Ethico – Moral responsibility of Nurses in Surgery

Ethos 
 comes from Greek work w/c means character/culture
 Branch of Philosophy w/c determines right and wrong
Moral 
 personal/private interpretation from what is good and bad.
Ethical Principles:
1. Autonomy – the right/freedom to decide (the patient has the right to refuse
despite the explanation of the nurse) Example: surgery, or any procedure
2. Nonmaleficence – the duty not to harm/cause harm or inflict harm to others
(harm maybe physical, financial or social)
3. Beneficence– for the goodness and welfare of the clients
4. Justice – equality/fairness in terms of resources/personnel
5. Veracity – the act of truthfulness
6. Fidelity – faithfulness/loyalty to clients
Moral Principles:
1. Golden Rule
2. The principle of Totality – The whole is greater than its parts
3. Epikia – There is always an exemption to the rule
4. One who acts through as agent is herself responsible – (instrument to the crime)
5. No one is obliged to betray herself – You cannot betray yourself
6. The end does not justify the means
7. Defects of nature maybe corrected
8. If one is willing to cooperate in the act, no justice is done to him
9. A little more or a little less does not change the substance of an act.
10. No one is held to impossible
 Law – Rule of conduct commanding what is right and what is wrong. Derived
from an Anglo-Saxon term that means“that which is laid down or fixed”
 Court – Body/agency in government wherein the administration of justice is
delegated.
 Plaintiff – Complainant or person who files the case (accuser)
 Defendant – Accused/respondent or person who is the subject of complaint
 Witness– Individual held upon to testify in reference to a case either for the
accused or against the accused.
Written orders of court
Writ – legal notes from the court
1. Subpoena
1. Subpoena Testificandum – a writ/notice to an individual/ordering him to
appear in court at a specific time and date as witness.
2. Subpoena Duces Tecum- notice given to a witness to appear in court to
testify including all important documents
2. Summon – notice to a defendant/accused ordering him to appear in court to
answer the complaint against him
3. Warrant of Arrest – court order to arrest or detain a person
4. Search warrant – court order to search for properties.
Public law  
 body of law that deals with relationship between individuals and the
State/government and government agencies. Laws for the welfare of the general
public.
Private/Civil Law 
 body of law that deals with relationships among private individuals
Private/Civil Law 
1. Contract law – involves the enforcement of agreements among private
individuals or the payment of compensation for failure to fulfill the agreements
 Ex. Nurse and client nurse and insurance
 Nurse and employer client and health agency
 An agreement between 2 or more competent person to do or not to do
some lawful act.
 It maybe written or oral= both equally binding
Types of Contract:
1. Expressed –when 2 parties discuss and agree orally or in writing the terms and
conditions during the creation of the contract.
 Example: nurse will work at a hospital for only a stated length of time (6
months),under stated conditions (as volunteer, straight AM shift, with
food/transportation allowance)
2. Implied – one that has not been explicitly agreed to by the parties, but that the
law considers to exist.
 Example: Nurse newly employed in a hospital is expected to be competent
and to follow hospital policies and procedures even though these expectations
were not written or discussed.
 Likewise: the hospital is expected to provide the necessary supplies,
equipment needed to provide competent, quality nursing care.
Feature/Characteristics/Elements of a lawful contract:
1. Promise or agreement between 2 or more persons for the performance of an
action or restraint from certain actions.
2. Mutual understanding of the terms and meaning of the contract by all.
3. A lawful purpose – activity must be legal
4. Compensation in the form of something of value-monetary
Persons who may not enter into a contract: minor, insane, deaf, mute and ignorant
Tort law
 Is a civil wrong committed against a person or a person’s property.
 Person/person’s responsible for the tort are sued for damages
 Is based on:
 ACT OF COMMISSION –something that was done incorrectly
 ACT OF OMMISION – something that should have been done but was
not.
Classification of Tort
Unintentional Tort
1. Negligence
 Misconduct or practice that is below the standard expected of ordinary,
reasonable and prudent person
 Failure to do something due to lack of foresight or prudence
 Failure of an individual to provide care that a reasonable person would ordinarily
use in a similar circumstance.
 An act of omission or commission wherein a nurse fails to act in accordance with
the standard of care.
Doctrines of Negligence:
1. Res ipsa loquitor – the thing speaks for itself – the injury is enough proof of
negligence
2. Respondeat Superior – let the master answer command responsibility
3. Force majuere – unforeseen event, irresistible force
2. Malpractice
 stepping beyond one’s authority
6 elements of nursing malpractice:
1. Duty – the nurse must have a relationship with the client that involves providing
care and following an acceptable standard of care.
2. Breach of duty
 the standard of care expected in a situation was not observed by the
nurse
 is the failure to act as a reasonable, prudent nurse under the
circumstances
 something was done that should not have been done or nothing was done
when it should have been done
3. Foreseeability – a link must exist between the nurse’s act and the injury suffered
4. Causation – it must be proved that the harm occurred as a direct result of the
nurse’s failure to follow the  standard of care and the nurse should or could have
known that the failure to follow the standard of care could result in such harm.
5. harm/injury –physical, financial, emotional as a result of the breach of duty to the
client Example: physical injury, medical cost/expenses, loss of wages, pain and
suffering
6. damages – amount of money in payment of damage/harm/injury
Intentional Tort
 Unintentional tort – do not require intent bur do require the element of HARM
 Intentional tort – the act was done on PURPOSE or with INTENT
 No harm/injury/damage is needed to be liable
 No expert witnesses are needed
Assault
 An attempt or threat to touch another person unjustifiably
 Example:
 A person who threatens someone with a club or closed fist.
 Nurse threatens a client with an injection after refusing to take the meds
orally.
Battery
 Willful touching of a person, person’s clothes or something the person is carrying
that may or may not cause harm but the touching was done without permission,
without consent, is embarrassing or causes injury.
 Example:
  A nurse threatens the patient with injection if the patient refuses his meds
orally. If the nurse gave the injection without client’s consent, the nurse would
be committing battery even if the client benefits from the nurse’s action.
False Imprisonment
 Unjustifiable detention of a person without legal warrant to confine the person
 Occurs when clients are made to wrongful believe that they cannot leave the
place
 Example:
 Telling a client no to leave the hospital until bill is paid
 Use of physical or chemical restraints
 False Imprisonment Forceful Restraint=Battery
Invasion of Privacy
 intrusion into the client’s private domain
 right to be left alone
Types of Invasion the client must be protected from:
1. use of client’s name for profit without consent – using one’s name, photograph
for advertisements of HC agency or provider without client’s permission
2. Unreasonable intrusion – observation or taking of photograph of the client for
whatever purpose without client’s consent.
3. Public disclosure of private facts – private information is given to others who
have no legitimate need for that.
4. Putting a person in a false/bad light – publishing information that is normally
considered offensive but which is not true.
Defamation
 communication that is false or made with a careless disregard for the truth and
results in injury to the reputation of a person
Types:
1. Libel – defamation by means of print, writing or picture
1. Example:
2. o writing in the chart/nurse’s notes that doctor A is incompetent because
he didn’t respond immediately to a call
2. Slander – defamation by the spoken word stating unprivileged (not legally
protected) or false word by which a reputation is damaged
1. Example:
 Nurse A telling a client that nurse B is incompetent
 Person defamed may bring the lawsuit
 The material (nurse’s notes) must be communicated to a 3rd party
in order that the person’s reputation maybe harmed
Public Law:
Criminal Law – deals with actions or offenses against the safety and welfare of the
public.
1. homicide – self-defense
2. arson- burning or property
3. theft – stealing
4. sexual harassment
5. active euthanasia
6. illegal possession of controlled drugs

http://rnpedia.com/nursing-notes/fundamentals-in-nursing-notes/ethico-moral-aspects-
nursing/

Sterilization/ Mutilation

Medical Definition of Sterilization, surgical

Sterilization, surgical: Surgical sterilization is a contraceptive option for people who do
not want children in the future. It is considered permanent because reversal requires
major surgery that is often unsuccessful.
Female sterilization blocks the fallopian tubes so the egg cannot travel to the uterus.
The procedure, including tubal ligation is done by various surgical techniques, usually
under general anesthesia.
Complications are rare but can include infection, hemorrhage (bleeding), and problems
related to the use of general anesthesia.
Male sterilization, called vasectomy, involves sealing, tying or cutting a man's vas
deferens, the tube which otherwise would carry the sperm from the testicle to the penis.
Vasectomy is a relatively short operation, usually takes under 30 minutes, and carries
the risk of surgical complications such as bleeding or infection.
https://www.medicinenet.com/script/main/art.asp?articlekey=9777
Preservation of bodily functional integrity

Catholic health care ethics select moral principles

Totality and Integrity

“All persons served by Catholic health care have the right and duty to protect and preserve their bodily
and functional integrity. The functional integrity of the person may be sacrificed to maintain the health
or life of the person when no other morally permissible means is available.” Ethical and Religious
Directives for Catholic Health Care Services.

The principle of totality is based on the natural law which says that life is to be preserved and
maintained. Although this does not mean using life-prolonging procedures that are insufficiently
beneficial.

Surgery for the good of the human body is directly opposed to mutilation which is a destruction of the
body. The principle of totality aims to preserve life in its totality, in its whole and sometimes that may
mean sacrificing a part of the body.

More concretely – examples may be amputations, cancerous tissue removal, organ removal. On the
removal of Healthy organs: 1) when the preservation of the organ may cause grave injury. 2)when the
removal means avoiding more serious complications 3) when the removal will diminish the risk of death.

This principle however may not be applied to the generative organs (sterilization) when the health of the
individual is not at stake. Here the end of preserving life is not present. Organ transplants are
permissible as long as the life of the donor is not placed at risk.

Ordinary and Extraordinary Means. These two terms refer to the means to preserve life. Ordinary means
are obligatory.Extraordinary are optional and many not be chosen. The extraordinary may be chosen
with the hope of healing a person or they may produce no benefit.

The principle to preserve life is not absolute. Patients have the right to all information concerning their
status, this is not a doctors decision.

https://www.slideshare.net/gmat2000/catholic-health-care-ethics-select-moral-principles
Issues on Organ Donations
Preface:
Organ transplantation has a key role in medicine worldwide and has become an
essential treatment modality in saving and prolonging lives in a wide variety of clinical
conditions. Kidney, heart, liver, lung, and pancreas are among the vital organs that are
routinely used for transplantation, but many other organs that draw less public attention
such as small bowel, skin, ligaments, bones, and cornea are used in various clinical
conditions to provide temporary or permanent relief for various clinical conditions. In
general, organ transplantation saves lives, prolongs survival, and increases the quality
of life. Kidney transplantation has been proven to have a survival advantage over
hemodialysis, accompanied by a marked increase in the quality of life. In general, organ
implantation is co-ordinated via regional or national allocation programs, which set up
the priorities for organ allocation and provide the essential logistics and laboratory
support for the transplantation process.1,2 These organs can be preserved for a
relatively short period of time, and therefore mechanisms for immediate organ
allocation, once a donor is identified, are critical.
Organ transplantation is one of the most complex procedures in medicine for several
reasons. First and foremost, it involves dealing with the medical aspects of the recipient
patient in parallel to dealing with a matched donor in case of a living donor or his family
for a deceased donor. Whether involving a deceased or a living donor, the ethical rules
that wrap the process of organ transplantation are complex and often convoluted by
ethical and religious nuances. Ethical issues with the timely and unequivocal definition
of death are among the most debatable and complex dilemmas in medicine,3–5 and the
public opinion is often skewed by religious and cultural influences and ethical standards
that vary between different cultures and religions. On top of that, the field of
transplantations is faced with a worldwide shortage of organs,6,7 and this mandates the
need to guard the ethical standard of medical priorities for those patients that depend on
the transplantation to save their lives.
In this review, I will discuss the major dilemmas that we face in Israel and worldwide
regarding organ transplantation.
Shortage of Organs
The shortage of organs is a major problem worldwide.6,7 There are many more patients
awaiting transplantation than there are organ donors. The improvement in medical and
surgical techniques that enable transplantation to take place in cases we would not
consider a decade ago has not been matched with a parallel increase in the availability
of organs for transplantation, and the problem of organ shortage has become more
profound. In 1999, some 40,000 Americans were on the waiting list for kidney
transplantation according to the Scientific Registry of Transplant Recipients. By 2009,
the list had grown to nearly 83,000 people, whereas only 16,500 people received a
transplant.8 In Israel, the number on the waiting list for kidney donors has increased
from 490 in 2006 to 690 in 2010, while the number of kidney transplants from deceased
donors decreased from 87 to 65.9 At the same time there was an increase in live kidney
donations from 54 to 78. Thus, taking into account transplants from both deceased and
living donors, there is only about one donor for every five potential recipients, both in
Israel and the USA. Similar shortage is also present for other organs. In Israel, 151,
133, and 66 patients were waiting for liver, heart, and lungs, respectively, whereas only
46, 32, and 11 transplants were performed in 2010.
The shortage of organ donors is multifactorial. In general, the number of potential
donors that meet the criteria of a brain death diagnosis is far greater than the number of
utilized donors where transplantation took place. The difference between these
numbers is due to medical and logistic factors, the ability to determine brain death, and
cultural and religious factors that affect the willingness of the population to donate
organs. As a result of these factors, there is a large variability in organ donation rates
among countries,10 and, therefore, the waiting time for transplantation is largely
variable.
Shortage of organs should be analyzed separately for living and deceased donors. For
deceased donor programs the most important factor is the availability of a sound
national or regional transplantation program that meets international standards.
According to the World Health Organization (WHO) criteria, such a program should be
present in each country, so that it becomes self-sufficient over time with respect to its
population organ needs.11 An important factor is the cultural compliance and general
consent of the society to organ donations. There are many and variable ethical and
religious issues related to organ donation. While in all major religions organ donation is
encouraged in order to save lives, there may be huge differences in the practical
approaches to the donation process among different factions even within the same
religion.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678939/