethics is about real power relations between people
the gut, or privileged access to moral truth and the basis of power-sharing between them
It is NOT a business for experts, for religious It is about participation in a moral community and
authorities, lawyers, philosophers or gurus ownership of the policies it develops
It is not about endless disputes, disagreements, It is a problem-solving activity based on knowledge of
dilemmas, nor about the grandstanding our opinions principles and skills in their application
It is not a matter of innate knowledge, special powers It is an educational process in which we can do what it
of intuition or supernatural revelation means to be responsible moral agents.
ETHICAL RULES
• Professional Codes of Ethics are statements encompassing rules that
apply to persons in professional roles.
• The rules found in these professional codes of ethics are specific
applications of universal moral principles.
• They are morally binding and legally required
• Codes of ethics prescribe duties that are required of the professional
in response to rights of the client.
PRINCIPLES OF ETHICS
PRINCIPLES OF ETHICS
• Beneficence
• Nonmaleficence
• Respect for autonomy
• Justice
Practical Ethics
• Two arms of thoughts exist in decision-making:
• In deontological ethics, duties/obligations are of prime importance
(i.e., end/outcomes may not justify the means)
• In utilitarian ethics, outcomes justify the means or ways to achieve it
DEONTOLOGICAL THEORY
• Established by Immanuel Kant (1724-1804)
• Deontological theories (sometimes referred to as Kantian theories)
hold that people should not be treated as means to an end and that
some actions are right or wrong regardless of the consequences.
• It is an approach to ethics that is focused on duties and rules.
• The goal of finding the greatest good by balancing the interests of all
affected persons depends upon judgments about likely outcomes for
all.
DEONTOLOGICAL (DUTY-BASED) ETHICS
• This is concerned with what people do, not with the consequences of
their actions.
• Do the right thing.
• Do it because it's the right thing to do.
• Don't do wrong things.
• Avoid them because they are wrong.
UTILITARIAN THEORY
• The utilitarian philosophy was developed by Jeremy Bentham (1748–
1832)
• He argued that the rightness of an act or policy was determined by
the extent to which it would result in the greatest happiness of the
greatest number.
• Mills believed that communities usually agree about things that are
good and the best to promote the well-being of most people.
UTILITARIAN THEORY
• There are three fundamental principles that utilitarianism follows to create
an ethical structure for society.
• Actions are right and only right if the consequences of them maximize
whatever is good or anything that is “bad.”
• The only thing that is good in society is happiness.
• Actions are only correct if they can maximize pleasure for the majority of
everyone.
Application to
practice
• BENEFICENCE
• The need for health care forms the basis of the
relationship between nurses and client and
imposes a moral duty on the nurse to benefit the
client through nursing actions.
APPLICATION FOR • Moral conflicts arise where decisions must be made
& may lead to Paternalism (a liberty-limiting
PRACTICE principle that is frequently invoked to override
people’s actions or expressed wishes for their own
good or best interest)
• BENEFICENCE
• Supporting health improvement with individuals,
families, and communities by identifying health
needs, taking account of the broader social
APPLICATION FOR determinants of health
PRACTICE • Applied to:
-Balancing harms & benefits to client populations
- The use of cost benefit analysis in decisions
affecting client populations
APPLICATION FOR PRACTICE
Ensuring that nursing
practice uses evidence-based
approaches and is This is important for two
NONMALEFICENCE
undertaken in a way that is reasons:
cost-effective for the
disadvantaged.
-delivering care to
-practice that is delivered
populations with fewer
inappropriately through
needs involves time and
outdated methods or
opportunity costs
without an evidence base
for the health of those who
may be harmful to clients
need it the most
• RESPECT FOR AUTONOMY
• Supporting self-determination by building the self-
esteem of clients and encouraging active
participation in how they change their lives to
improve their health.
APPLICATION FOR
PRACTICE • To respect persons as autonomous individuals is to
acknowledge their personal rights to make choices
and act accordingly(rational human beings)
• RESPECT FOR AUTONOMY MEANS:
• Respect for persons
APPLICATION • The protection of privacy
• The provision of informed consent
FOR PRACTICE • Individual freedom of choice
• JUSTICE
• Ensuring that nursing practice is delivered equitably
across the population and is focused on addressing
APLICATION TO the needs of vulnerable groups and seeking to
reduce the impact of health inequalities
PRACTICE • Equals should be treated equally
• “Those who are unequal should be treated
differently according to their differences”
(Beauchamps and Childress 1989)
Key Take aways
• Recognize ethical issues;
• Develop critical thinking and self-confrontation skills;
• Cultivate tolerance towards disagreement and the inevitable ambiguities in dealing with ethical problems; and
• Elicit a sense of moral obligation and develop a personal code of ethics.
References
• https://www.slideshare.net/slideshow/lecture1-introduction-to-ethics/122984524
• Types of Torts – Torts
