NUM1205 Legal and Ethical
Requirements in Nursing and
Midwifery Practice
An Introduction to Law and Ethics
Unit Coordinator: Dr Melanie Baker
Objectives
Students will be able to:
• Distinguish Ethics from Law;
• Compare and contrast the theories of Utilitarianism and
Deontology.
• Discuss the importance and the role of hospital ethical
committees;
• Discuss the importance of professional codes.
Ethics vs Law
Ethics Law
‘Ethics is a generic term Binding rules of conduct
covering ways of examining Rules and regulations that
and interpreting the moral guide society
life’ (Beauchamp &
Childress, 2019, p.1). Provide guidance for
healthcare professionals
So ethics examine the
values and actions of The patient retains the
people (that is what people right to refuse treatment
should do). Overriding state interests
can mandate against a
patients wishes
When laws are broken,
offences are punishable by
an authoritative figure
Distinctions between Ethics
and Law
Ethics Law
Internal to oneself: values, External rules and
beliefs and individual regulations of society.
interpretations. Conduct and actions: what a
Motives, attitudes and person did or failed to do.
culture: why one acted as
one did.
They govern society as a
whole, as opposed to the
Good of the individual individual in society.
within society as opposed
to all of society.
Include courts, statutes and
professional bodies
Ethics committees and (Nursing and Midwifery
professional organisations. Board of Australia
(NMBA)/Australian Medical
Association (AMA).
Ethics and Law
Ethics and law are different but may overlap.
Laws reflect the ethical values and morals within a
society.
Ethics and the law share some common ground, but
they are quite distinct.
An issue may have a legal and ethical component but
sometimes may conflict: the issues can be:
“morally right but legally wrong” or
“morally wrong but legally right”
Ethics and Law
Morally wrong but legally right!
Slavery
Apartheid – South Africa
Nazi Germany
Termination of pregnancy?
Animal testing?
Women being paid less for doing the same job
Ethics and Law
Legally wrong but morally right
Euthanasia?
Killing one person to save four people who will die if the
other person is not killed?
Speeding to the hospital with a person who needs
urgent medical assistance
Ethics and Law
The law is static (fixed) and cannot be bent or changed
just because you don’t agree with it.
Ethics are labile (changeable) and views can change just
because circumstances change, even though there is no
change in knowledge.
Can you think of other examples that are legally wrong but
morally right?
Post your thoughts on the discussion board please
Ethics
Ethics is a ‘branch of philosophy concerned with what
constitutes a good life’ (Atkins et al. 2020, p. 25).
Why do we need ethics?
• To assist in decision making
• To contribute to the debate on ethical issues e.g.
The ‘big issues’ include:
termination of pregnancy and euthanasia and end of life
wishes
Everyday issues include:
advising a patient of their diagnoses when the relatives
have asked you not to and washing a patient who
does not want to be washed
Lets explore Ethics further:
what ethics is!
Ethics is:
• prescriptive in that it is what we should do as oppose to
what we actually do;
• concerned with human well being and maintenance of
a peaceful society;
• is a system of overriding rules and principles, which
function by specifying that certain behaviours are either
required, prohibited or permitted.
(Staunton & Chiarella, 2020)
What ethics is not!
These may affect
ethical thought or
gut feelings; be based on ethics
public opinion; but they are not
ethics!
religion;
hospital policy;
medical authority;
professional etiquette;
law.
(Staunton & Chiarella, 2020)
Ethical Practice
Ethical practice is based on critical, reflective thinking
about one’s duties and obligations as a health care
professional in relation to clients or patients and as a
member of a profession fulfilling a social contract.
Healthcare ethics is applied ethics, often referred to
intergangably with practical ethics, and refers to the
practical application of moral considerations. It is ethics
with respect to real-world actions and their moral
considerations in the areas of, for example, private and
public life, the professions, health, technology, law, and
leadership.
Further reading Chapter 2, Staunton and Chiarella (2020).
Ethics: morals and values
The word ‘Ethics’ is derived from the Greek word
‘Ethos’ meaning character, customs or habitual uses.
It’s about determining right conduct from wrong
Concerned with motives and attitudes and associated
with the principles of morality (what is good or
desirable as opposed to that which is bad or
undesirable)
Morals
So if ethics are a system or philosophy of conduct and
principles, then morals are personal principles that are
acquired from life experiences, family and peer
relationships, religion, culture and the law.
Morals: what is considered right or wrong based on
social custom. In contrast ethics are about what is right
or wrong based on reason.
Morals provide the “principles or rules that should
guide human conduct “
(Atkins et al. 2017, p.28)
Values
Values come from within and are individual beliefs that we choose to
embody to guide our actions, the sort of person we want to be, the
manner in which we treat ourselves and others and our interaction
with the world around us.
They are “abstract standards that give a person a sense of what is
right and wrong and establish a code of conduct for living”
(Videbeck, 2004, p. 4).
May have intrinsic worth: love, truth and freedom
May describe traits or behaviours that are instrumental as a means to
an end: ambition, responsibility and courage.
Usually derived from societal norms, family orientation and religion.
They are difficult to compromise because they are perceived as
duties rather than as factors to be weighed in decision making
Values may change over time.
A word of advice..........
Before you move on please make sure that you have
completed the week 1 reading: Chapter 1: Atkins et al.,
2020 – Ethics and Law for Australian Nurses.
You will have a much clearer understanding of how we
as individuals develop ethics, morals and values.
It is available online from the ECU library
Personal/professional values:
where do your values come from?
Values come from individual differences; opinions; family/
socialisation; peers (influence/pressure); religion; life
experience etc. All these factors influence our decision-
making. (Atkins et al., 2020)
In the workplace they give you a sense of worth but two
people often have differing opinions and would reach a
different decision in any given situation, producing a
dilemma.
What is a dilemma?
It’s a predicament, a quandary, a deadlock, a stalemate, a
plight, a difficulty, a fix, a jam, a spot, a pickle!
For example: I was once faced with killing an injured
rabbit or allowing it to die in agony
Ethical dilemmas involve situations where a choice must be
made between alternatives, none of which are acceptable,
that an individual perceives he or she can accept and
reasonably justify on a moral plane or where there is not a
more favourable or appropriate choice that dominates the
situation (Beauchamp & Childress, 2019): When a situation has
two or more possible outcomes and neither (or none) are
desirable.
Study of ethical dilemmas in health care often called Bioethics
The best outcome must be chosen: the best still being
undesirable. But one has to choose the outcome that produces
the least disvalue/harm or the most benefit.
Stop and think……….
Have you had an ethical dilemma?
Post your thoughts on the discussion board
Who should make the
decision?
The best person for the job;
Usually and wherever possible, the person about whom
the decision is to be made;
If not possible, the person’s significant other together
with the multidisciplinary team;
The decision MUST be made in the best interests of the
person for whom the decision is made, regardless of
your own personal beliefs and values.
Hospital Ethics Committees:
ethics committees can……….
provide structure and guidelines for potential problems;
serve as an open forum for discussion;
function as a true patient advocate by placing the patient at
the core of committee discussions.
Ethics Committee Guidelines
Recognise the difference between ethical and legal rights
of individuals;
Health professionals understand and appreciate that their
ethical views and values often differ greatly from those of
the patient’s culture and value system;
When legal issues have not been addressed, health
professionals are guided by the ethics of the profession
and personal values;
Nurses may need to remove themselves from particular
patient care, if values of patient/nurse interferes with
quality nursing care.
Ethical dilemmas have no perfect answers, just better
answers. Legal questions have right and wrong answers.
Stop and think……….
Read and reflect on ‘Why nurses need to know about
ethics’. You will find this reading in the Learning
Resources, on the left side of Bb and in the Module/Week 1
folder under ‘Readings’.
Having read and reflected, please post your thoughts on
the discussion board
Provisions of Professional
Codes
The first International Code of Ethics for Nurses was
established in 1953
The codes address fundamental values and
commitments that relate to ethical obligations, duties,
standards and commitments to society.
Codes promote ethical analysis and aid decision making
in clinical situations.
Understanding of ethical theories and principles, values,
and decision-making models are essential.
Professional Codes for
Healthcare
Code of ethics for nurses (2018) ICN (2012)
Code of ethics for midwives (2018)
Code of professional conduct for nurses (2018)
Code of professional conduct for midwives (2018)
RN Standards for Practice (2016)
Midwifery Standards for Practice (effective 2018
October)
All found at
https://www.nursingmidwiferyboard.gov.au/
Access this website to access your codes and professional
guidelines with which you need to become very familiar.
Bioethics
Concerned with the ethical issues arising from
healthcare, biological and medical sciences.
Bioethics are triggered by, and a response to, the new
scientific/technological developments in biomedical and
life sciences, which create ethical issues in healthcare.
Examples to consider:
• Termination of pregnancy;
• Organ donation and transplantation;
• Withdrawal of treatment;
• Invitro fertilisation (IVF);
• Cloning and stem cell research;
• Female genital mutilation and male circumcision;
• Genetic engineering;
• Palliative care
Ethical Theories
Ethical theories provide part of the decision-making
process for decision making when ethics are involved.
The provide perspectives from which to consider the
course of action to be taken providing individuals with
guidance as they make decisions.
There are two main theories that we will consider:
Utilitarianism
Deontology
Utilitarianism
Utilitarianism is a form of teleology, which is the
explanation of occurrences in terms of the purpose they
serve rather than of the cause by which they arise.
A form of consequentialism, utilitarianism is about
producing utility or the best outcome and the greatest
happiness, regardless of what we have to do or the
action we take to achieve that outcome.
Actions are good or bad according to the their
consequences, rather than by any intrinsic value they
may have (Johnstone, 2016)
Principles of Utilitarianism
The greatest good for the greatest number
The end justifies the means
What is right is what is most useful or valuable. If only undesirable results are possible – having the least disvalue. (Johnstone,
2016.)
Strengths:
• General happiness is a good principle;
• All decisions on right and wrong are easy to make;
• The promotion of happiness seems to be a good moral principle
• The individual does not have to make difficult or distasteful decisions as ‘happiness’ is what is important and right;
• A life-governing principle to “do good” keeps the individuals in society on an even plane.
Weaknesses:
• Calculating good and harm is time consuming and one
might get the calculations wrong!
• How is happiness measured? Is it only physical, or may
psychological happiness be considered; and what of
social happiness and wealth.
• The individual is robbed of personal choice in decision
making, as one must always and only do what maximises
good.
• It may be expecting too much of all individuals to
devote their lives to always doing and being good.
• Can result in horrific acts!
Deontology
DEON = duty and OLOGY = the study of. So deontology is
the study of duty.
Deontology is concerned with what people do, the
morality of their actions, as oppose to the consequences
of their actions.
It is concerned with doing the right thing, regardless of
the outcome. Do it because it's the right thing to do and
don't do wrong things. Avoid them because they are
wrong.
Requires consideration of ones specific duty in this
specific situation? What is the right action to take?
Where does duty come from?
Relationships.
Principles of Deontology
Rights s right
Duty and obligations are of prime importance
Promises must never be broken
One must never (thou shalt not)
Strengths:
• Specific rules form an easy moral code to follow.
• Conscious feelings are easy to attach to duty: “I must keep my promise”; “I must not harm an innocent”
• These are easier to base one’s life actions upon rather than a vague “good for all” code.
• Specific rules absolve the individual: “It’s wrong, so I must not do it”.
Strengths continued:
• Conflicts in society are less: “Thou shalt not kill”.
• Individuals can be true to themselves and not have to
consider the consequences for everyone else.
Weaknesses:
• “ Duty” is a great burden for an individual.
• There may be a situation where two equal duties
conflict.
• The decision about the duty may be easy but the
consequences of it may be impossible to bear.
• It is not necessary to consider the needs of others when
decisions are made but those “others” and what
happens to them may be very important to the
individual.
• The individual has no freedom to act against the
duty/rule, no matter how severe or far-reaching the
consequences might be.
Stop and think
Read and reflect on the following to put utilitarianism and
deontology into context.
The Firing Squad and the In-growing Toenail
You will find this reading in the Learning Resources, on
the left side of Bb and in the Module/Week 1 folder under
‘Readings’. Consider the two scenarios from both
theoretical perspectives and reflect on the differences.
Watch the videos relating to the two main theories, found
in the Module/week 1 folder
Having read and reflected, please post your thoughts on
the discussion board.
Using the Theories
As with all theoretical approaches, they provide the
health care professional with a frame of reference.
No single theoretical approach is appropriate in all
contexts of healthcare.
One should combine the best features of both theories.
Professionals work within the confines of their code of
conduct and take into account their own beliefs,
cultural and social influences, in addition to those of
their clients.
Factors influencing ethical
decision making
The healthcare professional’s perception of his or her
level of influence within the health care setting.
The level of clinical expertise and competence of the
healthcare professional making the decision.
The degree of ethical concern involved.
The past experience of ethics education.
Ethical Decision Making
Ethical dilemmas involve situations where a choice must
be made between alternatives that an individual
perceives he or she can accept and reasonably justify on
a moral plane or where there is not a more favourable
or appropriate choice that dominates the
situation(Beauchamp & Childress, 2019)
The study of ethical dilemmas in health care is often
called Bioethics (Staunton & Chiarella, 2020)
A Model for Ethical Decision-Making
Clearly state the problem
Get the facts
Consider the ethical principles
Consider how the problem would look from
another perspective or using another theory
Identify ethical conflicts
Consider the law
Making the ethical decision
Decision Making Process: six
questions
What is my duty in this particular circumstance?
By carrying out my duty, will my actions produce the best
available consequences for all concerned?
Will my actions cause harm? (Nonmaleficence)
Am I going to do or promote good? (Beneficence)
Am I respecting the patient’s wishes? (Autonomy)
Are my actions fair? (Justice)
The last four statements refer to ethical principles and will
be the next issues we consider in the unit.
Summary
Ethical dilemmas arise frequently in healthcare.
The best person to make a decision that will affect the
life of an individual, is the individual.
Consider your duty as a nurse and promote beneficial
consequences – or the action with the least disvalue.
Consider the ethical principles (next lecture)
Act within:
• the law
• the confines of the Professional Code of Conduct for the
Nurses/Midwifes March 2018
• your scope of professional practice
• professional boundaries
• your contract of employment.
Remember
You will have a clearer and deeper understanding if you
read the recommended chapter/s from the required text
each week. Ethics and Law for Australian Nurses (Atkins et
al., 2020) is available online through the ECU library.
The other resources, including readings and videos, along
with the tutorial activities, are designed to help you
consolidate the theory provided in the lecture. Attending
and participating in them helps to retain the knowledge.
Reflecting on the lecture and activities each week and
contributing to the discussion board will develop a
community of knowledge and support, aiding your
understanding of the unit content.
HAVE A GREAT WEEK
